Willow Tree (Bournemouth) is a domiciliary care agency that provides personal care and support to people in their own homes in Bournemouth and Poole. At the time of our inspection 48 people used the service, 60% lived in Bournemouth and 40 % Poole.

There was a registered manager for the 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.

We carried out this inspection in response to information of concern we received regarding several people in the Poole area who were not receiving their package of care during the period of 31 August 2018 to 15 September 2018. We planned to undertake a focussed inspection to answer the key questions "Is the service safe?" and "Is the service well-led?"

This inspection visit took place on the 31 October 2018 and was announced. During this inspection we found all of the missed calls were in the Poole area and were as a result of high levels of staff sickness. This meant people didn't receive the care and support they needed. Several people didn't receive their medicines as prescribed. At the time the provider did not have a robust contingency plan in place.

The registered manager had informed us verbally of this event which affected the service, and explained they were waiting for more information before submitting the notification to us. However, the regulation states we must be informed ‘without delay’, therefore we recommend Statutory notifications are made to CQC as required.

The registered manager was responding to requests of information from the local authority safeguarding team. They also had to adhere to their duty of candour by providing an apology, in person, to those people effected by the missed calls.

The registered manager did not have a deputy manager, to support them in completing these tasks, or anyone to act on their behalf if they were on leave. The provider did not recognise or respond to this in a timely way. Similar concerns about the provider organisation oversight not picking up on areas that needed improvement at the location were highlighted at the last inspection

Our expert by experience spoke with five people who lived in Bournemouth and seven who lived in Poole, also three relatives of people who lived in Poole. Overall people said they felt safe, however they felt, “stressed and anxious” if a new carer arrived who they didn’t know, or if a member of staff of different gender provided their care (as they had requested same gender carer). This had been reported to the service but had not been rectified. We shared our concerns with the local authority safeguarding adults team.

The majority of people told us staff ,“rush” and they didn’t have continuity of staff, which made them, “distressed.” One person told us, “I would like a call if the carer is going to change or be late, I am on my own and I worry.”

There were high levels of dissatisfaction regarding call times and continuity of staff and whether any concerns raised would be taken seriously. Some people described the staff as being, “cheerful and very good.” However, some people said staff lacked experience in "basic tasks such as cooking and cleaning."

In response to the missed calls the registered manager had implemented a Red, Amber, Green (RAG) rating for each individual, which identified those people who must have a visit and for people who had family able to help in case of an emergency.

18 new staff had been recruited at the end of September 2018, to ensure that people received the support they needed.

The registered manager had implemented positive schemes to promote staff wellbeing, and to improve staff recruitment and retention.

Care plans were consistent and ‘at a glance’ guidance summaries h

Willow Tree (Bournemouth) is a domiciliary care agency. It provides personal care to people living in their own houses and flats. Willow Tree (Bournemouth) provided this service to 106 adults at the time of this inspection. Not everyone using Willow Tree (Bournemouth) receives regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.

This announced inspection took place on 14, 15, 16 and 17 May 2018.

There was not a registered manager for the 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 previous registered manager had left their post in January 2018 and the new manager had started their application process.

Willow Tree (Bournemouth) had entered a period of change when the previous registered manager left and a number of staff had also left. This meant the service was not able to provide visits at regular times with regular staff. There had also been some missed visits and medicines errors during this time. The manager and senior staff had robust and comprehensive plans in place and were working hard to stabilise the staff team.

The whole team were committed to providing a quality personalised service to people and felt close to achieving this.

Oversight structures and ethos of care were clearly communicated and the quality assurance systems had been effective in identifying areas for improvement at location level. The provider had not picked up on developing issues and they had changed their oversight process to address this weakness. People and relatives were listened to and we saw that their views informed improvement work.

Staff understood the risks people faced and how to reduce these risks. Measures to reduce risk reflected people’s wishes and preferences. Staff also knew how to identify and respond to abuse and told us they would whistleblow if it was necessary.

Staff encouraged people to make decisions about their lives. Care plans did not always reflect the care that was being delivered or how it was developed within the framework of the Mental Capacity Act 2005 when people lacked capacity and did not have other people who could make decisions for them legally. This was addressed during our inspection.

