Archived: Millbank

Millbank is registered to accommodate 36 people. There were 16 people using the service at the time of our inspection. Some of whom were living with dementia. Each person had their own bedroom and each bedroom had en-suite toilet and showering facilities. People had access to a variety of communal areas and outside spaces.

We found the following examples of good practice.

¿The home was visibly clean and tidy.

¿Posters and other guidance were placed around the home to remind people and visitors to wash their hands and to follow safe infection control practices.

¿The registered manager was aware of all current guidance provided both locally and nationally on how to reduce the risk of the spread of the infection at the home.

¿ Access to the home was restricted. No new admissions to the home were currently permitted .

¿ Regular testing was completed of staff and people living at the home.

¿ Visitors were currently prohibited from entering the home; however, an assessment of how to enable visitors to see relatives had been completed. A booking system will be in place. All visitors will be expected to have a COVID-19 test 24 hours prior to the visit and then again before the visit. Two negative test results are required prior to entry to the designated area of the home. An area of the home had been assessed as the safest place for visitors to see relatives.

¿ Staff supported people to maintain contact with family and friends in other ways. This has included the use of technology, such as Skype as well as regular phone calls.

¿ Clear admissions procedure were in place for people coming from their own home, the community and hospital. A 14-day isolation period will commence for all new admissions to the home.

¿ Ample supplies of PPE were in place. Training on the safe 'Donning and Doffing' of this PPE had been completed by all staff.

¿ Clear, designated isolation areas were in place that could be closed off to the rest of the home for people who had a positive COVID-19 test. These areas have their own communal areas and kitchen.

¿ A designated staffing team was assigned to the isolation areas. Those staff have their own entrance and exit, which means they do not enter other parts of the home.

¿Staffing hours had been increased and one to one support was provided for people living with dementia to keep them safe and reassured.

¿ No agency staff have been used throughout the pandemic. Employed staff have covered extra shifts where needed; this has helped to keep people safe from the risk of the spread of infection.

Further information is in the detailed findings below.

People felt safe living at the service. Staff knew how to recognise abuse and how to report it. Risks were assessed so that staff knew what action to take to keep people safe. Incidents and accidents were reported and actions were taken to reduce the risk of them happening again. Planned staffing levels were achieved, however, we asked the deputy manager to review the deployment of staff to ensure it was responsive to people’s needs. Safe recruitment processes were in place to ensure the suitability of staff for their roles. People’s medicines were managed safely and people told us they received their medicines regularly.

People continued to receive an effective service. Care and support was delivered in line with good practice guidance. Staff were provided with training and development opportunities to ensure they were able to provide care that was effective and met people’s needs. People were provided with a healthy and nutritious diet and were provided with the support they needed to eat and drink sufficiently. People were supported to access health services when required and staff worked well with other professionals to provide coordinated care. 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 place supported this practice.

Staff were kind, caring and respectful. They knew people well and provided reassurance and support to people when they were anxious. Staff protected people’s privacy and dignity. People were offered choices in their daily lives and staff respected their wishes. People were supported to maintain relationships with friends and families.

People continued to receive personalised care that was responsive to their needs. Care plans were reflective of people’s needs and were reviewed and updated regularly. A wide range of activities and entertainment were offered and people were encouraged to participate in activities to maintain their mobility and independence. People were able to choose whether they wanted to participate and how they spent their time.

Systems were in place to monitor the quality of the service and the care provided. A range of quality audits were completed by the registered manager and areas for improvement were identified. Views of people using the service and their relatives were sought and staff felt engaged and involved. An overall action plan was in place and updated regularly to ensure improvements to the service were taken forward.

Further information is in the detailed findings below.

The service had a registered manager in place at the time of our inspection. 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 and associated Regulations about how the service is run.

People were protected from the risk of abuse and staff had a good understanding of their roles and responsibilities if they suspected abuse was happening. The registered manager shared information with the local authority when needed. Risks to people’s safety were assessed and reviewed on a regular basis. These risks were managed in such a way as to both protect people and allow them to retain their independence.

