About the service: Willowgarth is a care home providing personal care and accommodation for up to 68 people, who have mental health needs, some of whom are over 65. At the time of the inspection 67 people were living at the service.

People’s experience of using this service: People and their relatives told us they were happy with the service they received and felt staff had a clear understanding of their needs and preferences. They told us they considered staff to be well trained and skilled.

People described a range of activities and events both within the service and the local community, based on their interests and preferences. There was also a day centre based on the site, which people could access if they wished. People and their relatives were supported to receive information in an accessible way either through easy read, large print and pictorial formats to enable them to be involved in their care and support.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; policies and systems supported this practice. People were treated with respect and dignity and their independence was encouraged and supported. Where people required support at the end of their lives, this was carried out with compassion and dignity.

The environment supported people to have time on their own and time with other people if they chose this. A variety of different accommodation was provided to enable people to practice and develop skills to enable them to live more independently. Cleanliness and health and safety were well managed.

Staff had appropriate skills and knowledge to deliver care and support people in a person-centred way. Staff recruitment was safe and staff understood how to keep people safe. The registered manager used information following accidents and incidents to reduce the risk of future harm.

The registered manager and staff team worked together in a positive way to support people to achieve their own goals and to be safe. Staff told us they were well supported by the registered manager and management team.

Checks of safety and quality were made to ensure people were protected. Work to continuously improve was noted and the registered manager was keen to make changes that would impact positively on people's lives.

The values of the organisation of offering choice, inclusion and respect were embedded. This supported people to receive the positive service described.

Rating at the last inspection: At the last inspection the service was rated Good (published 29 July 2017).

Why we inspected: This was a scheduled inspection based on the previous rating.

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

Willowgarth provides residential care for adults who have mental health needs, some of whom are over 65. It is located in a rural setting close to the town of Hornsea on the East Riding of Yorkshire coast. The service is registered to provide support to up to 68 people and at the time of our inspection 67 people were using the service. There is one main building and two further areas of accommodation on the site. People who need a higher level of staff support usually live in the main building but there is opportunity to move on to living more independently in the other accommodation on the site, as people’s skills and confidence develop.

At the last inspection in August 2014, the service was rated Good. At this inspection we found the service remained Good.

People told us they felt safe and were well cared for. Risk assessments were developed in relation to people's individual needs. Care plans contained information about potential triggers for deterioration in people’s mental health, risk factors and details of how staff should respond. Staff were knowledgeable about how to report any safeguarding concerns.

There were sufficient staff to meet people’s needs and the provider followed robust recruitment checks, to employ suitable people. People’s medicines were managed safely and in a person centred way.

Staff received an induction and completed relevant training. We found that staff received supervision and an annual appraisal, to assist them in fulfilling their roles effectively.

People were supported to have 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. The service was meeting the requirements of the Deprivation of Liberty Safeguards.

People's health needs were identified and they had access to a range of appropriate healthcare professionals in order to support their physical and mental health. We received positive feedback from visiting professionals about the support provided by staff, including some specific examples which demonstrated a highly person centred and flexible approach to meeting people’s needs.

People said staff were kind and treated them with dignity and respect. We found that people were supported to develop their independent living skills where possible.

Staff were knowledgeable about people’s individual care needs and care plans were in place to ensure staff were consistent in their approach. There was a range of activities available, including trips out, group and therapeutic activities and support to access community facilities. There was also a day centre based on the site, which people could access if they wished.

People told us that the service was well managed and they knew how to raise any concerns. The provider assessed and monitored the quality of care provided to people; satisfaction surveys were conducted and regular quality audits completed. People also had opportunity to give feedback in residents meetings and individual reviews.

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, and to provide a rating for the service under the Care Act 2014. 

The inspection was unannounced. At the last inspection on 19 August 2013 the service was fully compliant with all of the regulations assessed.

Willowgarth is a care home that is owned by Hatzfeld Care Ltd. It is located in a rural setting close to the town of Hornsea on the East Riding of Yorkshire coast. Support is provided to people of various ages (over 18) some over the age of 65 who have mental health needs.

There was a registered manager in post.  A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which apply to care homes. DoLS are part of the Mental Capacity Act (MCA 2005) legislation which is in place for people who are unable to make decisions for themselves. The legislation is designed to make sure any decisions are made in the person’s best interest. No-one in the home had been supported with DoLS as everyone had been assessed as having the capacity to make their own decisions.

We found that staff had an awareness of DoLS and MCA and people’s rights were respected. People told us they were able to make choices and this included declining activities.

