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Inspection carried out on 9 May 2019

During a routine inspection

About the service

Mill Green provides accommodation and support for younger adults living with a learning disability and/or autism. Some people also were living with a physical disability.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

The care home was registered to provide support for a maximum of six people, which is in line with best practice guidance. The service was an adapted two storey house in a residential street where people had easy access to local amenities. At the time of this inspection there were five people living at the home.

People’s experience of using this service and what we found

The service was led by an outstanding registered manager who was dedicated to the health and wellbeing of people living at Mill Green. She had worked tirelessly to identify each person’s risks, needs and preferences including investigation into the impact of health issues on people’s physical and mental wellbeing. She, and staff, had ensured they collected data to help provide information to health professionals which had led to diagnoses and health interventions. This enabled each person to have a hugely improved quality of life, where their independence was promoted, and they were free from pain. Best practice standards and professional research was used to implement high quality, effective care. Medicines were received, administered and recorded in line with best practice. Feedback from health professionals was extremely positive and described the registered manager and staff in glowing terms. For example, one professional commented “…staff are always striving to improve the quality of care being provided.”

The registered manager and senior managers fostered a culture of openness and professional challenge. This ensured all staff understood and were motivated to meet the high standards of quality expected of them. Staff and the registered manager had been recognised both within the provider organisation and the county council as providing exceptional care. They had been nominated for and been successful in achieving awards as the best performing team and as a finalist for the best registered manager in the county.

There was a consistent staff team, many of whom were very long-serving and knew people very well. Staff showed exceptionally caring, thoughtful and compassionate care to each person. Staff used different communication methods with each person and were able to interpret fluently what people wanted. This meant that the people living at Mill Green, some of who had little or no verbal communication, were very well understood and supported. Each person had a highly individualised communication and support plan taking into consideration all their communication methods. Support plans described the risks, needs and preferences and how staff should work with each person to ensure the person was able to lead as fulfilled and independent life as possible. New ideas for activities were explored and trialled to keep people occupied in a meaningful and enjoyable way. A professional commented that the care “…provided at Mill Green is personalised to meet physical, mental, emotional and social needs. They promote independence and autonomy.”

There were sufficient staff, who knew people very well, to support people safely both in the home and in the local community. Staff supported people to get involved in their preferred activities, individually and as a group. Staff knew how to keep people sa

Inspection carried out on 1 November 2016

During a routine inspection

This was an unannounced inspection which took place on 01 November 2016.

Mill Green provides accommodation and support for a maximum of six adults with a learning disability and or autism. At the time of this inspection there were five people living at the home. People had varied communication needs and abilities. Some people were able to express themselves verbally using one or two words; others used body language to communicate their needs. Everyone who lived at the home required support from staff for all aspects of their life including emotional and physical support.

During our inspection the registered manager was present. 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.

Staff were available for people when they needed support in the home and for group outings. Opportunities or one to one activities outside of the home would benefit from expansion. We have made a recommendation about this in the main body of our report.

Quality assurance audits and checks were completed that helped ensure quality standards were maintained and legislation complied with. Processes included obtaining and acting on the views of people in order that their views could be used to drive improvements at the home.

Medicines were managed safely and staff training in this area included observations of their practice to ensure medicines were given appropriately and with consideration for the person concerned.

Checks on the environment and equipment had been completed to ensure it was safe for people to use.

Robust recruitment procedures were followed to ensure staff were safe to work with people. People appeared very happy and at ease in the presence of staff. Staff were aware of their responsibilities in relation to protecting people from harm and abuse.

People were supported to take control of their lives in a safe way. Risks were identified and managed that supported this. Systems were in place for responding to incidents and accidents that happened within the home in order that actions were taken to reduce, where possible reoccurrence.

Staff told us that they had enough time to support people in a safe and timely way. Staff were sufficiently skilled and experienced to care and support people to have a good quality of life. Training was provided during induction and then on an on-going basis.

People’s legal rights to consent were upheld. Capacity to make decisions had been assumed by staff unless there was a professional assessment to show otherwise. The home followed the requirements of the Mental Capacity Act 2005 and was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS).

People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. People were routinely involved in the review of their care packages. People were supported to access healthcare services and to maintain good health. People had enough to eat and drink throughout the day.

Positive, caring relationships had been developed with people. Staff knew what people could do for themselves and areas where support was needed. Staff appeared dedicated and committed.

People received personalised care that was responsive to their needs. Activities were offered and people were supported to increase their independent living skills. People were also supported to maintain contact with people who were important to them.

Staff understood the importance of supporting people to raise concerns. Information of what to do in the event of needing to make a complaint was available to people.

People spoke highly of the registered manager. Staff were motivated and told us that management of the home was good. The registered manager w

Inspection carried out on 6 March 2014

During a routine inspection

During our inspection we spoke with three care workers and the newly appointed manager. People using the service had little or no verbal communication and consequently we were unable to speak with them but were able to observe how they were supported by staff in a sensitive and respectful manner.

However, as part of the inspection process, we did speak with relatives to obtain their views of the service and the care and support provided. One relative told us “My son is very happy living there. He is encouraged and supported to walk every day and that is very important for him - and me.” We also looked at care documentation, staff records, audits and minutes of meetings.

We saw that individual care plans provided guidance for care workers, to ensure that the assessed current and on-going support needs of people using the service could be met consistently and safely.

People were protected against the risks associated with medication because the provider had appropriate arrangements in place to manage medicines.

We saw that the service had effective recruitment procedures in place. Staff told us that they had received regular training and supervision. They said they felt valued and were supported to carry out their roles and meet the needs of people who used the service.

The service had effective systems in place to deal with people's comments and complaints.

Inspection carried out on 6 March 2013

During a routine inspection

On the day of the inspection six people were being supported at Mill Green. People were supported to communicate using a variety of speech, pictures and symbols. We spent time talking to people reviewing records and observing staff interaction in order to evaluate the care provided. We spoke to relatives that attended the service for a review meeting.

People were encouraged to be as independent as they were able to be and we saw people were supported people to reach their personal goals. Staff were observed to speak to people in a friendly and unhurried manner allowing time for response.

People’s care needs were identified in person centred plans and we saw that these had been updated as people’s needs had changed. The care plans provided structured guidelines that took account of people’s abilities and preferences.

The service had systems in place to ensure people were protected from abuse, or the risk of abuse and their rights were respected and upheld. Relatives told us that the felt their relative was “safe and well cared for.”

We observed people were supported staff who were supervised and received ongoing training to ensure they had the knowledge and skills to meet people's needs.

We saw that there was a system in place that allowed for the service to conduct their own regular reviews to ensure that they service was delivered in a safe and suitable way that met the needs of people.

Relatives told us that “we are extremely pleased with the care."