Willoughby House

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

We identified 2 breaches of the legal regulations. We could not be confident people received their identified individual support hours. Staff did not always assess risks to people's health and safety or mitigate them where identified. People received support to access health care services. The home was clean and tidy.

This service scored 59 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People were unable to explain how the learning culture affected their experience in the care home. However, processes were not always in place to identify learning opportunities and therefore people’s experience was not as good as it could have been.

Staff told us they were required to review care plans to understand people’s needs and risks. Incidents were discussed in staff meetings and learning from incidents was shared. However, as processes were not effective staff did not recognise all incidents or all learning from incidents and so missed opportunities to improve the care provided.

Systems were in place to review incidents and to share learning with colleagues. However, care plans had not fully identified the risks to people therefore did not support staff to learn people’s needs. In addition, staff lacked the skills and experience to recognise incidents. Therefore, opportunities for learning and improving the care they provided to people were missed.

Relatives told us that people were supported to access healthcare when needed. One relative told us, “They keep me informed of [Name’s] GP appointments. They are due a dental appointment.” Records showed another person had been supported to attend appointments for a device to help them walk better.

The registered manager explained how they monitored people’s needs and referred them for further health and social care support when needed. For example, they had requested an assessment for a person to support them to retain their independence in the community.

Partners had no specific feedback on this area.

There had been no recent admissions to the home. However, staff and the registered manager were able to tell us about the processes in place to support a safe and effective transition into the home. This included people visiting the service for meals and overnight stays to see if they would like to live at the home.

Relatives told us they were happy with the care provided. One relative told us, “The fact is we are 100% confident that he is safe, well-loved and looked after.” However, processes to support the safe management of money were not always followed.

Some staff lacked knowledge of the safe management of people’s monies. This meant on occasion they had failed to follow the correct guidance how money should be recorded in people’s accounts. Staff spoke knowledgeably about how to keep people safe and understood the different types of abuse people may face. They understood how to report any safeguarding concerns to the provider and external agencies such as the local authority and police. They also told us they received regular training about how to keep people safe. Staff had received training in how to restrain people safely if needed. However, staff told us they did not need to use physical restrain as they could calm the person down by talking to them and ensure their needs were met. One member of staff told us, “It's knowing the clients and knowing what works best.”

People living at the home appeared happy. People were comfortable with the staff and in the environment. We saw some financial processes had not been completed for people in line with the provider’s policies. For example, the cost of a takeaway had been split evenly between people instead of people paying for what they had chosen to eat. We raised this with the registered manager who told us they would correct this issue and ensure staff understood the correct process.

Systems were in place to protect people from the risk of most abuse. Processes clearly set out the actions that managers and staff should take if abuse had occurred or was suspected. The provider had appointed a member of staff to be the safeguarding ambassador. They took the lead on supporting other staff and ensured people were treated with respect. However, there was no clear guidance in place for the financial management of people’s money. For example, how much was appropriate to spend on clothes. This meant there was a risk people may not be able to afford to do other activities they may like.

Relative’s told us their loved ones were safe in the home and risks were well managed. However, during the inspection we found people’s risks had not been fully identified. For example, risks related to long term conditions had not been recorded. This meant staff may not respond appropriately in an emergency.

Staff told us they reviewed people’s care plans and risks were recorded, along with any care needed to keep people safe. However, staff had lacked the knowledge to fully understand the risks to people to ensure they received safe care. Where people were at risk of becoming distressed care plans listed the things that might upset people.

We found some risk assessments had not been followed. For example, substances which should have been locked away for safety such as cleaning sprays and washing powders had been left on the side in areas of the home accessible to people. Some people may not be able to identify that these materials could be harmful to their health. People’s care plans noted products that may be dangerous to people were in locked cupboards to reduce the risk to people.

Care plans did identify some of the risks to people, and care was planned around the identified risk to keep people safe. However, staff had not fully identified the risks a person faced. For example, some people were living with conditions which would deteriorate as they aged. There was no risk assessment in place for these conditions or how staff could support people to remain as healthy as possible. Additionally care plans at times identified risks to people but there was no associated risk assessment to show how the risks were mitigated. For example, one care plan noted a person was at risk of self-harm when upset, there was no advice to staff on how to mitigate the risk, just what staff should do after the incident to support the person.

Relatives had no concerns about the safety in the home. However, we found issues with the home which put people at risk and did not support their safety.

Staff told us how they had placed speaking buttons around the home for a person with a sensory impairment. This helped the person independently orientate themselves to where they were in the home and increased their independence.

