Millfield House

Millfield House is a residential care home providing personal care to 8 people at the time of the inspection. Some people using the service had physical and learning disabilities and other conditions such as Cerebral Palsy, Head Injury, MS and the effects of Stroke. The service can support up to 8 people.

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.

People’s experience of using this service and what we found

People and their relatives told us they were happy with the support they received. Staff knew people very well, and there was a low turnover of staff. However, guidance for staff was not always as detailed as it could be and did not inform staff on actions to take to mitigate risks to people. We identified these concerns at our previous inspection; however action had not been effective at addressing these concerns. We discussed this with the registered manager, who was aware and was in the process of updating care plans and risk assessments.

Right Support: Model of Care and setting that maximises people’s choice, control and independence

The service (or staff) supported people to have the maximum possible choice, control and independence be independent and they had control over their own lives. Staff supported people to achieve their aspirations and goals. Staff supported people to take part in activities and pursue their interests in their local area and to interact online with people who had shared interests.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Right Care: Care is person-centred and promotes people’s dignity, privacy and human rights

People received kind and compassionate care. Staff protected and respected people’s privacy and dignity. They understood and responded to their individual needs. Staff understood how to protect people from poor care and abuse. The service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it. The service had enough appropriately skilled staff to meet people’s needs and keep them safe. People could communicate with staff and understand information given to them because staff supported them consistently and understood their individual communication needs. People received care that supported their needs and aspirations, was focused on their quality of life, and followed best practice.

Right Culture: The ethos, values, attitudes and behaviours of leaders and care staff ensure people using services lead confident, inclusive and empowered lives.

People led inclusive and empowered lives because of the ethos, values, attitudes and behaviours of the management and staff. Staff turnover was very low, which supported people to receive consistent

care from staff who knew them well. People’s quality of life was enhanced by the service’s culture of improvement and inclusivity.

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 1 August 2019). The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations.

We have identified breaches in relation to safe care and treatment and good governance at this inspection. You can see what action we have asked the provider to take at the end of this full report.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

The overall rating for the service has changed from requires improvement to good based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Millfield House on our website at www.cqc.org.uk.

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.

Millfield House provides personal care and support for up to eight people, at the time of our inspection seven people used the service. Some people using the service had physical and learning disabilities and other conditions such as Cerebral Palsy, Head Injury, MS and the effects of Stroke including sight loss.

People’s experience of using this service:

The outcomes for people using the service reflected the principles and values of Registering the Right Support in the following ways. There were no signs outside the property to identify it as a care home. People were encouraged to be a part of the local community; attending clubs and music events, visiting local shops and cafes.

People told us they felt safe living at Millfield House, they were positive about the staff who supported them. We observed warm relationships between people and staff, people chatted, laughed and interacted well together and with staff. Staff were knowledgeable about people’s needs and how they preferred to be supported; they treated people respectfully and with dignity.

However, we found medicines were not always safely managed. There was no process or protocol when people needed to take medicines when they were away from the service and some instructions about giving medicines were not double signed to safeguard against mistakes. Additionally, a medicine administration record and the quantity of a medicine did not correspond, this indicated a possible error in the medicine a person was given.

People’s needs had been assessed and they were involved developing and reviewing their care plans. However, some risk assessments and care plans needed updating to fully reflect best practice guidance for staff. For example, about diabetes, stoma and catheter care. One risk assessment referred to incorrect rescue medicine a person needed to be given in the event of seizure.

Recording of accidents and incidents needed to be improved because they were incomplete. Records of the daily care were not always detailed enough to reflect if some people’s specific support needs were fully met.

Goals and aspirations were recorded; however, some were dated 2016 and 2017 with no evidence of review or progression. Some people told us the goals recorded did not represent what they wanted to do. Care plans contained some clear information about people and how they wanted to be supported, but they required more personal information about people’s goals and aspirations.

Further emphasis needed to be placed upon recording and reflecting people’s religious and or cultural choices and to actively ask about and consider any other life choices people may have made. People’s end of life wishes were recorded.

People told us the new manager was getting to know them and had already arranged some meaningful activities. A new activities coordinator had been appointed and they were working to broaden the range of activities and events within and outside of the service.

Staff understood how to protect people from abuse and to report any concerns they may have. There were enough staff to meet people’s needs, who had been recruited safely and had received training and supervision.

Information about how to complain was available to people and processes to record, investigate and respond to any complaints were well established. People were asked their opinions about the service by attending meetings and completing surveys, suggestions made had been acted upon.

People and staff were very enthusiastic about the new manager, describing her dynamic, approachable and friendly. People had built strong relationships with staff and told us the service felt like a family home.

Rating at last inspection:

This is the first inspection since the service registered under a new provider name on 14 May 2018. The staff had remained the same and prior to the provider name change the service was rated Good (report published 23 January 2018)

Why we inspected:

We inspect all newly registered services within the first year, this was a planned inspection.

Follow up:

Following the inspection, we requested and received an action plan and evidence of improvements made in the service. This was requested to help us decide what regulatory action we should take to ensure the safety of the service improves.

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.

Enforcement:

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations. You can see what action we told the provider to take at the back of the full version of this report. Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk