Willow Tree House is a supported living service for people with a learning disability and/or mental health needs. The site at Haxby supports people to live as tenants in self-contained flats comprising of a lounge, which includes a kitchenette unit, a bathroom and a bedroom. There is also a communal lounge where people can sit and socialise, if they choose. The registered provider is not the landlord for these flats, and people have a tenancy agreement with the landlord. The service can also provide support for people in their own homes, who do not live at the address in Haxby. Since our last inspection the service had started providing support to a group of tenants who lived in self-contained flats at a property in Heworth. At the time of our inspection, 13 people were supported at the site in Haxby and five people were supported at the site in Heworth.

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 respondent

This inspection took place on 7 January 2015. We contacted the service in the afternoon of 5 January to inform them of our planned visit. We carried out an announced visit to ensure that senior staff would be present at the service and to give senior staff the opportunity to speak with tenants and ask whether they would like to speak with us.

The last inspection was in May 2013 and we found the service met the relevant requirements.

Willow Tree House is a supported living service for people with a learning disability and/or mental health illness. The site at Haxby supports people to live as tenants in self-contained flats comprising a lounge, which includes a kitchenette unit, a bathroom and a bedroom. There is also a communal lounge where people can sit and socialise, if they choose. The provider is not the landlord for these flats, where there is on-site parking. The service can also provide support for some people in their own homes, who do not live at the address in Haxby.

The service is located in a residential area in Haxby, a large village on the northern outskirts of York, with a regular bus service into the city. Haxby has a range of amenities and the centre of the village is about five minutes’ walk from the service.

Willow Tree House has a registered manager. 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 service promoted people’s safety by having measures in place to ensure people were protected, as far as possible, from the risk of harm. Safeguarding policies were in place and staff understood their roles and responsibilities around managing abuse or allegations of abuse. People were supported to take risks in their day to day lives and the service carried out regular reviews to ensure those plans remained appropriate and relevant.

There were sufficient staff employed to enable people to follow their interests and lifestyles, both at home and in the community.

The service overall had robust systems in place to ensure people received their medication when they needed it. We found there was clear guidance about when to administer emergency medication in order to support people safely and appropriately, to minimise the risk of harm.

People received care and support from staff that may have been recruited in a robust way; however their recruitment records did not always evidence this well. We have recommended the provider looks at their recruitment practices and associated record keeping at Willow Tree House.

People were supported by a staff team who felt supported by their managers. They had regular meetings where they could meet and discuss their work as a group as well as one-to-one meetings with a more senior person where they could discuss their work and training needs.

Staff spoken with at Willow Tree House had a good understanding of the Mental Capacity Act (MCA) and how this affected people’s rights to stay in charge of their own lives, as far as possible. Staff we spoke with also understood the purpose of Deprivation of Liberty Safeguards (DoLS) and how these were authorised. Staff recognised that people had the right to make decisions and choices about their day to day lives and these needed to be respected.

People were helped by a staff team who were supported to undertake training and refresher training relevant to their role. We noted the numbers of staff who had attended different training courses varied quite a lot. We recommended the provider looked at the care needs of the people receiving support at Willow Tree House to see whether the training provided was meeting those needs.

People told us staff supported them to stay healthy and to attend health appointments if needed. Health care professionals spoken with by telephone and email told us the service managed people’s healthcare needs well.

People were supported by staff who were kind and respectful. They talked to people in a friendly manner and listened to what people said to them. The staff knew people’s needs and behaviours well and could support people appropriately, where necessary, before they became upset or angry.

People had care records which described the care and support they needed. We saw some people had helped with writing their own care records and these clearly described the support they wanted and needed. The records were reviewed regularly, though did not always well evidence that the individual had been involved in that process.

The service had a complaints process and people all told us they were confident speaking to members of the staff team or the manager. All thought any complaint would be looked into properly.

People living at Willow Tree House knew who was in charge. They saw her most days and liked and trusted her. The manager met with people regularly and used survey responses to find out what people thought about the service. This meant people’s views and opinions mattered.

Managers at Willow Tree House carried out regular checks on how the service was operating. This meant they were checking that the service was running effectively and people were receiving care and support that was appropriate and safe.

Willow Tree House was a new service and this was the first inspection since the service had been registered with the Care Quality Commission (CQC). We spoke with people who used the service who told us that they were very happy with the support they were receiving. We saw evidence that people were very involved in planning their care and writing their care plans. People were able to choose what support they would like and how this was organised. There were also opportunities for people to be involved in ‘speak out’ meetings where various topics were discussed. All documentation was provided in a format that suited the individual.

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.