We carried out this unannounced inspection on the 07 August 2018. At the last inspection carried out on the 19 January 2017 we found that the provider was not meeting all of the legal requirements. We identified that the provider did not have effective system in place to manage risks and drive up improvements. We found a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We rated the service as requires improvement. At this inspection we found that the provider had made the required improvements and were no longer in breach of this regulation.

Willow House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Willow House provides care and support for a maximum of six people who are living with a learning disability, autism or mental health conditions. There were six people living at the home at the time of the inspection.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

There was a registered manager in post at the time of our inspection. 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 supported for by staff who were trained in recognising and understanding how to report potential abuse. Staff knew how to raise any concerns about people’s safety and shared information so that people’s safety needs were met.

People were protected from risks associated with their health and care needs because risk assessments and associated care plans were developed, reviewed and monitored. This ensured that people received the support they required to remain safe. Staff were aware of the risks to people when supporting them in and outside of the home in order to promote people’s safety in the community.

People were supported by sufficient numbers of staff who had the knowledge and skills they required to care for people safely and effectively. People’s dignity was maintained and people were communicated with in their preferred way.

Staff understood the importance of ensuring people agreed to the care and support they provided and when to involve others to help people make important decisions. The provider was aware of their responsibilities in regard to the Deprivation of Liberty Safeguards (DoLS).

People were supported to enjoy a wide range of activities and were involved in their day to day care and chose how to spend their day. People were encouraged to maintain their independence and live active and fulfilling lives and were supported to meet religious and cultural needs.

Staff were caring and treated people with respect. We saw people were relaxed around the staff supporting them. It was evident that people had developed positive relationships with staff and there was a friendly and calm atmosphere within the home.

People received support from staff to take their prescribed medicines as and when required. Systems and processes were in place to ensure medicines were managed safely. Staff understood their responsibilities in relation to infection control and promoting a hygienic environment for people to live in.

People were supported to maintain a healthy diet that met people’s cultural and dietary needs. People were supported to maintain all their health needs.

Systems and processes were in place to monitor

This inspection took place on 19 January 2017 and was unannounced. The inspection team consisted of one inspector. This was the first ratings inspection of this service since the service was registered with the Care Quality Commission in September 2015.

Willow House is a care home for up to six people who have learning disabilities and some people may also be on the autistic spectrum. At the time of the visit six people were living there. The home did not have a registered manager, but an acting manager was in post, who was in the process of applying to become registered. The acting manager was present throughout the inspection. 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 of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People’s relatives and staff told us they felt people were safe in the home. Staff were aware of the need to keep people safe and they knew how to report allegations or suspicions of poor practice..

People’s relatives told us that they were happy with the care provided. People had opportunities to participate in a range of activities in the community, but activities and stimulation within the home were not provided in line with people’s individual needs. People were not regularly encouraged to become more independent.

People’s relatives and friends were encouraged to visit and made welcome by staff.

People were protected from possible errors in relation to their medication because the arrangements for the storage, administration and recording of medication were good. People had not received their ‘when required’ or PRN medication when they needed it.

Staff were appropriately trained, skilled and supervised and they received opportunities to further develop their skills.

People were supported to have their mental and physical healthcare needs met and were encouraged to maintain a healthy lifestyle. The manager sought and took advice from relevant health professionals when needed.

People were provided with a good choice of food in sufficient quantities and were supported to eat meals which met their nutritional needs and suited their preferences.

The registered provider did not have an effective system in place to consistently assess, manage and monitor risks within the service. There were no systems in place to assess the quality of service provided and to identify improvements needed. You can see what action we told the provider to take at the back of the full version of the report.