The Office

Willow Tree House is a supported living service that was providing personal care to 20 people with a learning disability, autistic spectrum condition or mental health needs at the time of the inspection. The service supports people at two sites in York; one in Haxby and another in Heworth. At both of these properties people have a tenancy agreement and their own flat.

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.

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

People received a safe and responsive service, but aspects of record keeping required improvement. In particular, records in relation to the Mental Capacity Act which had not been addressed since our last inspection. There were also some anomalies and gaps in other records, which had not been effectively identified and addressed by the provider’s quality assurance system. This meant there was a risk staff may not always have all the accurate information they needed to support people effectively.

We have made a recommendation in this report in relation to quality assessment and monitoring.

People were satisfied with the service and told us they were safe and happy. Staff were aware of risks to people’s safety and acted to mitigate these. Systems were in place to ensure people received their medicines as prescribed, but there were some minor recording issues which the manager agreed to address.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way, but records needed to improve to evidence this more clearly. People were supported with their health needs and had regular health checks. They had access to healthcare professionals when needed.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

People told us staff were kind and respectful, gave them privacy and involved them in decisions. People’s independence was promoted; the amount of support each person received was tailored to their needs. People accessed activities in the community, independently or with the support of staff.

Staff received an induction and supervision. The manager was taking action to bring refresher training up to date for all staff. Staff felt supported and told us the team worked well together. People, staff and visiting professionals spoke positively about the manager.

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

Rating at last inspection:

At the last inspection the service was rated good (published 12 April 2017).

Why we inspected:

This was a planned inspection based on the previous rating.

Follow up:

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

At the last inspection, the service was rated Good. At this inspection we found the service remained Good overall, although the key question: Is the service well-led? now requires improvement. This was because there was no registered manager at the service. The service is required to have a registered manager, and as such, the registered provider was not meeting the conditions of their registration. 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. A new manager was in post, but had yet to register with the Commission.

There were systems in place to prevent the risk of harm or abuse. Staff were knowledgeable about what constituted abuse and how to respond if they had any concerns. The registered provider completed a range of risk assessments according to people’s individual needs, and these provided guidance to staff on how to minimise the risk of harm to people.

There were systems in place to ensure people received their medicines as prescribed. People were also supported to maintain good health and access healthcare services.

There were sufficient staff to meet people’s needs, and staff received training and supervision. Staff had been recruited following appropriate checks, to ensure they were suitable to work in a care setting.

There was a lack of clarity in some mental capacity assessments, which the manager agreed to address. However, care staff we spoke with had an awareness of their responsibilities in relation to the mental capacity act and were able to demonstrate a good understanding of the importance of gaining consent before providing care to someone. People confirmed that their choices and decisions were respected.

People told us they had good relationships with staff and during our inspection we observed positive, caring interactions between staff and people who used the service. People also told us that staff respected their privacy and dignity, and always sought permission before entering their flats.

There were comprehensive care plans in place, which guided staff on how to meet people’s individual needs. These were regularly reviewed. The level of support people received was tailored to their needs, and support was provided to enable people to pursue hobbies and interests. Most staff demonstrated a good knowledge of people’s individual needs and preferences.

People confirmed they would feel comfortable raising concerns or complaints if they had any, and there was a system in place to respond to complaints. They were also able to raise issues in tenants meetings and individual care reviews.

The registered provider conducted quality assurance audits and satisfaction surveys to measure the quality of the service provided. Some suggestions for improvement from a relative and a visiting professional included activities and communication, but overall most survey respondents were satisfied with the service provided, and all the people we spoke with during our inspection were happy with the care they received.

The provider had clear processes in place for recruitment and selection and we found that all necessary checks were carried out before staff commenced employment. An induction process was followed when new staff started. We saw records of supervision and appraisal and staff reported that they felt supported and were given chances to develop their practice. Staff had completed training in various areas and there was an ongoing programme of relevant training that was offered to staff.

There were quality assurance systems in place including audits of health and safety, fire alarm testing, fire drills, first aid equipment and kitchen areas. Records were found to be up to date and accurate. Systems were followed for the storage and destruction of paperwork. Financial and medical records for individuals were up to date and regularly checked.