The Willows

Updated 18 March 2022

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 carried out by one inspector.

Service and service type

The Willows is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. The Willows is a care home without nursing care. 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

We gave a very short period of notice of the inspection. This was because the service is small, and people are often out, and we wanted to be sure there would be people at home to speak with us. Our return visit on the 19 January 2022 was unannounced.

What we did before inspection

We reviewed information we had received about the service since the last inspection. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke with two people who used the service and two relatives about their experience of the care provided. We spoke with seven members of staff including the registered manager and five support workers, one of which was an agency staff member and another a bank staff member.

We reviewed a range of records. This included two people’s care records and two medication records. A variety of records relating to the management of the service, including policies and procedures were reviewed.

After the inspection

We continued to seek clarification from the provider to validate evidence found. We looked at training data and quality assurance records. We spoke with three professionals who regularly visit the service and the local authority quality monitoring officer.

Updated 18 March 2022

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.

About the service

The Willows is a residential care home providing personal care to nine people at the time of the inspection. The service can support up to nine people in three separate bungalows on the same site.

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

People were not always protected from risk of harm and abuse because safeguarding systems were ineffective. People were not receiving their commissioned one-to-one support, this and the high use of agency staff in the service had impacted on the support people received to engage in their local community and activities away from the service. Assessments of people’s needs and wishes, particularly in relation to visiting and activities in the context of COVID-19, had not been carried out collaboratively with people and other relevant parties.

People were not supported by effective governance systems and processes. This had resulted in regulatory requirements not being met. People were not supported to engage in meaningful feedback on the support they received.

Risks to people were assessed and responded to, this included in relation to the environment. People received their medicines safely and as prescribed. Staff worked well with other professionals to help identify and meet people’s needs.

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

Right support

The model of care and setting did not maximise people's choice, control and independence. People were not receiving person-centred care due to the systems in place and staffing issues. Some people's specific support needs were not always clearly identified and met.

Right Care and Right culture

Some practice raised concerns regarding the culture in the service. Whilst some actions taken, such as restrictions around visiting and activities, were well meant they were not anchored in the values of empowerment, inclusivity and person-centred care. The provider's oversight of this issue was poor.

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 05 June 2018).

Why we inspected

We received information of concern about infection prevention and control measures and staffing levels at this service. We visited the service on 12 January 2022 to look at the infection prevention and control measures the provider has in place. We also asked the provider about any staffing pressures the service was experiencing and whether this was having an impact on the service. During the visit we identified further concerns about person centred care and governance. As a result, we returned to the service on 19 January and undertook a focused inspection to review the key questions of safe and well-led only.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to person-centered care, safeguarding, staffing, and governance at this inspection

Please see the action we have told the provider to take at the end of this report.

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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.