About the service:

• Willow House is a residential care home that was providing personal and nursing care to eight people with a range of needs including learning disabilities and behaviours that challenged 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.

People’s experience of using this service:

• People were safe and staff knew how to keep them safe from harm. The provider had a recruitment process to ensure they had enough staff to support people safely. People received their medicines as prescribed. Staff followed infection control guidance and had access to personal protective equipment. Accidents and incidents were recorded and appropriate action taken.

• Staff had the skills and knowledge to meet people's needs. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. People's nutritional needs were met and they received enough to eat and drink to ensure they had a healthy diet. People accessed health care when needed.

• People were supported by staff who were kind and caring and knew them well. Staff were patient, compassionate and empathetic and had built good relationships with people. People's privacy, dignity and independence were respected by staff.

• People's support needs were assessed regularly and planned to ensure they received the support they needed. People's support was individualised. People were supported to take part in activities of interest and their preferences, likes and dislikes were known to staff. The provider had a complaint process which people were aware of to share any concerns.

• The service was well managed. The environment was friendly, warm, and clean. The registered manager was known to people and made themselves available. Feedback questionnaires were used to gather information about people’s views. Spot checks and audits were carried out to ensure the quality of the service was maintained.

More information is in the Detailed Findings below.

Rating at last inspection:

• Rated Requires Improvement overall (report published 23/11/2017).

Why we inspected:

• This was a planned inspection based on the rating at the last inspection.

Follow up:

• We will continue to monitor the service through the information we receive until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

We inspected this home on 12 and 13 September 2017. This was an unannounced Inspection. We brought this inspection of Willow House forward due in part to notification of an incident where a person went missing from the home. An incident had occurred in the community which was still under police investigation at the time of our inspection

The home was registered to provide personal care and accommodation for up to eight people who may have a learning disability or mental health support needs. At the time of our inspection eight people were living there.

The home had not had a registered manager in post since February 2017. 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 saw there were systems and processes in place to protect people from risk but these needed to be more robust. We identified that there was a breach of the Health and Social Care Act 2008. (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

Staff were available to keep people safe and there were enough staff to allow care and support to be provided. Recruitment was underway to reduce the use of agency staff.

People we spoke with told us they felt safe. Staff that we spoke with understood their responsibilities to protect people from harm and abuse. After our inspection visit we received a concern about an incident of inappropriate restraint which were passed to the local authority. The concerns were investigated and the provider informed us they were unsubstantiated.

People received their medicines as prescribed and systems to manage medicines were safe.

Staff had access to a range of training to provide them with the level of skills and knowledge to deliver care efficiently to meet people’s individual needs. Staff were inducted and prepared for their roles.

People’s needs were met by staff who told us they felt supported in their roles. People’s choices and decisions were respected and promoted. Staff demonstrated an understanding of the Mental Capacity Act (2005).

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. People were supported when necessary to access a range of health care professionals.

People were involved in how they wanted their care provided. People were supported by staff who were kind and caring and who treated them with dignity and respect. Staff knew people well and supported people to maintain their independence.

The culture of the home promoted people's independence and involvement. There were opportunities for people to pursue hobbies and activities that were of interest to them.

People felt listened to and able to raise concerns they may have. The complaints procedure was available in different formats to meet the communication needs of people living at the home and advocacy services had been made available to people.

There were quality assurance systems in place to monitor and improve the quality of the service. These needed to be more robust. People and staff we spoke with were complimentary about their experience of the home and the quality of the leadership. People told us they were encouraged to express their views and experiences about living at the home.

We inspected this home on 19 April 2016. This was an unannounced Inspection. The home was registered to provide personal care and accommodation for up to eight people who may have a learning disability or mental health support needs. At the time of our inspection seven people were living at the home.

The registered manager was present during 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 we spoke with told us they felt safe. Staff that we spoke with understood their responsibilities to protect people from harm and abuse. Risks had been assessed to keep people and staff safe.

