The Millings

We found the following examples of good practice.

All essential visitors had to wear appropriate personal protective equipment (PPE). In addition, complete NHS Track and Trace information, have a negative COVID-19 test result and have their temperature checked prior to entering the home.

People were admitted to the home safely and procedures were in place and followed to ensure this.

People were supported to receive organised visits from relatives in a designated safe indoor ‘visiting pod’ area with robust cleaning procedures in place.

Staff supported people’s social and emotional wellbeing. Meaningful activities were adapted and taking place in smaller groups in separate rooms or on a one to one basis . Where people were isolating then they had an activity pack made up for them. The used different methods including information technology to assist communication. Staff supported people to use other technology for making video calls.

The home had ample supplies of appropriate PPE which was stored hygienically and kept safe. Staff were provided with appropriate areas to put on, take off and dispose PPE safely.

Social distancing practices were in place at the home, where people used communal areas such as dining rooms and lounge areas, they were able to share these spaces safely.

Additional cleaning of all areas and frequent touch surfaces was in place and being carried out and recorded regularly by housekeeping staff. Additional deep cleaning was also carried out where required.

Staff completed online training and paper-based learning booklets provided by the local NHS infection prevention and control team. Training included putting on and taking off PPE, hand hygiene and other COVID-19 related training and updates.

Additional competency checks and spot checks were carried out by the registered manager with all staff regarding safe use of PPE and some staff were designated infection prevention and control (IPC) champions and were given extra responsibilities to help manage PPE requirements with staff.

The registered manager had quality systems in place to check the service was providing safe care. There was a robust communication system in place to ensure staff received consistent updates in relation to infection control policy and practice.

People’s experience of using this service: People living at The Millings were consulted with and included in the delivery of care that was provided by a team who had built upon the already outstanding work they did.

Everyone we spoke to including people, family members and staff said they would rate the home as “exceptional” and “outstanding.” One family member said, “There are no improvements needed, they are incredibly responsive and I really admire the patience of staff.”

The atmosphere of the service was exceptionally welcoming and homely. Staff told us throughout the inspection that they were working in people’s home and needed to be respectful of that. People commented that The Millings was “My home, I love it here and would highly recommend it.” External healthcare professionals also commented on the exceptionally friendly yet professional atmosphere.

Outstanding practice had been developed and improved upon to provide people with care that was truly compassionate, caring and inclusive. People were recognised as unique individuals with strengths who could make a contribution to society. There was a culture of people being equal partners in their care whose individuality and diversity was acknowledged, respected and celebrated.

Partnership working was exceptional and led to improved quality of life of people. Work had been completed with Bradford University to introduce a falls huddle which had resulted in a 45% reduction in falls. A system called Immedicare was used for online consultations with healthcare professionals. People were fully included in the consultation and the healthcare professional was able to see the person and any injury they may have. This had also resulted in a reduction in the number of calls for ambulances and also the number of calls to GP surgeries.

Leadership was exceptional and staff at all levels were dedicated and motivated to provide truly personalised care, which the provider described as relationship focused care. There was a focus on getting to know the person so care and support could be tailored to the person, maintaining their individuality and uniqueness.

People were matched with staff based on interests and hobbies. People had two ‘care partners’ who were the key staff members involved in people’s support. They developed strong and meaningful relationships with people to make sure people received care and support in a way they wanted.

Staff supported people to maintain their independence and continue their interests and hobbies whilst developing new interests and maximising social inclusion. A ‘Bees Knees’ project had been introduced so people had photographs on display which made them feel like the bees knees. These photographs were used to prompt conversation and staff said they acted as, “a reminder of who people were as individuals and what they had achieved in their lives.”

Community involvement was exceptional. People were active members of the local community and were involved in community events from organising a Jo Cox memorial event, to the Tour de Yorkshire cycling event to hosting speakers, including the author of ‘The Shepherdess.’ Relationships had been developed with care homes in the south of the country and also in France so people were able to share experiences. Technology was used to maintain relationships so people could speak over video calls or instant messaging services.

