Willoughby House

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• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

We identified 1 breach of the legal regulations. Decisions made in people’s best interest were not always recorded and guidance was not always available to staff to support them to implement decisions consistently. People’s needs were assessed but staff failed to recognise ways to improve people’s life experiences and independence.

This service scored 67 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Relatives told us they knew about any changes to their loved ones care. One relative said, “The staff understand his needs and they have a new key worker. They always let me know by e mail or telephone to let me know about any changes.” However, there was no evidence of people or their relatives being involved in developing their care plans. There was no evidence of goals being assessed for people to give them opportunities for growth and to increase their independence.

Staff were able to speak knowledgeable about people’s needs as recorded in their care plans. However, despite having some insight into how people communicated their distress and how it affected their lives they had failed to use this knowledge. This meant people continued the behaviors with restrictions in place to minimize the impact but were not offered opportunities for growth to improve their communication.

People had not received a functional assessment of their needs. This meant at times how people communicated their needs was not fully understood or care planned adequately. Therefore, the care provided did not always support people. For example, one person communicated a feeling by using a certain behaviour. The registered manager has minimised the damage by locking the person’s wardrobe and drawers restricting their access to clothes and belongings. However, there was no care plan in place to support what the person was trying to communicate or how staff could help the person express their feelings in a different way. There was no plan in place on how these restrictions could be reduced.

We did not look at Delivering evidence-based care and treatment during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at How staff, teams and services work together during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at Supporting people to live healthier lives during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at Monitoring and improving outcomes during this assessment. The score for this quality statement is based on the previous rating for Effective.

Staff ensured people were asked for their consent before any personal care was provided. However, some people were asked to make decisions they would not fully understand. For example, people were sometimes asked if they wanted a takeaway. However, not everyone was financially aware and so did not fully understand the impact of spending the money on a takeaway may have on future financial decisions.

The registered manager and staff understood the principles of the mental capacity act. They were clear about supporting people to make their own decisions about the support needed. They understood people may be able to make some decisions independently, but some people might need support with more complex decisions. They told us when people were not able to make a decision for themselves staff need to act on what they thought was best for them. However, they had failed to understand the need to record decisions made in the person’s best interest.

People’s care plans did not have any best interest decisions. We raised this with the registered manager who advised that best interest decisions were completed with social workers. We saw that this was the case for big decisions, for example, a person who needed an operation had a full best interest decision made with clinicians, family and staff all involved. However, staff made other decisions for people and no best interest decisions were made. For example, staff went clothes shopping for clothes and personal items for a person. There was no record of a best interest decision to show how much to spend on these items and how much money to retain for the person to spend on other activities and interests. Other people who lacked the ability to manage their own finances were having weekly massages, again there was no record of any decision to show that this was in the person’s best interest or what benefit having the massage was to them. Where people were unable to make the decision to live at the home, the registered manager had ensured their rights were protected and applied for a Deprivation of Liberty Safeguard authorisation.