Archived: Millennium Forge

Millennium Forge is a Domiciliary Care Service and Extra Care Housing Services providing personal care to older people, people with learning disabilities or autistic spectrum disorder, people with mental health concerns, physical disability, sensory impairment or younger adults at the time of the inspection. 76 People were using the service at the time of the inspection.

People’s experience of using this service:

Some people and their relatives told us they felt that the level of staffing required improvement and there was concern around the numbers of agency staff used. Medicines were mostly given as expected, but staffing issues had impacted on when they were given. Risk assessments were in place to minimise any potential risk to people’s wellbeing

People felt that not all staff assisting them knew their needs. Staff did not receive regular supervisions. Staff received adequate inductions and training. People were supported to maintain their health.

Not everyone knew the acting manager, but those who did felt they were approachable.

People were supported to have choice and control over their lives and staff understood that they should support them in the least restrictive way possible; the policies and systems in the service supported this practice.

People's care plans reflected their needs and preferences and staff could explain specific care that people required. People knew how to complain and that any concerns would be listened and responded to by the provider. Actions were taken as a response to complaints.

Quality monitoring systems included audits, checks on staff practice and checks on people’s satisfaction with the service they received, using questionnaires. The provider has systems in place to ensure they kept up to date with developments in the sector and changes in the law.

Rating at last inspection: The rating for the service at our last inspection was ‘Requires improvement’ with our last report published on 10 May 2017.

Why we inspected: This was a planned comprehensive inspection that was due based on our scheduling targets.

Enforcement:

No enforcement action was required.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

The provider is registered to provide personal care to adults. People received their care and support within their own flats within three extra care facilities within the community. Supported living enables people who need personal or social support to live in their own home supported by care staff instead of living in a care home or with family. On the day 55 people received a service.

At previous inspection of 13 and 14 July 2014. We judged that four of the five questions we ask, Is the service safe? Is the service effective? Is the service caring? and Is the service responsive as being good, the remaining questions, is the service well-led? we judged to be ‘requires improvement’. This was because the provider the audit systems were not sufficiently robust. During this, our most recent inspection, we found that some improvement had been made regarding the quality monitoring of the service.

Since our previous inspection of July 2014 we received a number of notifications from the provider to inform us of medicine errors. Because of this our pharmacist undertook a focussed inspection on 19 February 2016. The pharmacist found the provider had implemented actions to improve the medicine systems and that these had started to decrease the number of medicine errors.

The previous registered manager had left the service in September 2015. Following this another manager had been employed who had not been registered with us. It is a breach of the law not to have a registered manager. A new manager had been employed shortly before our inspection and the senior manager told us that this new manager was going to apply to us for registration as is required by law. The new manager was not available on the day. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Sufficient staff were not always available to meet people’s needs. Medicines were not always given to people at the correct times. Risk assessments to maintain the safety of the people who used the service had been undertaken. The provider had policies in place and staff had received training on the procedure they should follow to ensure that any risk of harm and/or abuse was prevented. Staff were recruited safely to prevent unsuitable staff being employed.

Staff had received the training they required to give them the knowledge they needed to support people safely. The staff knew that people must receive care in line with their best interests. People were encouraged to make decisions about their care. The staff supported people appropriately with their nutritional needs. Meal options were offered to ensure that people’s food and drink preferences were catered for. Input from external healthcare professionals was secured to meet people’s healthcare needs.

People and their relatives told us that staff were kind and caring. People’s privacy, dignity and independence was promoted and maintained.

People’s needs were assessed and reviewed. Provider feedback forms were used to enable people and their relatives to give their views on the service provided. Complaints systems were in place for people and their relatives to raise their concerns or complaints if they had the need to.

A lack of consistent management had resulted in a lack of confidence of people and staff in the leadership of the service. A new manager had been employed in order to promote better leadership. Audits and checks were undertaken to ensure that the service was operated in the best interests of the people who used it.

We carried out an unannounced comprehensive inspection of this service on 13 and 14 July 2015. After that inspection we had concerns as the provider had notified us over a number of months that medicine errors had occurred that included, staff not ensuring that people had the correct dose of their medicine or that people had not been supported by staff to take their medicine as it had been prescribed. As a result we undertook a focused inspection to look into those concerns. This report only covers our findings in relation to those/this topic. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Millennium Forge on our website at www.cqc.org.uk.

We undertook this focused inspection on 19 February 2016. The inspection was carried out by one pharmacist inspector.

We found that systems had been implemented by the provider in relation to how medicines were managed and how staff supported people to take their medicines aimed to prevent further medicine errors.

No-one knew we would be visiting as our inspection was unannounced. Our inspection team consisted of three inspectors. We carried out this inspection over two days.

Care and support was provided from three units that were located close to each other. The three units were called Millennium Forge (which is the main registered premises), Swallowfields and Exon Court. At the time of our inspection a total of 109 people lived within the three units. Of those 109 people only 61 required some degree of personal care or support. People who used the service had varying levels of need. Some people required minimal support and prompting whilst other people required intensive care packages which meant they required in excess of four care calls a day to provide full care and support.

During our inspection we spent time in all three units. We spoke with 12 people who used the service, eight relatives, ten staff members and the registered manager. We spoke with people when we met them in communal areas, and by asking their permission to visit them in their homes (the individual flats they lived in within the three units). We did this with people's consent and did not observe any areas of care that would impact on people's privacy or dignity. We spoke with peoples relatives by telephone. We took these actions to give us an overview of the experiences that people had, to determine the standard of care provided and the satisfaction of the people who used the service.

