MillerHouse Residential Care Home

MillerHouse Residential Care Home (referred to in this report as MillerHouse) is registered to provide accommodation and personal care for up to six adults with mental health conditions. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided and both were looked at during this inspection. Nursing care is not provided.

The service is located in the centre of Crawshawbooth village. Shops and services are a short distance away and transport links available nearby. MillerHouse is a mid-terraced house, there are two shared and two single bedrooms and communal lounge and dining area. At the time of our inspection, five people were using the service.

At the last inspection, the service was rated overall Good.

At this inspection, we found there was evidence support the continued overall rating of Good. There was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns.

However, we found some shortfalls with person centred care planning therefore we have made a recommendation to make improvements. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

We found there were good management and leadership arrangements in place to support the effective day to day running of the service.

Arrangements were in place to ensure staff were properly checked before working at the service.

There were sufficient numbers of staff at the service, to provide support in response to people’s needs and choices.

Safe processes were in place to support people with their medicines.

Risks to people’s well-being and safety were being assessed and managed. We found some progress could be made risks assessments and action was taken to make improvements.

Staff were aware of abuse and adults at risk, they knew what to do if they had any concerns. Managers and staff had received training on safeguarding and protection matters.

Staff received ongoing learning, development and supervision.

Arrangements were in place to gather information on people’s backgrounds, their needs, abilities, and choices before they used the service.

People made some positive comments about the staff team and the support they received. We saw positive and respectful interactions between people using the service and staff.

Each person had care records, describing their needs and preference. These needed to provide clearer information on people’s needs and goals, and how staff should provide support.

People’s independence, privacy, dignity, individuality and choices was promoted. People were supported to engage in meaningful activities the community.

Processes were in place to support people with any concerns or complaints.

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

People were supported with their healthcare needs and medical appointments. Changes in people’s health and well-being were monitored and responded to.

Arrangements were in place as appropriate, to support people with a healthy, balanced diet.

There were systems in place to consult with people who used the service, to assess and monitor their experiences.

Checks on quality and safety were carried out. We were told these would be developed to make sure the service keeps improving.

Further information is in the detailed findings below.

We carried out an unannounced inspection at MillerHouse Residential Care Home on the 17 and 18 May 2016.

MillerHouse Residential Care Home is registered to provide care and accommodation for six adults who have a mental illness. Bedroom accommodation is available on the first floor of the building with two twin rooms and two single rooms. There is a communal lounge, kitchen, dining room area and a bathroom with shower available. MillerHouse Residential Care Home is located in the village of Crawshawbooth within the Lancashire area. There is no car park available; however, there is ample parking in the surrounding streets.

The service was last inspected in June 2014 and was found compliant in all areas inspected.

At the time of this inspection there was a registered manager employed. 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.

During this inspection we received positive feedback from people who used the service and their family members. People who used the service told us they felt happy and content and indicated they had the freedom to independently live their lives and access the community whenever they wished. People expressed satisfaction with the service provided and spoke very highly of the staff team that supported them.

We noted the service had robust processes and procedures in place to maintain a safe environment for people using the service and for staff and visitors. The service had appropriate and detailed risk assessments to cover both inside and outside of the building with additional reference to areas of risk such as smoking and the control of substances such as bleach and cleaning fluids.

Fire audits were up to date and compliant. Fire drills were carried out weekly to ensure people using the service were able to recognise the sound and safely evacuate the building. Staff fire training was in date.

People using the service told us they felt safe living at the home. Family members were also confident that their relatives lived in a safe place. We noted robust safeguarding procedures were in place and staff showed a good understanding around recognising the signs of abuse. Staff had also undertaken safeguarding training.

At the time of inspection we found the service had adequate staffing levels. People we spoke with confirmed this by telling us there was always a staff member present and that they were supported well with day to day living activities. Staff told us they had adequate time to support people effectively and safely. We observed a good level of staff interaction to support what people were telling us. We looked a month’s staff rotas which showed a sufficient level of staffing was maintained.

