Willow Tree Lodge

People can only be deprived of their liberty to receive care and treatment with appropriate legal authority. In care homes, this can be done through a procedure called the Deprivation of Liberty Safeguards (DoLS), which is part of the Mental Capacity Act 2005 (MCA). We checked whether the service was working within the principles of the MCA and how DoLS were managed. DoLS applications were made appropriately, and oversight arrangements were in place. However, some mental capacity assessments were not decision-specific or sufficiently detailed, and assessments had not been completed for some identified restrictive practices.

We assessed the service in line with the ‘Right support, right care, right culture’ guidance to determine whether people with a learning disability and autistic people were supported with respect, equality, dignity, choice, independence, and good access to their local communities that most people take for granted.

People were kept safe. There were enough suitably skilled and trained staff to meet their needs. Staff understood safeguarding and felt able to raise concerns. One staff member said, “We need to raise it and always speak up. I have raised concerns and it was looked into immediately.” A professional told us they had not had any concerns about the person’s safety during the 2 years they had lived at the service. Incidents and feedback were used to support learning, and the environment and equipment supported people’s safety and wellbeing. Medicines were managed safely overall, although some records and ‘when required’ guidance needed greater clarity and consistency. Care plans and risk assessments did not always clearly demonstrate how people had been involved in identifying and managing risks or provide staff with consistent guidance. However, the immediate risk was mitigated because staff knew people well and could describe how to support them safely, and relatives confirmed staff understood their family members’ individual needs. The provider had already identified and begun addressing some of these shortfalls.

People’s health, care, wellbeing and communication needs were assessed, and staff supported them in line with their individual needs. Staff could describe the positive outcomes people achieved.

People were treated with kindness, dignity and respect. Staff knew people well, understood their preferences, and supported them to make choices and have control over their daily lives. A professional told us that a person’s wishes, feelings and choices were always respected.

People received personalised care that reflected their diverse needs and communication preferences. They were supported to maintain important relationships, access community opportunities that promoted inclusion and wellbeing, and share feedback about their support. A professional told us the provider worked collaboratively with professionals, completed required follow-up actions and adapted its approach to meet one person’s complex and changing needs, promoting their health, wellbeing and engagement.

The registered manager was visible, had positive relationships with people and staff, and promoted an open culture where staff contributed ideas to improve service delivery and the support people received. One staff member said, “Nobody’s idea is looked upon as insignificant; everyone is open to new ideas, and we’re listened to about how the service could improve.” A professional told us the registered manager was collaborative, took feedback on board and asked for advice when needed, adding, “I have confidence in her as a manager.” Governance systems had identified areas for improvement in risk assessments, outcome monitoring and consent, and steps were being taken to address these. However, these processes had not identified the full detail or extent of the shortfalls, and the actions taken had not yet resulted in sustained improvements.