Millbrook House

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated this key question good. At this assessment the rating has remained good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

People’s care needs were thoroughly assessed and regularly reviewed through the provider’s resident of the day process, which ensured assessments were kept up to date and reflective of people’s changing needs. People were actively involved in these assessments, contributing to discussions about their care and making choices about how they wished to be supported. Care documentation was detailed and covered all key areas, including people’s physical, mental and social needs. Relatives described the assessment process as being ‘very thorough and in-depth. One relative told us their loved one had recently moved in and “Millbrook house feels like family, {person] has settled in very quickly”.

The provider planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards.

People had individualised care plans created in partnership with them and those important to them. These plans were developed following initial assessments and updated whenever new risks were identified, after changes in needs, or following any accidents or incidents. Care plans were tailored to each person and included detailed information about health needs, personal history, preferences, and people important to them.
Staff used the Malnutrition Universal Screening Tool (MUST) to identify individuals at risk of malnutrition. Records showed appropriate referrals had been made in line with good practice guidance to dietician. For example, when people experienced difficulties in swallowing, they would refer to a GP who could make appropriate referrals on to speech and language therapy (SaLT). Skin integrity was assessed using best practice assessments and concerns raised with GP’s or district nurses as needed. Staff training was up to date and reflected current good practice and standards.

The provider worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

The provider worked closely with healthcare professionals, including the GP. During our inspection a nurse from the local GP surgery visited people as part of a weekly routine. The nurse told us senior staff were always available to support with their visits, this helped ensure relevant information was shared and people were seen when they needed. This supported effective partnership working and ensured people’s health needs were monitored and responded to in a timely way.

The provider used an electronic care planning system and staff told us this made information easily accessible. We saw input from healthcare professionals such as physiotherapists and district nurses. This partnership approach enabled people to access timely specialist support.

The provider had ‘Grab sheets’ designed to capture important information to be shared with relevant people in case of an emergency. During the inspection we observed staffing working well together and completed handovers to ensure all staff were updated on people’s care and health.

The provider supported people to manage their health and wellbeing to maximise their independence, choice and control. Staff supported people to live healthier lives and where possible, reduce their future needs for care and support.

Care plans set out people’s health needs and lifestyle choices. Staff knew people very well and were alert to any changes in their well-being and health. If staff had any concerns they sought appropriate professional advice in a timely way.

People were encouraged to spend time in the garden to support their wellbeing and promote healthier, more active lifestyles. For example, one person was actively involved in planting and tending to the borders. The garden included raised borders designed specifically to ensure people could access them safely, enabling individuals with reduced mobility to participate fully.

Produce from the garden which is incorporated into meals prepared by the kitchen team. One person described picking tomatoes from the vines to eat, and strawberries.

The provider routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

Staff and management participated in daily ‘flash meetings’ where any changes in health or wellbeing were discussed, recorded, and acted upon.

Regular reviews of care plans were completed, both with the person and their relatives and by the provider. Relatives told us they were involved in reviewing the care and support their loved one receives.

Care notes were reviewed to ensure people were receiving their support as per care plans and to monitor people’s well-being and make referrals on to healthcare professionals should this be necessary. This ensured plans were effective in meetings people’s needs and remained current.

Relatives and healthcare professionals told us staff knew people well and identified and responded promptly to changes in people’s health needs. Comments made included “They [staff] are very good at updating us when there are signs of deterioration. They encouraged a person with diabetes to eat healthier to assist with this.”

Monitoring charts, such as food and fluid records were consistently completed and kept up to date. People’s weights were monitored monthly, and where concerns were identified this frequency increased to weekly to ensure any risks were identified and managed promptly. Nutritional and hydration needs were assessed and met through appropriate care planning and ongoing reviews. This was reviewed and updated monthly, enabling the provider to monitor changes in people’s risks, outcomes and needs over time. These processes supported effective oversight of people’s health and ensured emerging concerns were recognised and acted on without delay.

The provider told people about their rights around consent and respected these when delivering person-centred care and treatment.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that, as far as possible, people make their own decisions and are supported to do so when needed. Where a person lacks capacity to make specific decisions, any made on their behalf must be the least restrictive and in their best interests. People’s rights had been upheld, and where people lacked capacity to make specific decisions, mental capacity assessments were carried out in accordance with the principles of the Mental Capacity Act 2005. However, we found inconsistencies in the completion of consent and best interest documentation. The management team responded to this immediately to ensure all information was up to date.

Staff demonstrated a clear understanding of their responsibilities in supporting people to make informed choices about their care and treatment. We saw, for example, how they used people’s preferred communication methods to ensure people had the right information to make their choices and decisions. Such as staff facing people when they speak and at the same level, to ensure the person could see and hear what was being said.

We observed staff knocking on doors before entering people’s rooms. Staff told us, “I would always explain what I’m doing and ask for permission first.”