We found the service had a good recruitment system in place. The service took appropriate steps to check people’s previous employment and conduct, identity and any criminal record before being successfully appointed. Thorough induction processes were in place to ensure the correct amount of training and support was given to new staff. Disciplinary procedures were also in place to support the organisation in taking immediate action against staff in the event of any misconduct or failure to follow company policies and procedures.

The service had processes in place for appropriate and safe administration of medicines. Staff were adequately trained in medicines administration. Medicines were stored safely and in line with current guidance.

We saw detailed care plans, which gave clear information about people's needs, wishes, feelings and health conditions. These were reviewed monthly and more often when needed by the person’s key worker with oversight from the deputy manager.

We saw evidence of detailed training programmes for staff. Training was appropriate to supporting people with a mental health diagnosis and or learning disability. The training records we saw were in date. The deputy manager told us all staff would have completed ‘Care Certificate’ training in the next twelve months. The ‘Care Certificate’ is a recognised qualification which aims to equip health and social care support workers with the knowledge and skills which they need to provide safe, compassionate care.

We checked whether the service was working within the principles of the Mental Capacity Act and whether any conditions or authorisations to deprive a person of their liberty were being met. These provide legal safeguards for people who may be unable to make their own decisions. We spoke with the deputy and registered manager in relation to a Deprivation of Liberty Safeguards request which had not been submitted. We were provided with evidence from the service that this had been made to the relevant authority shortly following our visit.

Meal times were very relaxed and people could choose what they wished to eat. People freely used the kitchen area to prepare meals, snacks and drinks with the support of staff when required.

We saw appropriate referrals had been made to dieticians and instructions were strictly followed in cases where people had known dietary requirements.

Over the two days of the inspection we noted positive staff interaction and engagement with people using the service. Staff addressed people in a respectful and caring manner and the service had a calm and warm atmosphere. We observed people enjoying each other’s company, conversing, playing games and accessing the community.

We had positive feedback from people using the service, relatives and staff about the registered and deputy manager. People told us they were happy to approach management with any concerns or questions.

This is a summary of what we found:

Is the service safe?

Before people were admitted to the home arrangements were in place to make sure they would be safe in the environment and there was enough skilled and qualified staff to meet their needs.

We found people had been given a contract of residence outlining the terms and conditions of residency therefore protecting their legal rights.

The manager and staff had been trained and understood their obligation to apply the principles of the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards (DoLS). This is a legal framework designed to protect the best interests of people who are unable to make their own decisions.

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. Staff had been made aware of who may be at risk of self-harm, self-neglect, and exploitation, and they had a plan of care to deal with this.

People's care and treatment was planned and delivered in a way to protect them from any unlawful discrimination within the home and wider community. Restrictions imposed on people for their welfare and safety as required under sections of the mental health act was managed well.

Staff were trained in emergency procedures such as fire and first aid. Other emergency situations were planned for such as responding to a missing person alert.

Care had been taken to make sure people were kept safe by only employing people who had proven good character records.

People were supported to manage their own finances. Strict financial procedures were followed to prevent any misuse of people's monies.

We found the provider had taken steps to make sure health and safety checks were carried out at regular intervals and all essential services such as fire, gas, electric and water were certified as being safe. Safety locks were fitted as standard on bedroom doors.

Systems were in place to make sure the provider continually checked the service was safe. This reduced the risks to people and helped the service to continually improve.

Is the service caring?

People told us they were happy with the care they received and the staff team. They said, 'We go on holiday with the staff. We are going to Blackpool in July." And 'Staff help me with my bath. I can manage most things myself but I have trouble getting in and out of the bath."

People said they were treated with respect 'I think staff treat me with respect. No-one goes in my room unless I say so. I don't go in other people's rooms either. We respect each other.'

