This inspection took place on 25 October 2016 and was unannounced. At our last inspection of the service on 10 May 2014 the registered provider was compliant with all the regulations reviewed at that time. This visit was the first comprehensive inspection, using new methodology, where a service is given a quality rating.

The registered provider, Hollybank Trust, provides education and residential care for children, young people and adults living with complex and multiple physical disabilities and associated communication, sensory and learning difficulties. Willow Court is registered to provide nursing and personal care for up to 19 people who require care and attention relating to their complex needs. The single storey purpose built premises provides 19 en-suite bedrooms, three assisted bathrooms, communal lounges and kitchen/ diners. The service is split into three smaller units, known as bungalows. Access into and around the home is level and therefore has good access for people who mobilise using a wheelchair or other walking aids. The home is on Hollybank’s main site and has good transport links to local shops and amenities.

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 spoke to five relatives in person and by telephone. They told us that their relative was safe at Willow Court and that they had no concerns about the quality of care being provided. We found that the staff had an in depth knowledge of how to keep people safe from harm and they spoke confidently about their roles. Staff knew the correct procedures to follow if they considered someone was at risk of harm or abuse. They had received appropriate safeguarding training and there were policies and procedures to support them in their role. Risk assessments were in place to identify risks due to people’s medical, physical and mental health conditions and to make sure these were minimised.

The service recruited staff in a safe way, making sure all necessary background checks had been carried out and that only suitable people were employed. Processes were in place to assess the staffing levels that were needed, based on people’s dependency and the lay out of the building. Relatives told us staff were always available, during the day and night when required. Our observations during the inspection showed there was appropriate deployment of staff, including staff providing care, catering and housekeeping tasks.

Records showed staff received the training they needed to keep people safe. The manager had taken action to ensure that training was kept up to date and future training was planned.

Medicines management was well organised and administered in a safe way. This meant that people received their medicines in accordance with the prescriber’s instructions.

Staff told us the manager, and other senior staff employed by the service, were supportive and approachable. They also confirmed to us that the on call arrangements were well organised, and that they could seek advice and help out of hours if necessary. This meant there was good oversight of the service, and staff were confident about the management structures.

Staff had a good understanding of the Mental Capacity Act and we observed consent being sought routinely before any support or care was given. People had been supported to make their own decisions wherever possible, and staff had taken steps to support people to do this. Where people were unable to make a decision there was a best interest decision recorded within their care plan and we saw the person and relevant people had been involved in making this. This meant people were given the opportunity to be involved in decision mak

The service cared for and supported people with a wide range of complex needs. They were

not able to verbally tell us their experiences. We therefore used a number of different methods to help us understand the experiences of people who used the service, including observing the care being delivered, talking with staff and looking at records in the home.

As part of our inspection we spoke with the deputy manager and staff at the home. We also observed people receiving care and looked at care records.

Below is a summary of what we found.

Is the service safe?

People were treated with respect and dignity by the staff. Systems were in place to make sure that managers and staff learned from events such as accidents and incidents, complaints, concerns and investigations. This reduced the risks to people and helped the service to continually improve. The home had a safeguarding adults' procedure that complied with all of the relevant legislation and good practice guidelines. Staff understood their responsibilities to protect people from harm.

Is the service effective?

People’s health and care needs were assessed with them. We looked at the care records for two people who lived at Willow Court. We found that people's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. We saw evidence that demonstrated staff were provided with regular formal supervision. Staff told us that they were supported by management who enabled and encouraged them to access appropriate training on a regular basis.

Is the service caring?

Staff communicated well with people and were attentive when they needed support. We saw evidence that people were involved with the planning of their care.

Is the service responsive?

We saw staff caring for the needs of people in a professional manner. They ensured the people they cared for were supported in taking part in activities in the local community.

Is the service well-led?

The service had a quality assurance system, records seen by us showed that identified shortfalls were addressed promptly. As a result the quality of the service was continuingly improving. This helped to ensure that people received a good quality service at all times.

Due to the complex needs of people living at Willow Court and our inability to communicate with them non-verbally, we were unable to ask people their views about the care they received. However, we spent a significant proportion of our time observing care practice. We observed staff were attentive to people's needs and appeared to know them well. Although people did not have capacity to consent to complex care decisions, we observed staff involving people in decisions such as what they wanted to eat and drink and what activities they wanted to participate in.

We reviewed people's care records and spoke with commissioners involved in funding the care for these people. The care records we looked at were person centred and provided an accurate and up to date picture of the person's needs. The commissioning staff we spoke with were happy with the quality of care the people they funded received.

We saw there were systems and processes in place to protect people from unsafe equipment.

Due to the complex needs of the people living at Willow Court, we were unable to seek their views about the service they received. In order to gain an understanding of people's views about the service we looked at the minutes of five adult involvement meetings. These were meetings which were help between staff and the young adults living at the Willows. The minutes showed that people were involved in planning their care, particularly around how they wanted to spend their leisure time and were involved in making changes to the décor of the home.