The Willows

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

The provider had not effectively deployed staff with the right skills to meet people's needs. On the first day we visited the service, staff deployment was not safe as staff without necessary training to meet people’s needs were on shift. The management team took action to address this. Staff completed a robust induction process and with ongoing supervision and appraisal meetings. However, there were no records of agency staff induction. This was a breach of Regulation 18 (Staffing) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. There were however enough staff to support people and ongoing training being implemented made sure that staff had the skills needed to support people safely. People lived safely and were protected from avoidable harm. Staff and leaders were able to identify situations that amounted to safeguarding and staff were confident to use the whistleblowing process if needed. Risks were managed well. Staff knew people well and were able to identify changes in behaviours and presentation that meant that people were feeling anxious, upset or concerned about something. Lessons were learned when things went wrong.

This service scored 72 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People benefited from staff responding to incidents and risks. This promoted their health and well-being. For example, staff had recently received training on the management of risks associated with constipation. These had been highlighted through learning from external organisations. Staff awareness and understanding had been put into practice. The managers responded positively to areas raised by the inspector during the site visit that confirmed a learning culture. For example, recording and checking of equipment that was used to reduce the risk of skin damage was implemented immediately. This ensured effective and safe use of equipment for the benefit of people.

Staff told us they received regular training to develop their role and ensure people’s needs were responded to. Staff confirmed practice was changed in response to incidents to keep people safe. For example, a staff member told us how staffing arrangements had been changed along with strategies in responding to people’s emotional needs. The quality assurance systems in place ensured a learning culture. The management team shared the quality tool and corresponding action plans that demonstrated the learning and improvement mechanisms.

Systems were in place to record and respond to accidents and incidents proactively and quickly. The registered manager and regional manager had a clear oversight of any accidents or incidents. Lessons learnt were implemented and shared with the staffing team. Following the site visit the management team introduced a shift folder to provide clearer staffing responsibilities on each shift. This demonstrated an ability to respond to issues raised in a positive way to improve outcomes.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

People were kept safe with staff able to respond and act when any safety issue was identified. Staff could recognise safeguarding concerns and were alert to any risks. Relatives were confident that people were safeguarded. A relative told us, “I believe measures in place will keep [person] safe.”

Staff had completed safeguarding training and could describe what action they would take if they had any concerns. A staff member said, “You have to ensure people are safe and happy. I would report straight away to senior staff, they are always contactable. I know the police should be contacted if very serious along with social services.” Another staff member confirmed they knew where the safeguarding procedure was along with the whistleblowing policy.

People demonstrated that they were comfortable around staff with eye contact and social smiles. Records seen confirmed safeguarding issues were identified, responded to quickly and reported appropriately. The service worked closely with the local authority to look for solutions and actions to keep people safe, for example, improving the alert systems in the service to monitor one persons’ movements.

The organisation had a safeguarding procedure in place. Following the first site visit the safeguarding procedure was placed within a new shift folder along with a flow chart to follow when possible safeguarding concerns were identified. This made it more accessible to staff. The local authority contact number was added to this.

Staff knew people well and responded to people’s risks in an individual way. For example, risks around eating and drinking were fully assessed and responded to with individual plans of support drawn up with the Speech and Language Therapist (SaLT). This ensured people could continue to enjoy their food and eat safely which was important to them. A relative remarked on how important food was to people. “I know [person] is content, [person] looks for [their] food. [Person] loves [their] food.”

Staff knew people well and knew how to respond to people’s identified risks. For example, they recognised people’s changing emotional status that impacted on the safety of people in the service. Positive Behavioural Support plans (PBS) were written to guide staff on what actions to take to respond to people’s emotional needs. Staff told us they understand how to recognise and approach people displaying increased anxiety. A staff member told us, “They don’t like you in their personal space when they are anxious, so your approach has to be tailored to their mood.”

Staff were trained to respond to people's risk and had completed training to support them. For example, staff completed training on moving people safely, the use of PBS plans and supporting people with epilepsy. Staff used equipment to reduce people’s risks associated with movement. For example, people were moved safely in wheelchairs and equipment including air mattresses and specialist beds were used to reduce the risk of skin damage. Staff followed the guidelines recorded within individual support plans in response to risks. For example, staff spoke to people as suggested within PBS plans. Staff told us, “It’s best to make a joke of things when talking, this reduces any tensions.”

There were systems to assess and manage people’s risks. For example, moving and handling assessments were completed, these gave specific guidelines on how to move people safely. They recorded what equipment to use and what procedure to follow. The organisation had health and safety procedures in place and routine checks and maintenance was in place. For example, regular checks on the lifting equipment. Each person had a personal emergency support plan. This gave guidance that would be shared with the emergency services to support quick and effective evacuation in an emergency.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

There was enough staff to support people. People had their needs attended to in a timely manner for example, staff were available to assist people to eat taking plenty of time to ensure people had a good and safe experience. People were having individual time with staff and meaningful interaction was planned. This included staff supporting people on outings to places people enjoyed. For example, coffee at local café where people were well known.

Staff told us the staffing numbers were maintained however there was a high use of agency which had impacted on the staff. Staff told us, “We all support each other, the team is supportive we all work well as a team despite recent staff leaving and high use of agency”; “Working with agency staff is difficult, a lot of pressure makes it difficult” and “Would like less agency staff.” The management team recognised the staffing difficulties and confirmed management cover readily available for support. The management team recognised at the time of the first site visit the staffing arrangements were not suitable and did not fully ensure the safety of people.

The staffing deployment observed did not ensure suitable staffing. On the first site visit the Registered Manager was on annual leave. On the morning shift there was 2 regular staff and 3 agency staff. The most senior staff member had worked for the organisation for 8 months. The second regular staff member was new. A person had gone out into the community with an agency staff member supporting them despite the person’s PBS plan stating they must be supported by a staff member who had been trained in PROACT-SCIPr-UK (Positive Range of Options to Avoid Crisis and use Therapy – Strategies for Crisis Intervention and prevention) and had suitable experience. The service did not hold the agency staff members training records and the agency worker confirmed they had not completed PROACT-SCIPr-UK training. On the afternoon evening shift we observed a new member of staff and 3 agency staff. The new staff member had not completed PROACT-SCIPr-UK training. They were trained to administer emergency medicines but had never completed this task. We discussed these concerns with the management team and they took action to address them. On the second site visit the staffing deployment had improved with regular experienced staff working in the service. Staff had time to engage individually with people.

The recruitment process ensured safe recruitment practice was followed. On the first site visit agency staff did not have records to support appropriate skills and checks to ensure safety of their employment in the service. There was no evidence that an induction had been completed and that they were familiar with the service and the people living there. On the second site visit all these areas had been addressed. Designated 1-1 time was allocated in accordance with funded hours. There was a system to ensure the correct numbers were deployed. On the second site visit the staffing arrangements and systems had been reviewed and now ensured a suitable skill mix deployed. A shift folder recorded who was shift leader and identified what skills and experience staff had to ensure they were deployed at the correct time to meet people's assessed needs. Recruitment was being progressed to cover the shortfall covered by agency staff. Staff had been safely recruited. We examined 2 staff files and all of the required checks had been carried out and documents were all in date. The provider had a central system in place which ensured that all recruitment checks were completed before a staff member started. These included copies of references, interview notes, photographic identification and Disclosure and Barring Service forms (DBS). DBS checks provide information including details about convictions and cautions held on the Police National Computer. The information helps employers make safer recruitment decisions.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Medicines optimisation during this assessment. The score for this quality statement is based on the previous rating for Safe.