Archived: Millfield House

There was a registered manager listed for the service but they had been absent for some time. A registered manager is a person who is 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.

Interim arrangements to manage the service by the deputy manager with support from senior managers had been in place throughout the registered manager’s absence and this had worked well.

Improvement was needed to the way in which support for people with diabetes was recorded to ensure all staff could recognise deterioration and knew the actions to take. Since the previous inspection access to regular physiotherapy exercise sessions had tailed off and this left people at risk of losing flexibility and muscle tone.

Staff said they felt supported, valued and listened to, they said communication was good and there was always opportunity to discuss things with the deputy manager in relation to work issues but these were not formally documented and formal supervision to look at staff training, development and performance were infrequent and not in keeping with company policy.

People said their needs were attended to by staff when and if they required it. People respected each other’s privacy. People were supported to maintain links with the important people in their lives and relatives told us they were always consulted and kept informed of important changes. Observations showed staff behaved in a kind patient manner with people, treating them with dignity and respect.

Relatives told us they had no concerns about the service and were satisfied with the overall standard of support provided. They felt confident in the quality of care and said they were kept fully informed by the service and that communication was good. Professionals we contacted about the service also commented positively about the service and raised no concerns.

There were sufficient staff to meet people’s needs. People said they thought there were enough staff, and existing staff were covering gaps in shift to ensure people received consistent familiar support, staff knew this was only for a short while and that further recruitment was well underway.

Recruitment processes ensured only suitable staff were employed. New staff completed a probationary period and received induction into their role and the organisation, a range of training was provided to give them most of the knowledge and skills they needed, but there were gaps in this. Staff told us that they felt listened to and supported, they said there were always opportunities to share information with each other.

People’s medicines were well managed by trained staff. Staff were able to demonstrate they could recognise, respond and report concerns about potential abuse. The premises were well maintained and all necessary checks tests and routine servicing of equipment and installations were carried out. Fire arrangements were satisfactory and staff attended regular drills and practiced evacuation.

People ate a varied diet that took account of their personal food preferences. Their health and wellbeing was monitored by staff that supported them to access regular health appointments when needed. Staff understood how people communicated and ensured they received technological support where possible to aide their communication and retain independence to share their thoughts and views. Risks were appropriately assessed to ensure measures implemented kept people safe.

People were encouraged by staff to make everyday decisions for themselves, but staff understood and were working to the principles of the Mental Capacity Act 2005 (MCA). The MCA provides a framework for acting and making decisions on behalf of people who lack mental capacity to make particular decisions for themselves. People and relatives told us they found staff approachable and felt confident of raising concerns if they had them. The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. No one at the home was currently subject to a DoLS but the provider understood when an application should be made and the service was meeting the requirements of the Deprivation of Liberty Safeguards.

People and relatives were routinely asked to comment about the service and their views were analysed and action taken where improvements could be made. Quality assurance audits were undertaken on a regular basis, with regular visits also under taken by the provider representative to look at aspects of service quality and highlight shortfalls and timescales for addressing these.

We have made two recommendations

We recommend that the registered manager seek from a competent person guidance regarding the frequency of staff practice around use of evacuation equipment.

We recommend that the registered manager reviews and implements fully relevant company policy in regard to the required frequencies of staff supervisions and staff meetings.

A visitor to the service spoke positively about the staff and the quality of care provided and commented 'I can't fault the way (relatives name) is cared for'.

People told us how they were involved in making decisions about their care and support and had consented to the care and treatment received. However, we found that guidance to staff, contained in some people's care plans, could be improved.

We looked at the overall safety and suitability of the building. We found that safety checks were in place and that the service was provided within maintained premises, but specific risk assessments were required.

Staff recruitment records confirmed that appropriate process had been followed. Checks had been made to make sure that the staff employed were suitable to work with vulnerable people.

We saw that the quality of care was monitored by the service and provider and people were asked for their views about the service.

People we spoke with said they were happy living at Millfield House and liked the staff. Comments included 'I feel more relaxed here, I like it. I feel I have a life because I get more care'.

People told us they were involved in making decisions about their care and support. People were given choices about their daily routines, such as when to get up and go to bed, what to eat and what to do each day. They had opportunities to choose and take part in activities and events which helped with daily living skills and offered access to the community. People said they enjoyed their activities and that they had opportunities to offer views and make suggestions about the service.

People were happy with their bedrooms, they were clean and tidy. People had been asked about how they wanted them decorated and furnished.

All of the people we spoke with told us they were satisfied with the care and support they received and spoke positively about the staff. One person commented 'I can't say enough about them, they are all very good'. We saw that staff were supportive and considerate of people's different needs and how to communicate with them. People were offered choices and we saw that their dignity and independence was respected.