moderate“Some areas of Willoughby Services were not clean, including a mouldy shower curtain, unclean bedding and a damp smelling bathroom with stained flooring.”
moderate“in one local service, some staff did not always wear a face mask, increasing the risk of transmission of COVID-19.”
moderate“in one local service, staff failed to ask our inspector for proof of a recent COVID-19 test, increasing risks to people and staff.”
person centred care
3 findings
moderate“The level of person-centred care that people received was not consistent across all of the supported living settings.”
moderate
“the staff member then walked into the room without waiting for a response, to find the person was getting dressed after a shower, compromising their privacy.”
moderate“another member of staff used the disrespectful term 'boys', to describe two adult men who used the service.”
governance
2 findings
critical“The provider had failed to assess, monitor and improve the quality and safety of the service. This was breach of regulation 17 (2) of the Health and Social Care Act 2008.”
moderate“organisational governance was not consistently effective across the service and people did not always receive safe care and support.”
leadership
2 findings
moderate“There had been numerous changes in the management of the service in the previous 12 months...at service manager level, manager level and regional manager level.”
moderate“The provider had failed to establish a wholly consistent culture of care across the service.”
staffing levels
1 finding
critical“Staffing rotas showed that Willoughby Services was not always staffed at the safe levels set by the provider, during both the day and night.”
staff training
1 finding
critical“Not all staff had completed the training necessary to meet people's needs...positive behaviour support, epilepsy awareness, specialist epilepsy medication, dysphagia and autism training.”
complaints handling
1 finding
moderate“We reviewed 3 complaints that had been received by Willoughby services. Only one of the 3 had been investigated and responded to in line with the provider's policy.”
incident learning
1 finding
moderate“Audits of quality and safety were not always completed as they should have been, which meant that lessons were not always learnt, and improvements made in a timely way.”
record keeping
1 finding
minor“Medicines stock levels and records were not consistently checked by management. We were told medicines audits were not available for Willoughby Services.”
care planning
1 finding
minor“staff gave greater consideration to identifying people's sexual needs and preferences, as this area was generally under-documented in people's individual support plans.”
medication management
1 finding
minor“the registered manager took action to improve medicine stock control checks in response to an issue we identified in one local service.”