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

Staff development was exceptional and there was a focus on training staff to value the importance of building open, honest and inclusive relationships with people. Free To Be Training run by the Lesbian, Gay, Bisexual and Transgender forum had been attended by staff. This promoted a culture of inclusivity and respect. Engaging Hearts training and Ladder to the Moon Training had also been attended. This promoted an ethos of values-based recruitment which included a focus on getting to know the person, what was important to them and how to have engaging and meaningful conversations. Ladder to the Moon training focuses on creativity, coaching and learning through experience to improve confidence and encourage new ways of thinking. This results in support that is focused on wellbeing and improved quality of life for both staff and people.

Governance procedures were fully embedded and inclusive methods of consultation and seeking feedback were used to ensure exemplary quality of care was provided. Technology was used appropriately which had a focus on effectiveness and efficiency so it freed staff time so they were able to spend more time focusing on people and ensuring their needs and preferences were met.

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

Rating at last inspection: Outstanding (Report published 17 October 2016)

Why we inspected: This was a scheduled inspection based on the previous rating of outstanding. The service has improved its rating of outstanding in two key questions and has now achieved outstanding in four key questions.

Follow up: We will continue to monitor the service and complete a further inspection in line with the rating of outstanding. If any information of concern is received, we may inspect sooner.

At the time of our inspection the service was providing support to 35 older people.

There was a registered manager in place. 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.

People’s independence was actively encouraged through a range of imaginative, person-centred approaches to activity-planning. The service provided innovative support to people to enable them to live fulfilled and meaningful lives. Links had been made with local services such as schools and Durham University to ensure people were offered very person centred opportunities not just to undertake activities they enjoyed but also to learn new skills. The activity staff worked as a team to ensure their individual skills such as creative writing, gardening and exercise were utilised so their job satisfaction and motivation were visible to see. Staff were skilled at ensuring people were safe whilst encouraging them to stretch their potential and achieve as much independence as possible.

The registered manager and staff team demonstrated commitment to providing the best possible care and opportunities for people. The close links with the local community meant the service provided support to local schools, churches and community groups via sharing their facilities and we saw people either independently or with support could access the community freely.

We saw people were actively involved in all aspects of the service from meeting with the cooks regularly to recruiting staff and assisting the writing of the home’s brochure. People told us, “You can be involved as much as you want in how things are done.”

The registered provider demonstrated how they had sustained outstanding practice, development and improvement at the service. The leadership sought out creative ways to provide a personalised service and had achieved good results through close working with other agencies. The staff team were highly motivated and were actively involved in and contributed to continuous improvements in care and running of the service.

There was enough staff to meet people’s needs and to ensure they were able to access activities and be part of their local community. The provider operated safe and robust recruitment and selection procedures which people were involved in where possible.

Staff protected people’s privacy and dignity. All interactions between staff and people were caring and respectful, with staff being patient, kind and compassionate. Staff supported people with patience and an unhurried approach to ensure they promoted active involvement in their care and do as much as possible for themselves.

Thorough investigations had been carried out in response to safeguarding incidents and these had also been appropriately reported to CQC by the provider. Learning from incidents was evident in adjustments to procedures such as how medication was managed, to ensure people were protected from harm. Comprehensive audits were carried out by the management team to ensure the appropriate improvements took place within the home.

Records and conversation with the registered manager, people and relatives showed that people were listened to and complaints or concerns were taken seriously and responded to appropriately.

The registered manager ensured that staff had a full understanding of people’s support needs and had the skills and knowledge to meet them. Training records were up to date and staff received regular supervisions and appraisals. Staff were clear about their roles and responsibilities and told us they received support from the registered provider and registered manager to provide care for people.

A variety of choices of food and drinks were offered at the home. Staff supported people to eat and drink with patience and dignity. People told us they had good access to their GP, dentist and optician. Staff at the service had good links with healthcare services and people told us they were involved in decisions about their healthcare. This meant that people who used the service were supported to obtain the appropriate health and social care that they needed.

There were robust systems and processes in place to protect people from the risk of harm. Staff were aware of different types of abuse, what constituted poor practice and the correct action to take if abuse was suspected. Appropriate checks of the building and maintenance systems were undertaken to ensure health and safety for people and staff was maintained. We saw accidents and incidents were closely monitored by the registered manager.

Staff had received training in the Mental Capacity Act 2005 (MCA) to make sure they understood how to protect people’s rights. There was guidance in relation to the MCA and people were asked for their consent before staff carried out any care or treatment. CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The registered manager, registered provider and staff ensured that people were supported in ways that did not restrict their freedom and were supported appropriately to uphold their rights.