Staffing levels in the home were sufficient and the registered manager regularly reviewed staff levels to ensure that they remained safe depending on the needs of the service. People received their medicines safely from suitably trained staff. Staff had a full understanding of people’s care needs and received regular training and support to give them the skills and knowledge to meet these needs.

People were encouraged to make independent decisions and staff were aware of legislation to protect people who lacked capacity when decisions were made in their best interests. We also found staff were aware of the principles within the Mental Capacity Act 2005 (MCA) and had not deprived people of their liberty without applying for the required authorisation.

People were protected from the risks of inadequate nutrition and dehydration. Specialist diets were provided if required. Referrals were made to health care professionals when needed.

People who used the service, or their representatives, were encouraged to contribute to the planning of their care They were treated in a caring and respectful manner by staff who delivered support in a relaxed and considerate manner.

People, who used the service, or their representatives, were encouraged to be involved in decisions about their care and their environment, and systems were in place to monitor the quality of service provision. People also felt they could report any concerns to the management team and felt they would be taken seriously.

We carried out this inspection to answer five key questions; is the service safe, effective, caring, responsive and well-led. Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service, their relatives and the staff told us. If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

There were systems in place to ensure people received their medication safely. A person who used the service told us, 'I am given my medication. They bring it to me when I have my breakfast and when I go to bed. I trust them to do it, I would get in a muddle remembering what to take when.'

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have needed to be submitted, proper policies and procedures were in place. The manager and senior staff have been trained to understand when an application should be made, and how to submit one.

Is the service effective?

We found staff were effective at respecting and involving people who used the service. The cook went round mid-morning asking people to choose from the menu what they would like for lunch that day.

Staff were effective and met people's health and welfare needs. A staff member told us, 'It is really good here, we will cover if someone is off work. I love my job.'

We found the provider was effective at assessing and monitoring the quality of the services provided. A relative told us, 'I am very fussy so I raise anything that is not right. There is nothing to raise currently.' A person who used the service told us, 'There is nothing to complain about this place.'

Is the service caring?

We found the care and welfare needs of people who used the service were met in a sensitive and caring manner. A person who used the service told us, 'I am looked after very well.' Another person said, 'Staff keep me clean, they are very kind and helpful.'

Is the service responsive?

We found staff responded to people who used the service in a way that respected and involved them. A person who was being made comfortable by staff told us, 'I rang my bell, that's why they helped me.' A staff member told us, 'We take the time to listen to what people have to say.'

There were sufficient care workers to respond to people's health and welfare needs. People who used the service told us they had to wait sometimes for the support they needed, but understood the reasons for this. One person told us, 'You have to wait a little while sometimes, you have to wait your turn.'

We found the provider responded to the views of people who used the service. A person who used the service told us, 'The manager comes and asks me how I am.'

Is the service well-led

We found staff received the direction and leadership needed to respect people who used the service and involve them in their care. One example was people who used the service were involved in the recruitment of new staff.

Staff were supported to introduce a new care planning system. A staff member said, 'I am learning at the moment, I am happy with the training we have had.'

The manager held an open surgery where any person who used the service or relative could come to discuss things with them We saw some relatives speaking with the manager as they were leaving the home .

The building had recently been completely refurbished and had a large extension built. The staff and people who used the service said they were very pleased with the changes. A new manager had recently been appointed and told us they were putting new systems into place to run the home effectively.

We found where people were able to they gave consent to their care and support. A person told us, 'I am happy with my care, I am able to decide things, and they (staff) get my permission first before they do things.'

We found the plans for people's care did not always show the care and support people needed or when people's needs had changed. A senior staff member said the documentation was not properly completed and told us, 'I think the reviews (evaluations of people's care plans) need to be done better.' The manager told us they knew more work was needed on the care plans.

We found people who used the service were kept safe and protected from harm. A person who used the service told us, 'They are always checking on me, that helps me to feel safe.' Staff knew how to respond to any allegation of abuse.

We found the staff team were supported through training and the provider maintained records that were accurate and fit for purpose. A person who used the service told us, 'They (staff) know what they are doing, they are very professional when they help me.'