This inspection took place on the 22 May 2018 and was unannounced.

Willow Health is a bungalow which has been adapted and provides accommodation in single bedrooms. It is a ‘care home’ and is located in a residential area within the town of Colchester. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Willow Health is registered to support up to seven people who have a learning disability, an autistic spectrum disorder and /or a physical disability. There were six people living in the service on the day of our inspection.

Willow Health was last inspected in April 2017and was rated Requires Improvement as they were not meeting the legal requirements. For example, we found that medicines were not being managed in a safe way and incidents between individuals identified as safeguarding issues. Following the last inspection, we met with the registered provider and discussed with them what they would do to improve the quality of care at the service.

At this inspection we found that some progress had been made but further work was needed to fully imbed the changes and ensure that people consistently received a good service.

The service is required to have 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. The previous registered manager was no longer working at the service and a new manager had been appointed. We saw that they had made an application to the CQC to be registered as manager.

Risks to individuals were identified and guidance provided to staff on the steps that they should take to mitigate the risks. Records however were not always well maintained and meant that oversight of the environment and safety was not fully effective.

The systems in place to safeguard people from abuse had improved. There was greater openness and staff were clearer about what was a safeguarding incident and the steps that they needed to take to protect individuals. Incidents were reviewed to identify learning and this meant that staff were able to see how effective their actions had been.

The processes in place for the oversight and management of medicines had improved since the last inspection. Medicines were securely stored and regular checks were undertaken, to ensure that staff were following procedures and any errors quickly identified.

There were some staffing vacancies and the service was dependent on agency staff. Recruitment was underway. Staffing levels did not always promote individualised care and the manager told us that they were working with the local authority on reviewing people’s needs to ensure that people had the support they needed.

Recruitment procedures for new staff had been strengthened and staff only commenced employment when the pre-employment checks were complete. We have recommended that when staff transfer between the providers different services there is a clear audit trail of decision making.

Newly appointed staff received an induction to ensure that they had the knowledge required to meet people’s needs. Ongoing training was provided for existing staff to ensure that their skills were kept up to date.

Staff had a better understanding of the Mental Capacity Act 2005 (MCA) and their responsibilities. Routines were more flexible and staff were working with people on improving communication and choice. However, we have recommended that the use of new technology is expanded to support people’s communication needs. Care records demonstrated that people had good access to health care support when neede

This inspection took place on the 27 April 2017 and was unannounced.

The service is registered to provide accommodation and personal care support for up to seven people who have a learning disability and /or an autistic spectrum disorder. There were six people living at the service on the day of our inspection.

There was a registered manager in post who is registered as manager for this service and another nearby service. 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. The registered manager did not attend for the inspection as they had a meeting with the directors at another service.

People were supported by an experienced staff team who knew them well. Risks to individuals from distressed behaviours and the environment were identified and guidance provided to staff on the steps that they should take to mitigate the risks. Records however were not always well maintained and meant that oversight of safety was not fully effective.

The systems in place to safeguard people from abuse were not sufficiently robust. Staff received training in safeguarding and there was guidance for them to follow if they had concerns but this was out of date and not sufficiently comprehensive. Incidents had occurred which had not been recognised as safeguarding.

Medication was not consistently well managed and this placed people at risk.

There were sufficient staff available to support people however recruitment procedures for new staff were in need of strengthening to ensure that people were protected.

Newly appointed staff received an induction to ensure that they had the knowledge to meet people’s needs and ongoing training was provided for existing staff to ensure that their skills were kept up to date.

Staff understood the principles of consent, but were not knowledgeable about the Mental Capacity Act 2005 (MCA) and best interest decisions were not clear or decision specific. Therefore we could not be assured that people were always supported to have maximum choice and control over their lives. Staff did not always support people in the least restrictive way possible.

People had sufficient amounts to eat and their nutritional needs were met. Care records demonstrated that people had good access to health care support when needed.

People told us that they were happy and we observed that they had good relationships with staff. Staff were kind but there was a lack of flexibility in the routines and dignity was not always promoted.

There was a complaints procedure in place to address concerns and the management had a number of ways of gathering people’s views including satisfaction surveys.

Care plans were detailed and informative. Reviews were held on a yearly basis but more regular analysis would enable issues to be identified and goals to be set.

People were provided with opportunities to access the local community but these were largely on a group basis. People would benefit from more individualised and imaginative opportunities.

At the last inspection we required the provider to strengthen the quality assurance systems. At this inspection we found that there were systems in place but they were not well developed. We did not see evidence that they drove improvement or challenged practice to develop a high quality innovative service for people.

You can see what action we told the provider to take at the back of the full version of the report.

This inspection took place on the 18 February 2016 and was unannounced.

The service is registered to provide accommodation and personal care support for up to seven people who have a learning disability and /or an autistic spectrum disorder. There were six people living at the service on the day of our inspection.

There was a registered manager in post who is registered as manager for this service and another nearby service. 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. The registered manager was only present at the inspection for a short period as they were on duty elsewhere.

Staff knew how to keep people safe from the risk of abuse as they had been trained and knew what to do if they had concerns. Risks were however not always well managed and there was a lack of clarity about how people should be supported and the staffing levels required. Staffing levels had recently been reduced to accommodate staff holidays and this impacted on people’s ability to lead a meaningful life and access their community.

The service provided training in the form of an induction to new staff and on-going training to existing staff. Staff understood the principles of consent but were not knowledgeable about the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Best interest decisions were not clear and the service had not made any referrals to the local authority. This piece of legislation should be known and fully embraced by staff in learning disability services to ensure peoples human rights are respected. We have made a recommendation about this and asked the service to seek advice.

People were supported to have sufficient to eat and to access health care to remain healthy.

Staff were kind and caring and knew the needs of the people that they were supporting. There were systems in place to enable people to communicate and promote decision making.

People were supported to maintain relationships with those who were important to them. There was a complaints procedure in place which was accessible and concerns were investigated.

Care plans were detailed and informative. Reviews were held on a yearly basis but more regular analysis would enable risks and other issues to be identified and managed.

People were provided with opportunities to access the local community but these were largely on a group basis. People would benefit from more individualised and imaginative opportunities and we have made a recommendation about this.

Quality assurance systems were in place but were not well developed or robust. We did not see evidence that they drove improvement or challenged practice to develop a high quality innovative service for people.

We found that this was a breach in the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and you can see what action we have told the provider to take at the back of the full version of the report.

Some people living at Willow Health Limited had complex needs and were unable to speak with us but we saw that they were comfortable and happy. People spent time relaxing in the garden and enjoyed lunch outside.

A relative told us: “I am very happy with the level of care X is getting at the home. I don’t have a problem with anything at all. The most important thing is that X is very happy and all [their] needs are being met.”

It was evident that staff knew people well and we saw that there were friendly and caring interactions between members of staff and people living in the home; staff listened to people and treated them with respect.

People received care and support that met their needs and took into account their individual preferences. Staff were able to demonstrate that they understood the specific needs of the people using the service and provided care in a person-centred manner.

We found that staff received the training and support they needed to provide care and support safely.

We gathered evidence of people’s experiences of the service by talking with people, observing how people spent their time and noting how they interacted with other people living in the home and with staff.

Some of the people using the service had complex needs which meant they were not able to tell us their experiences. During our visit we spoke generally with some people who told us they were happy. We saw that people smiled and appeared relaxed and comfortable with staff and other people living in the home.