Willow House provides care, support and accommodation for up to nine adults with a learning disability, many of whom are aged 65 years and over. At the time of our inspection there were eight people living there.

The care service had 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 were two registered managers in post. One of these was also the registered provider. 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. Throughout this report we have referred to the provider and the registered manager as both were present during the inspection.

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 on going 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.

People living at the service said they felt safe. Staff knew how to protect people from avoidable harm and abuse. Risk assessments had been completed and when risks had been identified, care plans provided clear guidance for staff on how to reduce the risks. Medicines were managed safely.

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 said they were trained and supported in their roles. People were supported to have enough to eat and drink.

People living at the service spoke highly of the staff. They said “The staff are nice. The staff are kind” and “Staff are very friendly.” We observed many positive interactions between staff and people. Staff spoke passionately about their roles.

Feedback from relatives was overwhelmingly positive with comments such as “There is a real sense of sensitivity and inclusivity at Willow House” and “There are incredibly close relationships between staff, the managers and the residents.” Health and social care professionals told us “All clients are enabled to lead full lives and all health and social needs are met in a timely fashion. I have no concerns regarding the care provided at Willow House and it is always a pleasure to visit”.

Care plans were person centred and detailed all aspects of people’s choices and preferences for how they wanted to be supported. Health action plans were in place. We saw examples of staff providing additional levels of support, such as staying with people when they were in hospital.

There were robust quality assurance systems in place. Staff spoke highly of the management team and management values. The provider’s values were embedded in the day to day support of people.

This inspection took place on 24 October 2015 and was unannounced. The last inspection took place on 1 December 2013 and no breaches of legal requirements were found at this time.

The home provides care and accommodation for up to nine people with a learning disability. At the time of our inspection there were nine people living in the home. There was a registered manager in place. 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’s rights were protected in line with the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. People’s capacity was considered in decisions being made about their care and support and best interest decisions were made when necessary. Staffing levels were flexible to accommodate the needs of people and the activities they chose to do in their local community.

Sufficient numbers of staff were available to support people’s individual needs safely. This was observed throughout the inspection and included the lunchtime activity where we saw people were supported with their nutritional needs.

Support plans and risk assessments were representative of people’s current needs and gave detailed guidance for staff to follow. Staff understood people’s individual needs and preferences which meant that they received care in accordance with their wishes.

People were supported by staff who were kind and caring in their approach and were treated with dignity and respect. This was confirmed by the observations we made during our inspection.

People had choice about their daily activities. People were involved in their support planning and chose what activities they wanted to undertake.

Safe procedures and a policy was in place to guide staff to manage people’s medicines safely. Following our inspection the provider made improvements to the stock audit system that ensured stock levels of medicines were accounted for at all times.

People, relatives and friends that we spoke with told us people received a good quality of care and support. They confirmed people’s needs were managed safely and staff responded quickly to any changes in their health needs.

The provider had ensured that staff had the knowledge and skills they needed to carry out their roles effectively. Training was provided and staff we spoke with were knowledgeable about people’s needs.

The service was well led. Staff spoke highly of the management team and the vision of the service. There was a positive attitude amongst staff towards their work and staff responded well to the direction of the management team. A detailed system was in place to monitoring the quality of the service that people received. This included a system to manage people’s complaints.

Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. One person said ‘they ask me what I want to do’.

Care and treatment was planned and delivered in a way that was intended to ensure people’s safety and welfare.

People were provided with a choice of suitable and nutritious food and drink and supported to eat and drink in sufficient quantities. One person said ‘the food is great’.

There were enough qualified, skilled and experienced staff to meet people’s needs.

There was an effective complaints system available. One person said ‘If I was unhappy I’d go to a member of staff’.

Summary

A person told us they were confident in staff knowledge of them as an individual. They told us “Staff check out how I am, this is home to me.” The provider had equipped this person’s room with a new fire exit and hoisting equipment so they could return to the home from hospital.

We found staff had a wide knowledge of people’s interests and abilities, which was used to support people to maintain activities relevant to them. Staff offered people choices and showed understanding of how people communicated. A person’s relative told us they had always been able to share their views with the staff and management. They felt included in how the home planned for meeting their relative’s needs.

The home liaised with community health services. Staff kept full notes of changes in people’s wellbeing and requested medical attention for people in a timely way. Staff provided care and support in line with people’s care plans.

Staff felt confident in their understanding of and ability to work with people’s behaviours. They were clear about their safeguarding responsibilities and how they would respond to any suspicion of abuse.

All staff received regular supervision. Staff members told us this helped build on strengths and support development. One support worker told us “You always know where you stand.”

The providers had systems for continually monitoring the quality of care and support provided. They used feedback from all people with an interest in the service.