Willow Home Care Support Services Limited is a domiciliary care agency for adults of all ages who may have dementia, mental health problems, physical disability, sensory impairment, an eating disorder, a learning disability, autistic spectrum disorder or misuse drugs and alcohol. The service was providing personal care to 406 people at the time of the inspection.

This inspection was carried out between 14 and 25 January 2019 and was announced.

At our last inspection we rated the service ‘good’. At this inspection we found the evidence continued to support the rating of ‘good’ and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

The provider had a registered manager in post. 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.

People were protected from harm and abuse by the provider’s safeguarding systems and staff knowing their responsibilities and being trained in this area. Any risks in people’s lives were reduced as necessary. The provider ensured staff that worked in the service were safely recruited. There were sufficient numbers of them to meet people’s needs. Staff practice around medication and infection control management was robust and safe.

Staff were trained and qualified to carry out their roles. They received supervision and an appraisal and demonstrated an understanding of people’s rights and treating them equally. People were supported with their nutrition and health. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Staff were caring, compassionate and attentive in their support of people. Staff communicated well with people and respected their independence, choice, privacy and dignity.

People’s support plans were detailed and instructive. They enabled staff to provide the right support. Complaints were appropriately addressed and satisfied. Staff were responsive to the needs of people and their families at the end of their lives.

The service met its registration requirements. There was a registered manager and a general manager with day-to-day running of the service, with the registered manager being accountable for all management systems and practice. Staff understood their organisation’s visions and values and there was an organisational quality assurance system. Some people told us they had been asked about their views of the service and felt included in the organising of their support. Willow Home Care Support Services Limited continued to provide a good service.

Further information is in the detailed findings below.

Willow Homecare and Support Services Limited is a domiciliary care agency that supports people to live in their own homes. At the time of our inspection the service was providing support to 490 people.

The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered person’s’. 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.

In November 2015 the service secured a contract with North East Lincolnshire as one of their three preferred providers. This involved the transfer of high numbers of new clients and staff from other care agencies and has led to considerable expansion within the service. The development of the agency has also posed challenges for the management team and staff which they have worked hard to meet, including the on-going recruitment, training and deployment of staff.

We found staff were recruited in a safe way. All checks were in place before they started work and they received a comprehensive induction. Additional experienced staffing was available to support with assessments and offer support in emergency situations. People received a reliable service, with staff having time to provide the care people needed.

Staff received training in how to safeguard people from the risk of harm and abuse. They knew what to do if they had concerns and there were policies and procedures in place to guide them when reporting issues of potential abuse.

Safe systems were in place for the administration, storage and recording of people’s medicines.

The registered manager ensured staff had a clear understanding of people’s support needs whilst recognising their individual qualities and attributes. Staff were positive about the support they received from their manager.

Records showed people had assessments of their needs and support plans were produced. These showed people and their relatives had been consulted and involved in this process. We observed people received care that was person-centred and care plans provided staff with information about how to support people in line with their personal wishes and preferences.

Staff supported people in line with their nutritional and health needs. They encouraged and respected people’s independence and dignity. Staff liaised with healthcare professionals on people’s behalf if they needed support accessing their doctor or other professionals involved in their care.

Risk assessments were completed to guide staff in how to minimise risks and potential harm. Staff took steps to minimise risks to people’s wellbeing without taking away people’s rights to make decisions.

Staff had received training in legislation such as the Mental Capacity Act 2005, Deprivation of Liberty Safeguards and the Mental Health Act 1983. They were aware of the need to gain consent when delivering care and support, and what to do if people lacked capacity to agree to it.

There was a complaints procedure in place which was available in a suitable format, which enabled people who used the service to access this infomation if needed. The service had developed systems to review the quality of service provision and highlight areas which required further action. Action plans with identified timescales had been produced to address shortfalls.

People told us staff treated them with respect and were kind and caring. Staff demonstrated they understood how to promote peoples independence whilst protecting their privacy and dignity.

People told us they were respected and their dignity was upheld. A relative told us, “They are very good and very considerate.” People were supported to make visits of their choice. People and their relatives spoke positively about the care they received. One person said, “I am very happy with the care. They involve me in reviews. They come round and ask and they do ring me up.” Another person told us, “They are fine with the care. I do look at the care records. They are in the home.” Relatives’ comments included: “The care they receive is good and there are no issues,” and “They are very good during the week although sometimes there is a bit of a muddle at the weekend, and staff sometimes don’t know the area as well. They complete the book every time they come.”

People were mainly positive about the staff that worked with them. One person told us, “Staff are very good.” Another person said, “I have always found them friendly and helpful.” Relatives comments included: “Staff are consistent and regular,” and “They are very good carers who come. There are no shortcomings.”

Questionnaires were used by the provider to gather the views of people who used the service during 2012. We saw that these were issued monthly and the action taken in response was recorded. One person told us, “I do complete a survey. Sometimes I get feedback. They will ring or send me something in the post which deals with it.”

Care is provided in people’s homes and although we were not able to visit anyone who uses the service, the manager arranged for us to speak with some people by telephone.

People we spoke with told us that they were satisfied with the care they received and that if they had any complaints they would raise these with the manager. We asked people if the carers visited them on the dates and times that had been planned and they told us that they did. We received comments such as “The staff bend over backwards to help”, “I have no complaints, they are wonderful” and “I am very happy with the care”.

We also spoke with some relatives of people who use the service and they told us that they were satisfied with the care provided for their relatives. They felt confident that any concerns or complaints they may have would be quickly addressed by the manager. The people that we spoke with had no concerns or complaints to raise about the service provided or staff.

As part of our inspection we gained feedback from questionnaires of 32 people who used the service and their friend/ relative. We also spoke with three members of staff, the registered manager, general manager and the training manager. These are some of the

comments people who used the service told us:

"Willow Care are 100% reliable"

"The carers that come are very good and I find them to be very professional in what they do."

"I have the regular care workers who are very good, the problems arise when they are not on duty."

"Generally the carers have been very good, and the problems have been down to a few individuals who do not come regularly and are not fully familiar with my relative's needs."

We found before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes.

People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. We saw care plans were person centred and people's likes and dislikes were recorded in their care plan.

People's health, safety and welfare was protected when more than one provider was involved in their care and treatment, or when they moved between different services. This was because the provider worked in co-operation with others.

We found medicines were handled appropriately.

People who use the service, their representatives and staff were asked for their views about their care and treatment and they were acted on.