Willow Brook

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

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Based on our review of key questions safe, effective and well-led, the provider was not able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

Right Support: People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

Right Care: People were at risk of harm because staff did not always have the information they needed to support people safely. Medicines were not always managed safely. People did not receive consistent person-centred care that was empowering, of a high-quality and achieved good outcomes.

Right Culture: Ethos, attitudes and behaviours of leaders and care staff did not fully ensure people using services led confident, inclusive, and empowered lives.

Infection prevention and control was not managed safely. There was a lack of timely action by leaders to ensure safeguarding incidents were responded to.

New starters were not trained in a timely manner. This meant they might not always be aware of current good practice. We have made a recommendation about this.

Premises were untidy and unclean. There was a lack of cleaning schedules in place.

People were not being supported to maintain a varied and healthy diet. We have made a recommendation about this.

Leadership was inconsistent. Governance systems were ineffective and did not identify the risks to the health, safety and well-being of people or actions for continuous improvements. Where the need for improvements had been identified, these had not been fully implemented. Records were not always complete. People and stakeholders were not always given the opportunity to feedback about care or the wider service.

The provider did not always submit notifications to CQC which is their legal responsibility to do so when certain significant events occur.

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

Rating at last inspection

The last rating for this service was good (Published 4 June 2020).

Why we inspected

The inspection was prompted in part due to concerns CQC received regarding a person using the service who sustained a serious injury. This matter is subject to further investigation by CQC. The information shared with CQC indicated potential concerns around the timeliness of seeking medical intervention. This inspection examined those risks.

As a result, we undertook a focused inspection to review the key questions of safe and well-led only, during the inspection we made the decision to look at the effective key question as well.

For the key questions caring and responsive not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

You can see what action we have asked the provider to take at the end of this full report.

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

Enforcement and Recommendations

We have identified breaches in relation to risk management including infection control and medicines, safeguarding, the Mental Capacity Act, maintaining suitable premises, governance and failure to notify CQC of significant events at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures.’ This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it, and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

We found the following examples of good practice.

¿ Staff received relevant infection control and prevention training and adhered to good practice around using personal protective equipment.

¿ The home was purpose built and well laid out to facilitate isolation and social distance when required.

¿ An appropriate PCR testing programme was in place for both staff and people using the service.

We were some what assured that this service met good infection prevention and control guidelines.

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.

A registered manager was in post. 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 and associated Regulations about how the service is run.

We previously inspected Willow Brook on 23 August 2017 and found the provider had not ensured staff were always appropriate trained. We also identified governance systems were not robust in recognising areas for improvement. We rated the service ‘Requires Improvement’. At this inspection we found improvements had been made so we rated the provider as ‘Good’.

Medicines were managed safely and in accordance with current regulations and guidance. There were systems in place to ensure that medicines had been stored, administered, audited and reviewed appropriately.

People were happy and relaxed with staff. They said they felt safe and there were sufficient staff to support them. When staff were recruited, their employment history was checked and references obtained. Checks were also undertaken to ensure new staff were safe to work within the care sector.

Risks associated with the environment and equipment had been identified and managed.

Emergency procedures were in place in the event of fire and people knew what to do, as did the staff.

Staff were knowledgeable and trained in safeguarding adults and what action they should take if they suspected abuse was taking place. Staff had a good understanding of equality, diversity and human rights.

People were being supported to make decisions in their best interests. The registered manager and staff had received training in the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS).

Accidents and incidents were recorded appropriately and steps taken to minimise the risk of similar events happening in the future.

Staff had received essential training and there were opportunities for additional training specific to the needs of the service, including challenging behaviour and epilepsy.

Staff had received both supervision meetings with their manager, and formal personal development plans, such as annual appraisals were in place.

People were encouraged and supported to eat and drink well. There was a varied daily choice of meals and people could give feedback and have choice in what they ate and drank. Health care was accessible for people and appointments were made for regular check-ups as needed.

People felt well looked after and supported. We observed friendly relationships had developed between people and staff. Care plans described people's preferences and needs in relevant areas, including communication, and they were encouraged to be as independent as possible.

People chose how to spend their day and they took part in meaningful activities.

People were encouraged to express their views and had completed surveys. They also said they felt listened to and any concerns or issues they raised were addressed.

People's individual needs were met by the adaptation of the premises.

Staff were asked for their opinions on the service and whether they were happy in their work. They felt supported within their roles, describing an 'open door' management approach, where managers were always available to discuss suggestions and address problems or concerns.

The provider undertook quality assurance reviews to measure and monitor the standard of the service and drive improvement.

Willow Brook provides personal care and support for adults with a learning disability, a mental illness and/or other health conditions. The home is a purpose built building on one level with each person having their own room with ensuite shower facilities. There is a communal lounge and kitchen/dining area for people to use and a bathroom for people who choose to have a bath rather than shower. At the time of our inspection there were five people living at Willow Brook.

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.

Although the registered manager sought feedback from people, staff and external professionals to ensure the continual improvement of service provision, the registered manager did not always follow up on the actions with regards to staff training in a timely manner.

People were kept safe from potential abuse and avoidable harm by staff who knew them well. Staff were able to demonstrate a good knowledge of how to recognise the signs of abuse and how to report this appropriately. The provider supported staff to keep people safe by providing mandatory safeguarding training.

The provider followed safe recruitment practices to ensure that those working in a care setting were suitable. There were enough staff employed to keep people safe.

Medicines were stored managed, disposed of and stored securely.

Detailed risk assessments were in place and tailored to each person to mitigate any potential risk of harm to people and staff.

Staff were mostly up-to-date with mandatory training updates which enabled them to care for people effectively.

Staff were supported by regular supervision, well-being checks and group work and an annual appraisal.

Staff demonstrated a good understanding of the Mental Capacity Act 2005 and gave good

examples of seeking consent when providing personal care and support. Deprivation of Liberty Safeguards (DoLS) applications were all completed thoroughly with a robust system in place to renew applications when required.

The service supported people to maintain a healthy and balanced diet. People actively contributed towards their meal choices and were supported to engage in cooking meals if they wished. People were encouraged and supported to access health and social care professionals when required.

People developed warm relationships with their support workers who knew people well. Staff spoke in a caring and positive manner about people living at Willow Brook and demonstrated pride in the outcomes achieved by people living at the home.

Support plans were detailed and personalised. Each care plan was available in easy read format to support people in being able to contribute towards decisions about their care and treatment. There was evidence of support plans having been reviewed regularly.

People’s privacy and dignity was supported at all times with an emphasis on ensuring that people maintained their independence and had choice in relation to their care, environment and the activities they engaged in.

There was a complaints policy in place which was also available in easy read format for people living at the home and kept in the communal lounge. Evidence showed complaints were dealt with in accordance with policy.

The culture of the home was very caring and supportive which had been introduced and maintained by the registered manager. Staff spoke positively of the management team. The registered manager promoted staff well-being by introducing a number of processes to ensure staff felt valued. Meetings were held to encourage people and staff to discuss any issues they may have and for the management team to share best practice and learning from incidents.

There were quality auditing and management systems in place to ensure that any areas of improvement were identified and acted upon and to maintain best practice throughout the home.