About the service:

Willan House provides accommodation, care and support for up to 20 people who experience physical disabilities and those who live with dementia.

There were 13 people living at the service at the time of the inspection.

People’s experience of using this service:

• People received safe and effective services.

• People were protected against abuse and discrimination and their rights were upheld.

• People were supported to have choice and control over their lives and were encouraged to maintain their independence.

• People were treated with kindness and respect. They were encouraged to express their views and opinions and staff respected their choices and the decisions people made.

• There were enough staff who had the right knowledge and skills to meet people’s needs in a person centred way.

• There was an open and inclusive culture within the service. People who lived there, relatives and staff had a say in how the service was run.

• Governance systems ensured any shortfalls in the services provided were identified quickly and addressed in a timely manner.

Rating at last inspection:

Good (report published July 2016)

Why we inspected:

This was a planned inspection based on the rating at the last inspection. The service remained rated good overall.

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

The inspection took place on 22 June 2016 and was unannounced.

Willan House is registered to provide accommodation and personal care for up to 20 older people or people living with a dementia type illness. There were 16 people living at the service on the day of our inspection.

There was a registered manager in post at the time of our 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.

The Care Quality Commission is required by law to monitor how a provider applies the Mental Capacity Act, 2005 and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way. The management and staff understood their responsibility and made appropriate referrals for assessment. Ten people at the time of our inspection had their freedom lawfully restricted.

People who lived in the service felt safe and staff knew what action to take and who to report to if they were concerned about the safety and welfare of the people in their care. People were kept safe because staff undertook appropriate risk assessments and care plans were developed to support people’s needs. The registered manager ensured that there were sufficient numbers of staff to keep people safe and care for their needs.

People were cared for by staff who were supported to undertake training to improve their knowledge, understanding and skills to perform their roles and responsibilities.

People had their healthcare needs identified and were able to access healthcare professionals such as their GP or dentist. Staff knew how to access specialist professional help and emergency care when needed.

People were provided with nutritious home cooked meals that were made from fresh ingredients. There were plenty of hot and cold drinks available throughout the day.

People were supported to make decisions about their care and treatment and staff supported people with disabilities to maintain their independence. People were treated with dignity and respect by kind, caring and compassionate staff. People were treated as individuals and were enabled to follow their hobbies and pastimes. There were a wide range of activities provided.

There were systems in place to support people and their relatives to make comments about the service or raise concerns about the care they received. People and their relatives were encouraged to attend meetings and lunches with staff to discuss ways to improve the service. People told us that the registered manager and staff were approachable.

There were robust systems in place to monitor the quality of the service. Staff received feedback on the outcomes of audits, lessons were learnt and improvements to the service were made. The service had received national accreditation for end of life care.

At the time of our inspection the registered manager was away on holiday. During this inspection we spoke with the deputy manager, three care staff, a domestic, three people who lived at the home (one of whom was largely being cared for in bed) and four relatives who were regular visitors.

We considered all the evidence we had gathered under the outcomes we inspected.

This is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service, their relatives and the staff told us.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. Care plans were well organised and the information was clear.

We saw that there were risk assessments in place for mobility, nutrition and tissue viability. Where someone was assessed as being at high risk then control measures had been recorded to state how the risk would be minimised.

We saw there were robust systems in place to assess and check appropriate and safe care was being delivered. These included daily and monthly internal audits. These audits included medicines management and tissue viability.

The provider had appropriate security arrangements in place to protect people who lived at the service. We found that the entrance door was secure and visitors could only enter the building with the knowledge of the staff. People told us they felt safe and secure in the home.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have needed to be submitted, proper policies and procedures were in place. Relevant staff have been trained to understand when an application should be made, and how to submit one.

We saw that medicines were handled appropriately by staff who had been adequately trained and who had access to regular updates. We found that the documentation associated with the giving of medicines showed that people received medication they needed when they needed it.

Is the service effective?

People told us the care they received met their needs. Relatives told us they had been involved in planning the care they received. Comments from people included, "I am happy here and feel very safe" and "I am content with my life and I am very fortunate to have found such a lovely place to live".

Staff we spoke with were clear about the needs of the people they supported and what they told us was reflected in people’s care plans.

We spoke with staff who told us they felt well supported by the manager who ensured access to regular training and development.

Is the service caring?

We saw staff treated people with dignity and respect and maintained their privacy and dignity. We heard care staff speaking courteously and kindly with people, asking permission before helping to support them and explaining what was happening. We observed care staff supporting people where needed in a calm and unhurried manner.

We observed how staff interacted with people whilst medicines were administered. Staff were respectful when they spoke with people and enabled people to take their medicines in an unhurried manner.

During our visit we saw the atmosphere was calm and relaxed. People appeared comfortable and were well dressed and clean, which demonstrated staff took time to assist people with their personal care needs. This showed us staff treated people who lived at the home with compassion and respect and encouraged them to retain their independence wherever possible.

Is the service responsive?

Care and support was provided in accordance with people's preferences, interests and diverse needs. Records we looked at, discussion with staff and observations showed that people's wishes were respected and acted upon.

People had access to activities and we saw staff actively engaging in conversation with people. This meant the home was organised so that it met people's social and emotional care needs, in addition to their physical care needs.

Is the service well-led?

We found the service had an effective quality assurance system in place and any identified actions had led to improvements in the service that people received.

Decisions about care and treatment were made by the appropriate staff at the appropriate level. Staff said they felt the service was well-managed and the registered manager and nominated individual were approachable and enthusiastic. They said they had confidence that any issues brought to their attention were always dealt with properly and thoroughly.

We found that the provider was not delivering the frequency of staff supervision and appraisals as set out in its own policy. The deputy manager assured us they would bring this to the attention of the registered manager at their earliest opportunity.

Staff told us they were clear about their roles and responsibilities. Staff told us the leadership at the service was inclusive and their views were taken into consideration.

During our inspection, we used a number of different methods to help us understand the experiences of people using the service. This was because many of the people using the service had complex needs which meant they were not able to talk with us about their experiences. We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experiences of people who could not talk with us. We were able to talk with one person using the service and spoke with the relatives of others. One person summarised the view of people we spoke with saying: "I couldn't wish for better."

We found that people and/or their relatives were involved in making decisions about their care and had their choices and preferences respected. We saw that each person received an assessment of their care needs, including any risks associated with their care provision. In all the cases we looked at, we found that the care provided matched with the care required.

We saw that people's care was provided by a sufficient number of suitably qualified staff. Those staff were completing a program of training and were knowledgeable in such things as protecting people from the risk of abuse. We found the service had appropriate systems in place to safeguard people from the risk of abuse.

We also saw the service had effective systems to regularly assess and monitor the quality of service that people received. These included surveys and audits.