Archived: Nottingham Neurodisability Service Hucknall

At our previous inspection in November 2016 the service was rated as good. However we returned to inspect the service following concerns raised by the local authority related to the care of people who lived at the service. During our inspection we found the concerns raised by the local authority had been addressed by the provider and the service has retained a rating of ‘Good.’

The service did not have 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 (CQC) 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. The previous registered manager had left the service in September 2017 and the present service manager was in the process of applying to become registered with the CQC and completed the process following our inspection.

People were supported by staff who knew how to recognise abuse and how to respond to concerns. Risks in relation to people’s daily life were assessed and planned for to protect them from harm and they lived in a clean, hygienic service.

People were supported by enough staff to ensure they received care and support when they needed it. Medicines were managed safely and people received their medicines as prescribed.

People were supported by staff who had the knowledge and skills to provide safe and appropriate care and support. People were supported to make decisions and staff knew how to act if people did not have the capacity to make decisions to ensure their rights were respected.

People lived in a service which met their needs in relation to the premises and adaptions were made where needed. People had access to information in a format which met their needs.

People were supported to maintain their nutrition and staff monitored and responded to people’s health conditions.

People were supported by staff who showed compassion and were empathetic towards them. They were supported to maintain their privacy dignity and independence.

People lived in a service that provided individualised care and staff had the information they required to provide that care. People were supported to follow their interests, take part in social activities and develop and maintain relationships that were important to them.

People were supported if they had complaints or concerns about their care and there was an open and transparent culture in the service where people were listened to and staff were valued.

The quality of the service people received was regularly monitored using robust quality auditing systems.

The service did not have a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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. The previous registered manager had left the service in June 2016 and the company’s head of nursing was supporting the service at the time of the inspection until a new manager could be appointed. We were told a suitable replacement had been interviewed and was due to join the company in December 2016 who once in post would be registering with the CQC.

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 manager shared information with the local authority when needed.

Staffing levels were sufficient to support people’s needs and people received care and support when required. People received their medicines as prescribed and the management of medicines was safe. Staff received appropriate training to assist them in their roles.

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 hydration. Specialist diets were provided if needed. Referrals were made to health care professionals when needed.

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

People felt they could report any concerns to the management team and they would be taken seriously. However systems in place to encourage people and their relatives to feedback their experiences of the service were not always consistent. The processes in place to monitor the quality of service had also not been undertaken consistently.

People told us they were well supported by staff who were good at their jobs and who they trusted. They told us that they felt safe at Millwood and knew how to pursue concerns and complaints. People said they felt listened to and involved in determining how their care was planned and delivered. We saw that care and treatment was planned and delivered according to individually assessed need. We observed that interactions between staff and people who used the service were positive, warm and laced with appropriate humour. One person told us, 'It's brilliant, I love it here.' A relative told us, 'It's a happy place, very friendly and welcoming.'

We noted that the provider had systems in place to ensure medication was safely managed and administered. We saw that staff recruitment and training provision helped ensure the delivery of safe and effective care and treatment. We found that the provider evaluated the quality of care provided, by consulting people who received a service and their relatives. We noted that service evaluation and learning was shared with staff in order to improve the care and support provided.

People's ability to make decisions was assessed. Care plans recorded how people communicated when they were unable to ask for what they wanted. We saw each care plan had been signed by the person receiving care to say they were happy with the plan.

Records showed care was planned and delivered safely. One person told us, 'I had nothing to get up for but since I came here this place is geared up to getting me independent. Last week I went home for the first time in a year. I'm given motivation to keep improving.'

We saw there were appropriate systems in place to obtain and store medication. However expiry dates had not been checked and out of date medication was found in the controlled drug cupboard.

Staff received appropriate training and support through supervision and appraisal.

There were systems in place to deal with complaints.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time.