13 August 2015
During an inspection looking at part of the service
We carried out an unannounced comprehensive inspection of this service on 24 February and 2 March 2015. After that inspection we received concerns in relation to staffing in the service, staff knowledge and skills, staff morale and the safety of people living there. As a result we undertook a focused inspection to look into those concerns. This report only covers our findings in relation to those topics. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for The Willows on our website at www.cqc.org.uk
The Willows is an all-male household and provides accommodation and personal care for up to six adults with a learning disability and behaviours that can challenge. At this inspection there were five people living in the service. There is a communal lounge/dining room, a small lounge and a kitchen with seating on the ground floor. There is a garden with a paved area at the back of the home.
The home is run by a registered manager who was absent on planned leave for one year. In the absence of the registered manager, an interim manager had been appointed who was present at the inspection. 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.
Concerns had been raised that there were not always enough staff on duty to support people safely and that some staff may not have the necessary skills.
Some people told us that they liked living in the service, but were made unhappy or upset when they witnessed or were involved in incidents involving other people they lived with.
Since the last inspection the provider had taken steps to recruit new staff but there were still vacancies. Some people now needed more support but staffing levels had not been adjusted to reflect this. Care staff told us they felt stressed by the present situation and did not feel that staffing levels were enough to keep people safe, particularly when everyone was at home and incidents were more likely to occur. Staff lacked confidence in working alone with some people particularly when out with them in the community.
Not all staff had received safeguarding training to recognise and act on abuse. In conversation they lacked awareness that enabled them to distinguish everyday incidents from those that would meet the criteria for a safeguarding alert, there was a risk therefore of some safeguarding incidents being under reported. Staff understood how to report and record other incidents appropriately and this information helped inform whether changes in support were needed.
There were weaknesses in some operational record keeping which did not always provide a clear picture that procedures had been followed. For example, some staff had received training in administration of medicines but their training documentation failed to reflect this or that competencies had been assessed.
Risks to people’s safety were assessed and measures were put in place to minimise the level of risk identified, staff told us and we saw that these were not always adhered to and this did place people and staff at risk.
The induction of new staff was not always recorded, therefore the interim manager was unable to assure either themselves or the provider of what the staff concerned had learned, read or achieved competency in during the period they had been in post. Staff had been put forward for essential training, but the provider had not been proactive in ensuring essential training was prioritised for staff dealing with people with complex needs; this could lead to people not receiving appropriate care and staff not feeling sufficiently informed or confident to deliver an appropriate level of support.
Staff told us their morale was low, some staff felt less well treated than others, and there was not a cohesive sense of team. Staff said they received supervision where they were able to express their views, but did not always feel supported that the issues they raised were acted upon.
Regular checks of the premises were made to ensure people lived in a safe environment and equipment was serviced and in working order.
People attended monthly ‘your voice’ meetings where they exchanged news and experiences with people from other services, they were given support if they had concerns they wanted to raise. A system to seek feedback from relatives and other stakeholders was not in place to inform or influence service development, but the interim manager told us they maintained active and good links with relatives, but this was not evidenced clearly within records.
Staff engaged well with people, except when incident occurred, and they supported them to lead busy active lives and made good use of the community. People were supported to develop and maintain relationships with people outside of the service.
There were continued breaches and three further breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what actions we have asked the provider to take at the end of this report.