The Willow

Updated 4 January 2024

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

This was a targeted inspection to check whether the provider had met the requirements of a Warning Notice in relation to Regulations 13 (Safeguarding), and Regulation 17 (Good Governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, as well as a requirement notice in relation to Regulation 12 (Safe Care and Treatment).

The inspection also checked on other recommendations that had also been previously made to the provider.

Inspection team

The inspection team consisted of two inspectors from the Care Quality Commission.

Service and service type

The Willow is a children’s home which is registered for accommodation for people requiring personal or nursing care as well as treatment of disease, disorder or injury. The service can accommodate one person. The service provides therapeutic psychological support to children and young people with mental ill health and / or additional needs, such as neuro-developmental disorders. At the time of our inspection there was one person using the service.

Ofsted are the lead regulator for services registered as children’s homes, however, the service was not registered with Ofsted at the time of our inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was a registered manager in post.

Notice of inspection

We gave the service 48 hours’ notice of the inspection. This was because it is a small service and we needed to be sure that the provider or registered manager would be in the office to support the inspection.

What we did before the inspection

We used a range of information to plan this inspection, including findings from our last inspection of the service, on-going monitoring information including complaints and concerns about the service, as well as information received from other stakeholders.

The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make.

During the inspection

We spoke with staff who worked at the service and members of the management team, including the registered manager, as well as professionals from other stakeholders such as the local authority. We also spoke with the young person who lived at the service and their parent.

We reviewed a range of information both during and following the inspection. This included important information such as care records, court of protection orders as well as policies and procedures.

Updated 4 January 2024

The published date on this report is the date that the report was republished due to changes that needed to be made. There are no changes to the narrative of the report which still reflects CQCs findings at the time of inspection.

About the service

The Willow is a children’s home which is registered for accommodation for people requiring personal or nursing care as well as treatment of disease, disorder or injury. The service can accommodate one person. The service provides therapeutic psychological support to children and young people with mental ill health and additional needs, such as neuro-developmental disorders. At the time of our inspection there was one person using the service.

Ofsted are the lead regulator for services registered as children’s homes, however, the service was not registered with Ofsted at the time of our inspection.

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right Support: Model of Care and setting that maximises people’s choice, control and independence

Right Care: Care is person-centred and promotes people’s dignity, privacy and human rights

Right Culture: The ethos, values, attitudes and behaviours of leaders and care staff ensure people using services lead confident, inclusive and empowered lives.

People’s experience of using this service and what we found

At the time of inspection, systems had not been fully established to safeguard service users from abuse and improper treatment as safeguarding incidents had not always been effectively managed. Effective safeguarding policies and procedures in place to manage allegations of abuse when made against members of the senior management team were not in place.

The provider did not have an effective policy and procedure for safeguarding vulnerable adults and staff had not received appropriate levels of training in safeguarding vulnerable adults.

The provider had not operated an effective system to make sure that the most up to date policies at The Willow reflected up to date legislation and guidance. Policies did not always reflect current practice or provide enough information to support staff.

The provider had not operated a system to assure themselves of the safety and quality of the services provided at The Willow. Roles and responsibilities of members of the senior management team had not been clearly defined.

The provider had failed to operate an effective risk management system to make sure that all organisational risks at The Willow had been identified and mitigated as much as practicably possible.

Although risk management and positive behaviour plans provided key information as well as strategies to support staff, the provider had not always taken all reasonable steps to make sure that risk management plans had been updated when needed.

There were enough staff to keep young people at The Willow safe.

Staff who we spoke with were committed to treating young people with compassion, kindness and respect. They were passionate about making sure that young people were cared for as best as possible.

The use of restraint had been kept to a minimum and verbal de-escalation strategies had been used successfully on several occasions.

Strategies had been implemented to support young people to access a range of community activities and pursue their own interests.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 14 January 2022) and the service had previous breaches of regulations.

At this inspection we found the provider remained in breach of regulations.

The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

This inspection was prompted by a review of the information we held about this service, information that we had following our last inspection as well as concerns received about how safeguarding concerns had been managed. A decision was made for us to inspect and examine those risks.

During this inspection, we followed up on actions we told the provider to take at the last inspection.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We have identified breaches and have issued a warning notice in relation to safeguarding and good governance. We also identified a further breach in relation to safe care and treatment. Although the provider took actions to address the concerns after the inspection, further improvements are still required.

Please see the action that we have told the provider to take at the end of this report.

Recommendations

We have made a recommendation about cleaning living quarters of young people who live at The Willow.

We have made a recommendation about supporting young people living at The Willow to maintain a balanced diet.

We have made a recommendation about making sure that all important documents such as health plans are available.

We have made a recommendation about the understanding that staff have of Gillick Competence.

We have made a recommendation about access to an Independent Mental Capacity Advocate by young people living at The Willow.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.