The Willows

Updated 22 July 2021

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was undertaken by two inspectors and an Expert by Experience.

An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

The Willows is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed the information we had received about the service since the last inspection and used this to plan our inspection

The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.

During the inspection-

Most people we met during the inspection had complex needs and were not able to tell us about their experience of life at the inspection. We therefore used our observation of care and other evidence to help form our judgements.

We spoke with one person who lived at the service and 12 relatives. We spoke to 13 staff as well as the registered manager and service manager.

To minimise the risk of infection we limited the records we looked at whilst on inspection and looked at selected care plans and focused on risk assessments in relation to behaviour and restraint. We looked at medication and quality assurance systems.

After the inspection

We continued to seek clarification from the provider to validate the evidence found and we spoke with the regional operation manager, area manager and quality assurance lead.

Updated 22 July 2021

About the service

The Willows is a residential care home providing personal and nursing care to 19 people aged 18 to 65. At the time of our inspection there were 19 people using the service.

The Willows accommodates 19 people who have a learning disability and, or a diagnosis of autism. People live in their own flats but share some communal facilities. Living accommodation included a bungalow and a main house. There was also an activity room.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

The Willows was registered to support of up to 19 people. This is larger than current best practice guidance. However, the size of the service having a negative impact on people was mitigated by having two separate accommodation types, a bungalow and a house. The properties were appropriate in design and within a residential area. There were no obvious signs to identify this as a care home. There was some additional security and external cameras to give people using the service and staff some additional protection.

People’s experience of using this service and what we found

The service had not consistently delivered good outcomes of care for people over the last twelve months. Some people had not been sufficiently supported with their health care needs, behaviours or been able to access social activities when they wanted to. This could be attributed to turn over and change of staff and management which has created inconsistent levels of service provision.

There is a new registered manager in post who has been in post for four months. They were supported by a management consultancy group who had introduced a robust governance process to measure and improve the quality of the service provided. An area manager started about the same time as the registered manager and was supporting the changes being made. They had begun to stabilise the service and had an improvement plan in place. Improvements were noted but there were still areas to address including establishing a regular staff team, filling vacancies and reducing agency usage to help ensure people have continuity of support. Staff were not yet working effectively because staff performance and competencies had not been adequately reviewed over a period and not all staff had completed all training considered necessary.

There needed to be clearer management oversight on shift as not all staff were working to the required standard particularly as agency staff did not have the same level of training as regular care staff which meant they could not always provide the most appropriate support to people using the service. Neither was their initial onsite induction recorded. We have made a recommendation about this.

Communication was not yet effective. We found arrangements for staff handover were poor which meant information was not effectively handed over or known by all staff. Record keeping was not of a consistently high standard particularly daily notes and incident recording did not always give enough detail making analysis more difficult. We have made a recommendation about this

The environment was mostly appropriate to people’s needs but some redecoration and refurbishment was necessary to bring the properties up to standard. Some people had behaviours which challenged, and this included the destruction of property. This was being addressed by the registered manager.

People’s care and support plans were being updated and had improved. There were enough staff on duty at any one time who had a good understanding of people’s needs and able to provide some stability and oversight. The service was not yet able to consistently manage people’s needs but core teams were being established and helping to reduce people’s anxieties.

Staffing levels were being maintained and people had the support the Local Authority commissioned. Staffing numbers were high due to the nature of support people required. Staff recruitment and retention were being effectively managed with robust recruitment processes in place. Staff were being supported to develop the necessary skills and competencies through training and observation of practice. Induction was robust and being strengthened by the introduction of the Care Certificate a nationally recognised induction course.

Medicines were being effectively managed and there were audits in place to determine if medicines were being given as intended.

Most people needed constant supervision for their and others’ safety, but this was provided in a sensitive way and where possible took into account people’s needs and preferences. People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People accessed services in the community and staff supported people to attend health care appointments. When necessary staff accessed more specialist services and took advice about how best to support people in line with best practice.

Rating at last inspection and update

The last rating for this service was good (Report published February 2017)

Why we inspected

This was a planned inspection based on the previous rating.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for on our website at www.cqc.org.uk.