Staff were available to keep people safe and there were enough staff to allow care and support to be provided flexibly and to consistently meet all people's needs. People could be confident they would get their medicines safely

Staff had access to a range of training to provide them with the level of skills and knowledge to deliver care efficiently to meet people’s individual needs. Staff were inducted and prepared for their roles.

We observed staff seeking people’s consent before providing any care and support. Staff understood their responsibilities under the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS). These provide legal safeguards for people who may be unable to make their own decisions.

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. People were supported when necessary to access a range of health care professionals.

People were able to make decisions about how they wanted their care provided. Staff maintained people’s privacy and dignity whilst encouraging them to remain as independent as possible. people were supported to take an active role in running of the home. Activities were provided to meet people’s individual interests. We saw people were engaged in day to day living skills.

People and their relatives knew how to share their experiences and raise any complaints or concerns. The complaints procedure was available in different formats to meet the communication needs of people living at the home and advocacy services had been made available to people.

People and staff we spoke with were complimentary about their experience of the home and the quality of the leadership. People told us they were encouraged to express their views and experiences about living at the home. Systems for monitoring the quality and safety of the service were being used to drive improvements within the service.

The inspection was undertaken by one inspector. We gathered evidence against the outcomes we inspected to help answer our five key questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with all of the people living at the home, with the registered manager and with five members of staff and from looking at records. We also spoke on the telephone with a care professional who had visited the home.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

We checked people's care plans and found that these were detailed. Risks were identified to ensure that people had the care provided safely and risks to them were minimised. Staff we spoke with were aware of the care that people needed to keep them safe. People did not raise concerns with us about their safety. One person told us, “No one shouts here. I’m very safe.”

We found that the registered manager was aware of her responsibility to notify the local authority safeguarding team if there were any allegations that people using the service had been, or were at risk of being harmed. Staff spoken with were able to give a good account of the actions they would take if they suspected abuse was happening.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. We were informed that policies and procedures were in place and the registered manager demonstrated a good level of awareness of this area.

Is the service effective?

Care plans contained information and guidance about people's specific conditions to enable care staff to meet the individual needs of the people who used the service. People's preferences, interests, aspirations and diverse needs had been recorded in their care plans and people were supported as much as possible with these interests.

We saw there was a full time member of staff employed to arrange activities for people living in the home. People were encouraged to participate in a range of activities.

People's healthcare needs were identified and addressed. Records confirmed people were attending health care appointments as required and that monitoring of people’s health took place

Is the service caring?

Staff engaged with people in a polite caring and sensitive manner, treating people with dignity and respect. We saw that staff showed patience and gave encouragement when supporting people.

People had access to information on contacting advocacy services and an advocate regularly visited the home.

People's preferences, interests, aspirations and diverse needs had been recorded and care and support was provided in accordance with people's wishes.

Is the service responsive?

We found that meetings were held with people using the service and staff to discuss issues affecting them. One person told us, “We have monthly meetings and staff listen to what we say.” The provider had recently set up a family and carers forum with a relative for each region volunteering to act as a contact point for other relatives to answer queries and respond to any worries.

The provider had a complaints policy which showed people how to make a complaint if they were unhappy. One person told us, “I would tell staff if I was unhappy but I’m happy with everything.”

There were only three people living at the home when we visited, but the home was registered for up to eight people. Staffing levels had therefore decreased to reflect the reduced number of people at the home. Staff we spoke with did not raise any concerns about staffing levels in the home. Staff told us that staffing was flexible and accommodated the different activities that people enjoyed doing. The registered manager told us that some staff had been working at one of the provider’s other locations but were returning to work at Willow House. This would help to make sure that staffing levels were increased when more people moved into the home.

Is the service well-led?

Staff told us that the registered manager was accessible and took account of their comments.

The service had a quality assurance system and records showed that identified problems and opportunities to change things for the better were usually addressed.

We saw that there were regular meetings with staff to discuss quality issues and this helped to ensure that people received a good quality service at all times.

In this report the name of a registered manager appears who was no longer in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a registered manager on our register.