The inspection took place on 8 September 2016 and was announced. We gave 72 hours’ notice to the provider as the service supports people with complex needs. The Willows provides care and accommodation for up to ten people who have learning disabilities and complex additional needs. The service is provided within a purpose built bungalow and is for gentlemen only. People had complex individual needs and could display behaviour that other’s might find challenging. On the day we visited, ten people were living in the service. Voyage 1 Limited is the provider and has other services.

The service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We met the gentlemen who lived at The Willows and spoke with two of these gentlemen during our inspection. Most people who resided at The Willows were not able to verbalise their views and used other methods of communication, for example gestures and sounds. Due to people’s complex needs we were unable to spend much time with people so we discussed their care with staff and reviewed family feedback.

People’s medicines were managed safely. Medicines were stored, given to people as prescribed and disposed of safely. Staff received appropriate training and understood the importance of safe administration and management of medicines. People were supported to maintain good health through regular access to health and social care professionals.

People’s care records were detailed and personalised to meet their individual needs. Staff understood people’s needs and responded when needed. People were not able to be fully involved with their care plans, therefore family members supported staff to complete and review the care plans. People’s preferences were sought and respected.

People’s risks were well documented, monitored and managed to ensure people remained safe. People lived full and active lives and were supported to access local areas and activities. Activities reflected people’s interests and individual hobbies. People were given the choice of meals, snacks and drinks they enjoyed to help support maintain a healthy diet. Some people had input in creating the menu and preparing some meals and drinks.

Staff understood their role with regards to ensuring people’s human and legal rights were respected. For example, the Mental Capacity Act 2005 (MCA) and the associated Deprivation of Liberty Safeguards (DoLS) were understood by the registered manager and staff. They knew how to make sure people, who did not have the mental capacity to make decisions for themselves, had their legal rights protected and worked with others in their best interest. People’s safety and liberty were promoted.

Staff had completed safeguarding training and had a good knowledge of what constituted abuse and how to report any concerns. Staff described what action they would take to protect people against harm. Staff were confident any incidents or allegations would be fully investigated.

Staff described the registered manager as being very approachable and supportive. Staff talked positively about their roles.

People, who required intensive support, had one to one staffing to meet their needs. Staff confirmed there were sufficient staff to meet these requirements and staffing levels were flexible dependant on people’s needs and activities during the week. Staff had completed appropriate training and had the right skills and knowledge to meet people’s needs. New staff received a comprehensive induction programme when they started work. People were protected by the company’s safe recruitment procedures.

All significant events and incidences were document and analysed. Evaluation of incidents was used to