People were supported to take risks in their lives. For example, to go out in their local community. Risks were identified, assessed and care plans were put in place to help make sure people remained safe. This helped people to be able to live their lives as independently as they wished.

Systems were in place to help make sure staff were correctly recruited and considered safe to work with vulnerable people. This included employment references and Disclosure and Barring checks (DBS). These checks would record if the person had a criminal conviction which would prevent them from working with vulnerable people and if they were on the list of people who were barred from working with vulnerable people. Staff and professionals told us there were enough staff in the home to make sure people’s needs were met.

Staff undertook training to help make sure they had the necessary skills to support people effectively.

People told us they were happy with the food provided in the home and we saw people were weighed regularly as part of the monitoring of their health.

We saw people had regular access to and support form health professionals to assist them in having their needs met.

People were happy with the staff and described them as compassionate and told us they listened to them. People’s needs were recorded in care plans. This provided clear information to staff when supporting people. We observed that interactions between staff and people who lived in the home were polite and respectful. People told us staff respected their privacy and dignity.

Staff had a good knowledge of the needs of people who lived in the home. Professionals told us they were happy with the home and felt staff supported people “Really well.”

There was a complaints system in the home. People we spoke with had no complaints about the service. We were told how people had complained in the past and this had been responded to.

There was a registered manager in the home. We observed people readily approach the registered manager and staff told us the registered manager was approachable. We heard interactions which were respectful and helpful. This meant that people would speak with the manager and any concerns could be quickly addressed.

There were quality monitoring systems in the home. Some of these were undertaken by staff in the home and some by an external monitoring organisation. These covered a variety of areas to help make sure people’s needs were met. People were consulted about the quality of the service provided and meetings took place to help make sure people were kept up to date about any change to the home.

People who lived in the home told us they were consulted in their care and that they were happy with the support they were receiving. They told us they were able to choose what to do each day, that staff treated them with respect and that they felt safe living in the home.

We saw evidence that people’s choices and wishes were recorded as part of the care planning process, which offered care plans for a variety of areas. People had access to other professionals to support them in the meeting of their needs.

There were systems in place for the handling of any allegations of harm and people were supported with their finances.

People were supported by staff who had undertaken a recruitment process which included providing suitable references.

Systems were in place to undertake audits and checks in the home to help keep people safe; to ensure on-going maintenance and to respond appropriately to people’s concerns.

People told us what it was like to live at this home and described how they were treated by staff and their involvement in making choices about their care. They also told us about the quality and choice of food and drink available. They told us that they liked the staff in the home and that they felt able to raise any concerns. They felt that they were treated with dignity and that the food in the home was good. Comments included, “I feel very safe and respected “,” This place is wondrous” and “It’s worth its weight in gold to me”.

This was because this inspection was part of a themed inspection programme to assess whether people living in care homes are treated with dignity and respect and whether their nutritional needs are met.

The inspection team was led by a Care Quality Commission (CQC) inspector joined by an Expert by Experience who has personal experience of using or caring for someone who uses this type of service and a practising professional.

People told us that they were able to make choices and decisions for themselves and they were able to make suggestions about how the service was managed. They told us they were able to get up and go to bed when they choose and come and go as they please, as long as they let the staff know where they were going and when they would be back. They also told us there was plenty for them to do to keep occupied.

People told us that they accessed a range of health professionals and that staff looked after them well. They said that the psychiatrist visited twice a year to review their progress.

People spoken with told us they felt safe in the home.

People spoken with told how much they liked their bedrooms, the home in general and the grounds. One person said, ‘My stay here has been very nice and I have a spacious apartment – very comfortable’.

People told us they liked the staff. They said they were always available, friendly and supportive. One person said, ‘If you are having a bad day they listen to you’.

People using the service told us that they liked living at Willowgarth and that things had improved over the past few months. People said, ‘I like living here and can’t wait for the summer’, ‘since the new manager has been here things have improved’.

People also told us that they have their privacy and dignity maintained and that they have their views listened to.

People using the service told us that they are able to access the health care support they need.

People told us that the food offered was of a good standard. They also said that they were involved in the menu development and that their likes and dislikes were taken into account.

People told us that they felt safe in the home and that they had access to their own money when they needed it.

People said that the home was always clean, tidy and hygienic.

People told us that there were usually staff available to assist them with practical and emotional needs. They told us that staff were friendly, kind and supportive.

People told us that they were able to make complaints and that their views and concerns are listened to. They also said that they were involved in the development of the service and described how they attended the service user groups, chaired meetings and helped to prepare the programme of activities.