There was an emphasis on person centred care. All the care records which were in an electronic format, showed people’s needs were continually reviewed. The plans ensured staff had all the guidance and information they needed to enable them to provide individualised care and support. People and their family members were consulted and involved in assessments and reviews.

The registered manager used effective systems to continually monitor the quality of the service and had on-going plans for improving the service people received. The registered manager gathered information about the quality of their service from a variety of sources including people who used the service, their family and external agencies. This was used to enable the registered provider to identify where improvement was needed and to implement and sustain continuous improvement in the service.

On the day of the inspection we talked with eight people about their experience of care at The Millings. We spoke with the relatives of two people. We talked with ten staff and looked at records. We also spoke with a district nurse who visited the home frequently. Below is a summary of what we found. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People were treated with respect and dignity by the staff and people we spoke with told us that they felt safe. Staff had received training in safeguarding and understood how to safeguard the people they supported. Systems were in place to make sure that managers and staff learnt from events such as accidents and incidents. This reduced the risk to people and helped the service to continually improve.

People were cared for in a service that was safe, clean and hygienic. Risk assessments were in place in individual support plans in relation to activities of daily living. Staff personnel records contained all the information required which meant that the provider could demonstrate that the staff employed to work in the home were suitable and had the skills and experience needed to support the people living at The Millings. Staffing levels were appropriate to meet the needs of the service and were reviewed and adjusted to address any changing needs.

Is the service effective?

People told us that they were happy with the care they received and felt that their needs had been met. It was clear from what we saw and from speaking with staff that they understood people's care and support needs and they knew them well. Staff had received training to meet the needs of the people living in the home. People's health and care needs were assessed with them and they were involved in writing their plans of care. Relatives we spoke with were able to describe specific benefits to the health and wellbeing of their relatives and the impact that this had had on their daily life. One relative told us. "You know [the person] is in safe hands. If you can't be happy here, you can't be happy anywhere."

Is the service caring?

People were supported by kind and attentive staff. We saw that staff were patient and gave encouragement when supporting people. People told us they were able to do things at their own pace and were supported to be as independent as possible. Where shortfalls or concerns were raised, these were addressed. People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with their wishes.

Is the service responsive?

People were regularly involved in a range of activities inside and outside the home. The home supported people to take part in activities within the local community which included attending University of the Third Age (U3A) sessions, visiting local places of interest and shopping. People knew how to make a complaint if they were unhappy and all the people we spoke with told us that they felt that they could talk with any of the staff if they had a concern or were worried about anything.

Is the service well-led?

The service worked well with other agencies and services to ensure that people received their care in a joined up way. The service had a quality assurance system which included planned audits. People who lived in the service, staff and relatives were asked for their views. Any identified shortfalls were addressed promptly and as a result the service was constantly improving. When we spoke with a visiting district nurse, they told us that they believed that the service was well run and was a positive place for people to live. They told us, "They seem to want to do the best for the residents, there's a nice atmosphere and the staff are always friendly." Staff told us that they felt well supported by the manager.

People spoke highly of the home and told us they were well care for. Comments made by people who lived there and their relatives included 'I find them very helpful', 'Very willing' and 'She's wonderfully looked after.'

People's nutritional needs were assessed and monitored, with a choice of regular meals, snacks and drinks being provided. People enjoyed positive dining experiences, with individual needs provided for. Comments included 'We have meetings with the cook', 'They know what we can and can't eat' and 'The food is generally very good.'

Arrangements were in place to obtain, store and administer medications. However, improvements were needed to ensure that people were protected from the risks associated with inaccurate or unclear medication administration records.

People who lived at the home spoke highly of the staff, telling us that they were professional and caring. Comments included 'They are all so kind, all the staff, not just the care staff.' Staff records confirmed that new staff went through a thorough recruitment process.

People who lived at the home told us that they would feel able to raise any issues or concerns with management. A complaints procedure was in place and records showed that comments and concerns were listened to and resolved appropriately.

There were lots of events and activities organised for people either at the home or within the wider community. Staff told us they felt settled and happy in their jobs and were well supported by their manager. People told us they felt safe living at the home and would raise any concerns they had with any of the staff and they would be dealt with. The home had in place a quality monitoring system that asked people who lived at the home for their views on the service provided. This helped to ensure that the provider was listening to the people who used the service and tailoring the service to meet the expectations of the people using it.