We found one large upstairs window did not have a restrictor on it. This meant the window could be opened wide and was a risk to people. We informed the registered manager about this issue and immediate action was taken to resolve the issue. Fire doors had been wedged open and there was no automatic closing device on them. We informed the registered manager and appropriate self-closing wedges were ordered before we left the home. However, one toilet had been labelled for staff or visitor use. This did not reflect the principles of providing a home that is person-centred as this is not something a person would have in their own home. It does not reflect the principles of Right Support, Right Care, Right Culture, which guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted.

The systems in place to monitor the safety of the home were not effective. Issues we identified had not been found by the provider when routine audits of the environment had been completed. While the provider took immediate action to resolve these issues, we would expect there to be staff with sufficient knowledge to have identified and resolved these issues independently of the inspection. The premises and environment met the needs of people who used the service and were accessible. There was a spacious communal area. There was a garden if people wanted to go outside. People’s rooms were decorated according to their preferences. Systems were in place to ensure routine safety checks were completed.

People were relaxed around the staff and staff understood their needs. Relatives we spoke to had no concerns about staff that supported people and with staffing levels. One relative told us, “The staff understand [Name]’s needs.” However, one relative we spoke with told us staff could be better training in relation to a person’s sensory impairment. While people were happy with the care we could not be confident that they were receiving all of their individual support hours. This meant people could miss out on life opportunities.

Staff told us the rotas ensured here were enough staff on duty to meet people’s needs. They confirmed that they had completed the provider’s mandatory online training and how they were prompted when training was due to refreshed. However, training was not always effective, one member of staff we spoke with was unable to tell us about what they had learnt in their training and how they used their training to improve the support they provided to people.

There was enough staff to support people safely. We observed that staff knew people well and supported them safely and responded to people's request promptly. However, we could not be sure people were receiving their individual support hours.

Four people living at the home had set hour of individual support they should receive each week. There was no allocation of staff to these hours, therefore we could not be sure people were receiving their individual support needed. Staff had received a Disclosure and Barring Service(DBA) check. This checks staff details against criminal convictions to ensure they are safe to work with people living in the home. Systems to ensure staff were safely recruited had not always been effective. For example, gaps in staff’s work history had not been investigated and there were no records kept of people’s interviews to show they had appeared to be capable of completing the role they were applying for. Staff members identity had not always been verified with official documents which contained photographic Id. Therefore, the provider had no assurance that the person working for them was who they said they were. Training records showed staff’s training was up to date. However, when speaking with staff we identified gaps in their knowledge and there was no evidence the registered manager checked staff’s competency following the training.

People and their relatives told us they were happy with the standard of cleanliness in the home. One relative said, “The home is clean, and [Name] has new furniture.” Some people liked to help clean and tidy, and do the laundry so staff supported them to ensure they were safe.

Staff told us they had a cleaning schedule and a daily plan they worked through to ensure high standards were maintained. When supporting people with personal care staff told us they wore gloves and aprons. They ensured they changed these each time they provided care to a different person.

We spent time in the home and could see that it was clean and tidy. Separate bins were available for clinical waste. However, some areas of the building needed remedial action to support infection control. For example, the clinical waste bin in the laundry was not pedal operated and some tiles were broken.

The provider had an infection prevention and control policy in place. It had been routinely reviewed and covered what to do in case of an outbreak. An annual audit reviewed all the processes and identified areas for improvement. Cleaning schedules identified all areas of the home and were reviewed weekly to ensure cleaning and been completed.

Relatives told us people’s medicines were well managed. One relative told us, “Everything is above board with his medication and they inform me of any changes.”

Staff were aware of people’s needs in relation to their medicine. They were able to describe when they would support people with medicines prescribed to be taken as required. For example, they were knowledgeable about how people who may not always be able to verbalise their needs may act when in pain or upset. Staff were aware of initiatives to help reduce the amount of medicine people took. For example, medicine to support people to remain calm was not used as the first action when people became upset, instead staff talked to the person to see if they could identify what the issue was and resolve it for the person. This meant people could go on to enjoy the rest of their day without being affected by the medication.

Staff administered medicines to people in line with best practice guidelines and observing infection control processes. Records showing the administration of medicines were fully completed and accurately recorded the medicines administered. Protocols were in place to support staff to administer as required medicine consistently to people when needed. The home had liaised with the local GP practice to ensure the use of over the counter medicines such as pain relief and cough mixture was safe for people to use alongside prescribed medicines.