We saw routines in the home were flexible and people were supported and encouraged to get involved in activities they enjoyed. 'The staff are very good. They don't talk down to us or shout at us.' And 'They don't make us go to bed when they say or do what they want us to do. We please ourselves. Sometimes I stay up late especially when I go out with my friends. They tell me to ring and let them know I am all right.'

Staff worked to care plans that were person centred, well written and sufficiently detailed on how best to meet individual needs. Daily records showed staff responded to people's needs as required day and night. Staff gave a good account of, and showed an understanding of, the varying needs of the different people we had discussed with them.

Within the constraints of the mental health act, where it applied, people were able to make some choices regarding their lifestyle. They had the opportunity and scope to express their wishes for daily living and social activity, and this was respected. This helped to make sure that they were supported in a way that did not inappropriately restrict their freedom.

Is the service responsive?

People were given plenty of opportunities to say what they wanted rom the service. They were involved in planning their care and support. Each person had a key worker who supported them in making decisions that were important to them. Care plans were regularly reviewed to make sure the level and type of support people had met with their needs and expectations. Professional help and support was sought from health and social care professionals when needed.

Activities were planned for and people were encouraged and supported to do the things they liked to do. Social and recreational activities were enjoyed and people had planned a summer holiday of their choice. Staff were available to accompany people where needed.

Residents' house meetings were held and people could say what they wanted and they felt listened to. A system was in place for receiving comments, compliments and complaints. People told us that they would know how to make a complaint, should they need to do so.

Is the service effective?

People told us they were happy with their care. They had their own preferred routines, likes and dislikes that the staff knew about. There were no institutional practices imposed on people and staff were flexible in their work to accommodate individual needs and preferences.

People's health and well-being was monitored and appropriate advice and support had been sought in response to changes in their condition. The service had good links with other health care professionals to make sure people received prompt, co-ordinated and effective care.

Staff worked to a key worker system to oversee people's care. Staff had been trained in dealing with mental health and other health related conditions people presented such as diabetes.

People told us they were consulted with and listened to. Quality monitoring was carried out.

Is the service well led?

The service had a registered manager responsible for the day to day management of the home. People told us the management of the service was very good. They said they were treated well. If they had any concerns they knew who they could talk to.

People were given the opportunity to meet new people who wanted to live in the home before they were admitted and had opportunities to be involved in staff recruitment.

Staff were clear about their role and responsibilities. They were given a job description and contract of employment. Staff were able to give their views and they were supervised well and had appraisals. Staff were encouraged to develop their skills and knowledge. Training was provided and staff were given opportunity to put their new skills into practice. Meetings were held for staff and residents.

There were systems in place to regularly assess and monitor how the home was managed and to monitor the quality of the service. Staff knew when to consult with health and social care professionals when required. Decisions about people's care and support was made by the appropriate staff at the appropriate level.

The service had achieved the Investors In People (IIP) award. This is an external accredited award for providers who strive for excellence, which recognises achievement and values people.

People living at the home made complimentary comments about the staff team. One person said, "The staff are the best' and 'They encourage us to cook our meals and to do daily living skills'.

We reviewed care records for two people who used the service and found evidence that there were procedures in place to ensure their consent was gained in relation to the care provided for them.

We also reviewed the care files of two people who lived in MillerHouse. We saw that care plans and the information recorded identified the needs of the person and included information on how they wished their care to be delivered.

We found evidence that there were effective systems in place for the safe administration and management of medicines.

One person we spoke with told us there were sufficient numbers of staff on duty. Staff were being provided with appropriate training and one staff member told us they loved working at the home and were well supported support by the management.

We found there was an adequate complaints process in place to ensure that any comments and complaints were listened to and acted upon.

We did not speak to people that use the service on this occasion but gathered evidence in other ways to check if the service was meeting the essential standards of quality and safety.

We found staff had been trained in how to protect people from abuse and supporting policies and procedures had been updated.

We also found that appropriate systems had been implemented to supervise and appraise the staff at MillerHouse as well as updating their policies to support their practice.