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People in Action - Milverton Terrace Good

Reports


Inspection carried out on 28 June 2017

During a routine inspection

Milverton Terrace is an assessment centre that provides short term accommodation and personal care for up to eight younger adults who may have learning disabilities or autistic spectrum disorder, a physical disability or sensory impairment. People live at the home for a short time period to develop their skills to assist them to live as independently as possible when they move to a

permanent home.

At the last inspection, the service was rated good. At this inspection we found the service remained Good.

Two weeks prior to our inspection visit, the previous registered manager of the home had moved to a different role within the organisation. The new manager was in the process of submitting their application to be ‘registered’ with us. 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 and relatives were complimentary and satisfied with the quality of care they received. People received care that enabled them to live their lives as they wanted and were able to make choices about maintaining their independence. People were encouraged to make their own decisions about the care they received and care was given in line with their expressed wishes. People were supported to maintain relationships with people who were important to them.

Care plans contained accurate and detailed relevant information for staff to help them provide the individual care people required. People and relatives were involved in making care decisions and reviewing their care to ensure it continued to meet their needs.

For people assessed as being at risk, care records included information for staff so risks to people’s health and welfare were minimised. Staff had a good knowledge of people’s needs and abilities which meant they provided safe and effective care. Staff received essential training to meet people’s individual needs, and used their skills, knowledge and experience to support people effectively and develop trusting relationships.

Medicines were stored and administered safely and as prescribed.

People’s care and support was provided by a caring staff team and there were enough trained and experienced staff to be responsive to meet their needs. People told us they felt safe living at Milverton Terrace and relatives agreed. Staff knew how to keep people safe from the risk of abuse. Staff and the manager understood what actions they needed to take if they had any concerns for people's wellbeing or safety. They took immediate action when we found an incident had not been reported to the local authority.

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.

People received a choice of meals and drinks that met their individual dietary requirements at times they wanted them.

People and relatives knew how to voice their complaints and felt confident to do so.

People. relatives and staff were encouraged to share their views of the service through regular meetigs and surveys. The manager had an ‘open door’ policy for people, relatives, staff and visitors to the home.

Further information is in the detailed findings below.

Inspection carried out on 27 March 2015

During a routine inspection

The inspection took place on 27 March 2015 and was unannounced. At our previous inspection on 26 January 2013 the service was meeting the regulations.

The service is an assessment centre that provides short term accommodation and personal care for up to eight younger adults who may have learning disabilities or autistic spectrum disorder, a physical disability or sensory impairment. People live at the home for a short time period to develop their skills to assist them to live as independently as possible when they move to a permanent home.

At the time of our inspection five people lived at the home. There was a registered manager in post. 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. On the day of our inspection we met with the home manager, who was responsible for the day to day running of the home as directed by the registered manager.

People we spoke with told us they felt safe living at the home. The provider had policies and procedures in place to minimise risks to people’s safety in relation to the premises, medicines and equipment. All the staff we spoke with understood their responsibilities to protect people from harm.

People were supported to assess risks to their health and welfare and to write a care plan that minimised the identified risks. The care plans we looked described the identified risks and the actions people and staff should take to minimise risks. Support workers understood people’s needs and abilities because they shadowed experienced staff until they knew people well.

There were enough staff on duty to meet people’s practical and social needs. The manager checked staff’s suitability to work one-to-one with people during the recruitment process.

The manager checked that the premises were well maintained and equipment was regularly serviced to minimise risks to people’s safety. People’s medicines were managed, stored and administered safely.

Staff received training and support that ensured people’s needs were met. Staff had opportunities to reflect on their practice and learn from other staff.

The manager understood their responsibility to comply with the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). No one was under a DoLS at the time of our inspection. For people who were assessed as not having capacity for their everyday decisions, records showed they were represented by other health professionals or an advocate who made decisions in their best interests.

