21 August 2023
During an inspection looking at part of the service
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
The provider had not always made sure that person centred care was provided in a way that met the needs of service users, particularly in relation to their diagnosis of autism as well as nutrition and hydration.
Action had not been taken to make sure that changes to the way in which CCTV was used at The Willow protected the privacy and dignity of service users.
The provider had not always taken all reasonable steps to make sure that risk management plans had been updated when needed or had contained sufficient information to support staff in making sure that service users were kept safe from avoidable harm.
The provider had not made sure that observations of service users had always been undertaken when needed, potentially exposing the service user to an increased level of harm.
Restraint had not always been used in a way that reduced the risk of avoidable harm to service users and in the least restrictive way possible.
The way in which safeguarding incidents had been managed had not always been effective and effective safeguarding policies and procedures to manage allegations of abuse against staff were not in place.
Policies did not always reflect current practice.
The provider had not operated a system to assure themselves of the safety and quality of the services provided at The Willow.
An effective risk management system to make sure that all risks at the Willow had been identified and mitigated as much as practicably possible was not in place.
Systems had not been established to make sure that incidents had been reported, investigated and managed in a way that reduced the risk of similar incidents happening again.
The provider had not always made sure that staff had received the required level of training to undertake their roles effectively.
The provider had taken action to make some improvements following our last inspection. This included making sure that the living quarters of the service user had been cleaned and that service users had access to an independent visitor, allowing them to raise concerns and seek independent advice when needed.
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 31 May 2023) 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.
At our last inspection we also recommended that the provider needed to make improvements against other important areas, such as making sure that important information, such as health plans were available for staff to use, as well as making sure that nutrition and hydration needs were better met. At this inspection we found that the provider had not acted on all recommendations and had not made all improvements needed.
Why we inspected
We undertook this targeted inspection to check whether the Warning Notice that we previously served in relation to Regulations 13 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. This inspection was also undertaken to check on a requirement notice that was also issued in relation to breach of Regulation 12, as well as several other recommendations that we made to the provider.
We use targeted inspections to follow up on Warning Notices or to check concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.
Enforcement and Recommendations
We have identified breaches in relation to person centred care, privacy and dignity, safe care and treatment, safeguarding, good governance, staffing and duty of candour.
Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.
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.