Millbrook House

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

People were protected from the risks of abuse and staff understood how to report any concerns. Risks people faced were understood and safely managed and people received their medicines as prescribed. There were enough, safely recruited staff to support people and staff were familiar to people. Where there were any accidents or incidents, these were recorded and any actions and learning shared with staff.

People had their needs assessed before moving to Millbrook House and the information was used as the basis for care plans. People had choices about all aspects of their care and we observed staff seeking consent from people about their care and treatment. People were positive about the meal options available to them and had access to healthcare professionals where needed.

Staff were kind and compassionate in their approach and interactions were caring and tactile. Staff knew people well and understood peoples preferences. Visitors were welcomed and professionals involved with the service were positive about staff understanding of people’s needs and interactions. People had their privacy and dignity respected and were enabled to be as independent as they wished.

People were supported to spend time in a variety of social opportunities and there were plans in place to further consider individual social opportunities for people. People and relatives were involved in decisions about their support and care plans were regularly reviewed. Feedback indicated that people and relatives would be confident to raise concerns if they needed to. End of life preferences were recorded for each person.

The registered manager was in the process of considering new electronic care plan systems and was focussing on ensuring that any system chosen would enable Millbrook House to record personal preferences, likes and dislikes for people to ensure that care plans were individualised.

People, relatives and staff were positive about the management of the home and feedback was sought through meetings, surveys and informally. Staff were positive about their roles and responsibilities and received regular supervision and training. Quality assurance processes were regular and used to discuss as a management team where changes and actions were required.

Further information is in the detailed findings below.

This inspection took place on 2 and 4 February 2016. It was carried out by one inspector.

Millbrook House provides residential care for up to 33 older people. There were 28 people living in the home at the time of our visit, some of whom were living with dementia.

A new manager had been appointed in April 2015, their application to be a registered manager had been submitted. The previous registered manager had left in October 2015. 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.

At our last inspection of Millbrook House in December 2014 we had concerns that people did not have their risk of harm sufficiently assessed and staff did not have the appropriate guidance to support people in a way that minimised risks to people. We had concerns that the manager did not respond appropriately to allegations of abuse and therefore people were not protected from the risk of abuse. We had concerns about record keeping and there were insufficient quality monitoring systems in place.

We found the provider had made improvements since our last inspection in December 2014. All staff had received safeguarding training and the manager was aware of how to report safeguarding concerns to the appropriate authority. Records were improved, all care plans had been rewritten and there was a system for ensuring they were kept up to date. There were specific risk assessments to identify when a person was at risk of harm. When a person was identified as having a specific risk , there was clear guidance in the care plan how to manage the risk safely. However one person was identified as high risk of skin damage. The care plan did not give guidance for staff how to provide support in a way that prevented the risk occurring. The manager had introduced a new system for ensuring there was regular quality monitoring checks.

People’s risks were assessed and in most cases there was a plan to ensure care was provided safely. A variety of risks were assessed which included risk of falls, malnutrition and skin damage. We saw one person had been identified as a high risk of skin damage, there was not a care plan to identify how to manage the risk. Although staff were providing the appropriate care it was not recorded. We talked with the manager about this and they advised they would ensure the care plan was updated. Other people’s risks had a plan which provided staff with clear guidance how to reduce the risk.

The manager had introduced a system for monitoring the quality of the service and had identified some keys actions required to continue making improvements. People, relatives and staff participated in an annual quality questionnaire. The manager had collated responses and had taken actions.

Staff were aware what constitutes abuse and what actions they should take if they suspected someone was being abused.

There were enough staff to meet people’s needs. Feedback from people and relatives included “I’m here at odd times and there always seems enough staff.” Staff were unhurried and staffing rotas reflected the staffing requirements as assessed by the manager.

Medicines were stored and administered correctly and there were systems in place to monitor that medicines had been given to the right person at the right time. People who were able to self-administer medicines were supported to do so.

People had access to healthcare when they needed it; healthcare professionals told us the home referred people quickly and appropriately.

People were treated with dignity and respect and their privacy was maintained. There were positive interactions between people and staff.

People received personalised care and staff treated them as individuals. They had knowledge about them and their histories. Feedback from people included “I couldn’t be anywhere better, the staff are wonderful.”

People had the opportunity to engage in a range of activities which took place in the home and in the wider community. Feedback from people included “I love the activities, I never say no.” Some people had spent an evening at a local pantomime which they told us was “thoroughly enjoyable.” People also received one to one time.

Complaints were managed appropriately and we saw there had been one complaint in the last twelve months which was investigated and reached a satisfactory conclusion.

People who use the service had their needs assessed and a detailed support plan which focussed on their abilities, needs and choices was in place. People told us that staff understood their needs well.

Accurate records were not always in place for each person who uses the service. For example, not all consent forms were signed.

We saw that people had access to appropriate specialist advice and guidance. Records showed that where one person had made a decision to not follow the advice given by the provider, the decision had been respected.

Procedures were in place to manage medication effectively. The provider might like to note that we found recording gaps on two medication administration records.

When a person's needs changed we saw that the provider obtained the equipment needed to meet their current needs. The provider told us that they informed people who use the service when additional equipment costs were to be passed to them directly.

We were told by family representatives that "they try to involve people in activities" and we saw the provider made a variety of activities available for people. We found the provider was providing personalised care, treatment and support.

There was guidance in the home on safeguarding people from abuse. Staff members spoken to knew how to report any concerns regarding abuse. Staff members told us that they felt it was important to protect people as they were vulnerable.

Guidance on infection control and cleanliness was in place and we found the provider had systems in place to ensure the home was clean and hygienic and that the risk of infection was minimised.

We found by looking at staff rotas and training records and speaking with the provider that there was sufficient qualified, skilled and experienced staff to provide care and support for people.

There was a system in place to seek the views of people, family representatives and staff and we found the provider had made changes as a result. We found the provider was investigating comments and complaints and accidents and incidents and was learning from these in order to improve the care, treatment and support provided to people.