People were supported by safely recruited staff who were committed, compassionate and enthusiastic. Staff told us they felt supported in their roles and had taken training that provided them with the necessary knowledge and skills.

There were systems in place to ensure people had enough to eat and drink and that people were supported safely when eating and drinking.

People, whilst concerned about the reliability of their care, were positive about the care they received from the service and told us the staff were kind. Staff were cheerful and treated people with respect and kindness throughout our inspection.

This inspection was announced and took place on 16 and 17 August 2016. We told the provider one day before our visit that we would be coming to ensure that the people we needed to talk to would be available. At the last inspection completed in July 2014 the service was meeting the requirements of the regulations that were inspected at that time.

Willow Tree Homecare Ltd provides personal care and support to people who live in their own homes. At the time of our inspection they were providing personal care to more than 110 people in their home.

A registered manager was not in post; however, the current manager had submitted an application to become the 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.’

People said their care and support needs were met and that care workers were kind, caring and respectful. People were generally very positive about the care staff saying they felt safe with good relationships.

Staff had been trained in safeguarding adults and were knowledgeable about the types of abuse and how to take action if they had concerns.

Accidents and incidents were monitored to look for any trends where action could be taken to reduce chance of their recurrence.

There were recruitment systems in place to make sure that suitable, qualified staff were employed in the right numbers for effective running of the service.

Medicines were managed safely.

The staff team were both knowledgeable and suitably trained.

Staff were well supported through supervision sessions with a line manager, and an annual performance review.

Staff and the manager were aware of the requirements of the Mental Capacity Act 2005 and acted in people’s best interests where people lacked capacity to consent.

People and staff were very positive about the standards of care provided. People were treated compassionately as individuals, with staff knowing people’s needs.

People’s care needs had been thoroughly assessed and care plans put in place to inform staff of how to care for and support people. The plans were person centred and covered all areas of people’s needs. The plans we looked at in depth were up to date and accurate.

There were complaint systems in place and people were aware of how to make a complaint.

The service was well led. There was a very positive, open culture in within the service.

There were systems in place to audit and monitor the quality of service provided to people.

At this inspection we were assisted by the registered manager of Willow Tree Bournemouth. The inspection was carried out over two days. The first day was spent in the agency’s office where we looked at how people’s care was planned, how the agency monitored the quality of service, including complaints, and at how the agency recruited new members of staff.

At the time of our inspection the agency provided about 1100 hours of personal care and support to 100 people in their homes in the Bournemouth and Poole area. The agency employed 48 carers to meet the needs of people receiving a service.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask:

• Is the service caring?

• Is the service responsive?

• Is the service safe?

• Is the service effective?

• Is the service well led?

This is a summary of what we found :-

Is the service safe?

People we spoke with during the inspection had no concerns or complaints about the care and support they received.

People's needs had been assessed and care plans developed to inform staff on how to care and support people. The plans were available in the office and a copy sent to the person receiving a service.

Staff records contained all the information required by the Health and Social Care Act 2008. This meant the provider employed staff who were suitable and had the skills and experience needed to support the people living in the home.

The agency had systems in place for monitoring the quality of service provided to make sure that the home was run safely. People we spoke with were happy with the service provided.

Is the service effective?

People’s care and support achieved good outcomes. People told us that they were happy with the care they received and felt their needs had been met. It was clear from what we saw and from speaking with members of staff that they understood people’s care and support needs and that they knew them well.

Results from returned satisfaction surveys from people who received a service were positive about the way people had been cared for. They told us that they received regular care workers and that they had never had missed calls.

Is the service caring?

We saw that care workers were patient and gave encouragement when supporting people. People told us they were able to do things that they chose and that care workers were always helpful and completed tasks as specified within care plans.

Is the service responsive?

Services provided to people were organised so that they met people’s needs. People’s needs had been assessed before they received a service. Records confirmed people’s preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided that met their wishes.

We found there was a system in place to make sure complaints were responded to and monitored. We also found that people were well informed on how to make a complaint.

Is the service well-led?

Good quality assurance processes were in place. People told us they were asked for their feedback on the service through a customer satisfaction survey and telephone surveys. The staff members we spoke with were clear about their role and responsibilities.