We saw people could choose their own meals and staff encouraged them to eat a regular, nutritionally balanced diet. Staff encouraged people to develop their skills by supporting people to plan, prepare and cook food and to consider mealtimes as an opportunity to socialise.

Staff monitored and recorded people’s moods, appetites and behaviours so they knew when people might be at risk of poor health. Staff supported people to obtain advice and support from other health professionals when their health needs changed.

We saw staff understood people who were not able to communicate verbally and supported them with kindness and compassion. Staff reassured and encouraged people in a way that respected their dignity and promoted their independence.

People told us they discussed and agreed how they would like to be supported. Support was planned to meet people’s individual needs, abilities and preferences. Care plans were regularly reviewed and changed as people’s needs or abilities changed.

People who lived at the home, their relatives and other health professionals were encouraged to share their opinions about the quality of the service to make sure improvements were made when needed.

The provider’s quality monitoring system included regular checks of people’s care plans, medicines administration and staff’s practice. Accidents, incidents, falls and complaints were investigated and actions taken to minimise the risks of a re-occurrence.

Inspection carried out on 26 November 2013

During a routine inspection

People consented to the care and support they received at the home. Two people we spoke told us they agreed that they would live there to develop their everyday living skills. They both planned to live more independently in the future. One person told us, “I will find somewhere else to live, somewhere smaller with people I can share with.”

The manager assessed people’s needs and abilities before they moved to the home. The manager identified risks to people’s health and wellbeing and put plans in place to minimise the risks. People were supported to understand complex written information with pictorial versions. One person told us they had an advocate, who supported them with their decision making and long term plans.

The provider had effective safeguarding policies and procedures. The manager checked that staff were suitable to work with vulnerable people. Support workers understood the actions they should take if they had any concerns about people’s safety.

Support workers told us they felt supported because they worked as a team and the manager was always available to give them advice and guidance. We found that each support worker was encouraged to consider their own personal development. One support worker told us, “I just love working here. I look forward to coming in.”

The manager kept detailed records of complaints and comments they received. The records demonstrated that complaints were resolved to the complainants’ satisfaction. The complaints policy was available in an easy to understand pictorial version.

Inspection carried out on 28 November 2012

During a routine inspection

Some of the people who lived at the home were not able to talk with us because of their complex needs. We saw that people were comfortable and relaxed at the home. We saw that people helped themselves to drinks and chatted easily with staff. One person we spoke with told us, “I’ve loved it since I’ve lived here. Mostly I wish this was a permanent place.” Another person said, “It is really nice here, all the staff do their job really well.”

We saw that everyone had an individual care plan to support them to develop the skills they needed to live independently in the future. The care plans we looked at were regularly updated with people’s new goals. People we spoke with told us how staff supported them with their plans and goals. We found there were enough staff on duty to support people with their individual activities throughout the day.

Support staff we spoke with told us how they obtained and administered the medicines that people needed. They told us they were regularly observed in practice and tested to make sure they followed the manager’s written guidance and administered medicines safely.

Support staff kept a written record about how people developed the skills they needed. The manager used the records at meetings with other health and social care professionals to assess when people were ready to move into independent living accommodation. The records were kept securely and were accessible to staff when needed.

Inspection carried out on 12 September 2012

During a routine inspection

We spoke to three people living in the home, who told us that they were happy to live there. One person said, "The staff are all very good. They know what kind of help I need to make sure I'm being independent." Another commented that they enjoyed being able to cook their own food and choose menus.

All three people said that if they had any concerns or worries about living at Milverton Terrace they were confident that the staff team would listen to and help them.

People who have the skills to contribute to care planning and record keeping are encouraged to do so. We were told, "I keep my plan in my bedroom and write things in my diary every day."

One person said that they felt "in control" at the home and went on to comment that "everything here happens to help me, I feel I am making some good decisions here."

Some people have complex communication needs so it was difficult for us to understand their views in relation to their experiences of living at the home. From observation of their interaction with staff, it was evident that positive relationships had been made.