All people and their relatives we spoke with were satisfied with the overall service and the care that was provided. One person said, 'It is good. I am happy with the staff and the service provided to me' Another person told us, 'I am looked after well'. A relative said, 'It is generally good there I have no issues'.

The summary is based on our observations during the inspection, discussions with people who used the service, the staff supporting them, and by looking at records. If you wish to see the evidence supporting our summary please read the full report.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

Is the service safe?

Staff knew about Deprivation of Liberty Safeguard (DoLS) processes. DoLS is a legal framework that may need to be applied to people in care settings who lack capacity and may need to be deprived of their liberty in their own best interests to protect them from harm and/or injury.

We found that where staff had identified concerns regarding risks associated with people's health and welfare they had been referred to appropriate agencies.

We identified that fire equipment was serviced regularly to ensure that it was safe.

We found that instructions had been produced for each person if there was a fire or emergency.

We determined that checks were not being undertaken to ensure that bedrails in use were in good working order and safe. This meant that the provider could not give ongoing assurance that this equipment was in good working order.

We found that there had been non-reporting of two medication errors. This meant that the incidents had not been reported to us as they should have been to meet legislation.

Is the service effective?

All people, relatives and staff we spoke with told us that people who used the service were safe and well cared for which gave assurance that an effective service was provided.

People had their needs assessed and staff knew how to support them in a caring and sensitive manner. The majority of care records showed how they wanted to be supported and people told us they could choose how this support was provided.

Staff received support from senior staff to ensure they carried out their role effectively. Staff we spoke with told us that they felt well supported.

Arrangements were in place to request heath, social and medical support to help keep people well.

Staff knew about people's needs. However, records we looked at did not highlight all people's needs. Dementia care plans were lacking which meant that there was a potential that specific needs might not be met.

Is the service caring?

We found that care and support was provided with kindness and compassion. All people and relatives we spoke with were very positive about the staff. One person told us, 'They are all kind'. A relative told us, 'I do not have any concerns. The staff care about the people very much'.

The staff knew of people's care and support needs which ensured that individual personal care was provided in a way that people preferred.

Is the service responsive?

We found that meetings were held to enable people and relatives to raise any issues they wanted to. This showed that the provider was willing to listen to the views of the people who used the service

We found that the provider had taken note of our previous concerns and had learnt from past experiences. For example, improvements had been made regarding complaints processes and record keeping which would ensure that people's needs were better met.

Is the service well led?

A registered manager was in post which meant that the provider was complying with the law, as it is a requirement to have a registered manager and consistency and familiarity was provided.

The staff were confident that they could raise any concern about poor practice at the service and it would be addressed to ensure people were protected from harm or abuse.

Staff were generally organised to ensure people's needs were met and the required support was available. We saw that robust induction processes were in place. Plans were in place as staff supervision processes required attention to ensure that staff received the one to one guidance they required.

People who used the service had varying levels of need. A number of people did not require any care or support whilst other people needed only minimal support and prompting. A number of people needed intensive care packages which meant they required in excess of four care calls a day to provide full care and support.

We carried out this inspection over two days. Our inspection team consisted of an inspector, one of our pharmacy inspectors and an expert by experience. No one knew we would be visiting as our inspection was unannounced.

During our inspection we spent time in all three units. We spoke with nine staff, the registered manager and the nominated individual for the provider. We met and spoke with 12 people who used the service and 11 relatives or friends. We did this by speaking with them when we met them in communal areas, by asking their permission to visit them in their homes (the individual flats or bungalows they lived in within the complex. We did this with people's consent and did not observe any areas of care that would impact on people's privacy or dignity.) or by telephone. We spent some time in the communal areas at each site so that we could observe interactions between staff and the people who used the service. We did this to give us an overview of the experiences that people had, to determine the standard of care provided and the satisfaction of the people who used the service.

We found that staff treated people with respect and dignity. One person who used the service commented, 'The staff are all lovely and polite'. Another person told us, 'The staff are friendly, polite and respectful'. We determined that the satisfaction of people regarding the care and/or support they received was mixed. The majority of people who used the service were happy with the way that their care had been planned and delivered. One person we spoke with said, 'I am happy with my care'. A relative told us, 'My parents are happy and settled here. Since they have lived here it has reduced my stress and worry'. However, other people we spoke with were not happy with the way their care had been delivered. They told us that they did not like the inconsistency of care due to the number of different staff they had to provide their care and that often their care calls were late. One person said, 'They do rush.' Another person told us, 'I complained about the carers timings and the lack of staff but nothing was done'.

We identified that improvement had been made regarding medication management systems. Those improvements had prevented people being at risk of ill health. Overall we found that people's medication was available and had been taken as it had been prescribed by their doctor.

We found that a number of permanent staff had left the service. Although bank and agency staff were being used this had a negative impact on the quality of care and support that had been provided. We found that processes were on-going to address this. Records we looked at and staff we spoke with confirmed that they had received the required training and that systems were in place to support them in their work roles.

The registered provider had identified that there were problems with the quality of service provision and had made resources available to start to address this. However, we found that improvement was needed to ensure that people recieved a safe service in the way that they want it provided.

Inconsistencies and gaps in record keeping meant that people may not be protected from the risks of unsafe or inappropriate care.

We saw that there was a good relationship between staff, people using the service and their relatives.

People told us that their needs had been met by a range of health professionals including doctors, the chiropodist and the optician.

We found that provisions and practices were in place to prevent malnutrition and dehydration.

We found that improvements were needed concerning medication recording and administration. These improvements are needed to make sure that people are given their medication as it had been prescribed by their doctor to promote good health.

Evidence we gathered did not identify that staffing levels were inadequate. People told us that there were enough staff to meet their needs.

We found that that service offered an adequate complaints process which responded to complaints people made.