Millview Short Stay Respite

Millview Short Stay Respite is a purpose-built care home that offers short breaks to people who have a physical disability, a learning disability or both. The service can accommodate four people and at the time of our visit the service was providing respite to three people.

We found the following examples of good practice.

The service had a safe procedure in place when people came to stay for respite. A welfare assessment was carried out prior to arrival for their stay. Each person had their temperature checked and their belongings were santised on entry to the home. Individual risk assessments had been completed.

Staff and visitors were required to wear personal protective equipment (PPE) in line with current Government guidance. Staff had a separate entrance to the building and staff room where they changed into and out of their uniform to avoid the risk of cross contamination. Staff had received additional training in infection prevention and control and the use of PPE.

The home was extremely clean. Comprehensive cleaning schedules were in place and carried out daily and weekly. Windows were open to provide ventilation and people had access to outdoor space.

The registered manager was supported to ensure effective infection prevention and control practice and manage risks. They received comprehensive support and guidance from the local authority and public health teams.

The service had detailed policies and procedures in place to manage the risks of Covid-19. Risk assessments had been completed for the service, staff and people who use the service.

About the service

Millview Short Stay Respite is a purpose-built care home that offers short breaks to people who have a physical disability, a learning disability or both. The service can accommodate four people at one time. At the time of our inspection the service was providing respite care to 31 people.

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

Safeguarding policies, procedures and staff training helped protect people from harm. Risk assessments helped protect the health and welfare of people who used the service. The administration of medicines was safe.

People were supported to live healthy lives because they had access to professionals, a well-trained staff team and supported to take a nutritious diet. The service worked with other organisations to provide effective and consistent care. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice

People were treated as individuals which helped protect their dignity. People’s equality and diversity was respected by kind and caring staff.

Relatives told us they felt able to raise any concerns. Individual activities were provided as part of people’s care package. Care plans were very person-centred and reflected people’s choice and preferences.

The management team and staff knew people well. Relatives and staff said managers were available and approachable. People and staff were able to air their views about how the service was run. Regular audits of service provision helped maintain and improve standards.

The service had assessed the individual risks to people’s health and wellbeing. Comprehensive risk assessments were in place to ensure staff were aware of how to safely care for people.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 7 December 2018) and there were breaches of four Health and Social Care Act regulations (Regulated Activities) Regulations 2014. We also identified two breaches of the Care Quality Commission (Registration) Regulations 2009. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Millview is a purpose build unit registered to accommodate 4 people for respite care and support. At the time of inspection, the service was providing respite care to 42 people. Milllview is part of a wider provision of supported accommodation for people with learning disabilities which included supported housing.

The first day of inspection took place on the 30 July and was unannounced. We returned to the service on 1, 6, 17 August 2018.

The service was previously inspected in March 2016 and at that time was rated good overall. The service was rated as being good in the four domains of effective, caring, responsive and well-led and rated as Requires Improvement in the Safe domain. This was because we found the provider to be in breach of Regulation 12, safe care and treatment. The provider was not taking reasonably practicable steps to reduce risks in relation to good infection control processes.

Following the last inspection, we asked the provider to complete an action plan to show how they would ensure they met the regulations. The action plan detailed the arrangements made to ensure the service was compliant with Regulation 12.

At this inspection we found the service continued to be in breach of this Regulation. This was because effective infection control policies and procedures were not in place to ensure the cleanliness of equipment, and health and safety and environmental checks were not being completed consistently. We also found new breaches of this regulation relating to how the service managed risk.

We identified breaches of three further regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to Regulation 11, Need for consent, Regulation 17,Good Governance and Regulation 18, Staffing.

We identified two breaches of the Care Quality Commission (Registration) Regulations 2009. These were a failure to submit notifications of incidents, accident and safeguarding concern and failure to have a registered manager in post.

It is a condition of registration that the service has a registered manager in place. At the time of inspection, the service did not have a registered manager. 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. The CQC had not received an application from the registered manager to deregister when they had left their post in April 2017. We advised the current manager to begin the process of registering with CQC as a matter of urgency and we took action to deregister the previous manager from the location.

The service kept records of accidents and incidents and these were investigated and monitored within the service. We could see that action was taken to reduce the risk of accidents reoccurring.

We looked at how people were supported to take their medicines safely. We found that people were supported appropriately with this but that checks were not being completed to ensure medicine that required storage at low temperatures could be stored safely.

We saw records that demonstrated staff received training, supervision and spot checks. However, the records indicated that some training needed updating

The service had systems for governance in place but these were not sufficiently robust to provide quality assurance. The management team had identified this as an area for improvement and we saw this was documented within the service action plan.

People had their needs assessed prior to attending the respite service and had care plans developed in line with these support needs. The service had identified improvements to be but these were not yet in place.

Care plan records and risk assessments were in place. They required reviewing and updating to ensure peoples current care needs were being met.

We looked at peoples care records and found that people were not supported to have maximum choice and control of their lives. We saw that people were subject to a number of restrictions but these had not been assessed under the Mental Capacity act (MCA) and Deprivation of Liberties Safeguards (DoLS).

We saw that the service was working in line with the values that underpin the 'Registering the Right Support' and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

Systems to support the safe recruitment of staff were in place. We saw references and Disclosure and Barring Service (DBS) checks were being completed before a member of staff began working for the service.

There were policies and procedures in place to safeguard people from harm. Staff were trained to respond to safeguarding concerns.

People and relatives told us that staff were kind and respectful. We saw that people’s privacy and dignity was respected.

There were records of peoples’ eating and drinking needs including preferences and support plans readily available within the kitchen. Staff had a good understanding of how to meet peoples’ dietary needs and promote independence.

There was a complaints procedure in place and the unit manager told us how they work with people and their families to address concerns when they are first raised.

The service had good links to other agencies and worked closely with people and services to enable them to deliver tailored package of care.

The rating from the last CQC inspection was displayed in the reception area.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Millview is a care home that offers a short breaks service to people who have a physical disability, a learning disability or both. The home is managed by Stockport Disability Services who are part of Stockport Metropolitan Borough Council. The home is a purpose built bungalow which has four single bedrooms, two bathrooms, a combined lounge dining room and a large kitchen. It is situated in the Marple area of Stockport.

There was a registered manager in place. 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.

On the day of our inspection there were three people using the service. We spoke with one person during our visit and they told us they were very happy with the care they received. There were effective systems in place to ensure people’s safety and manage risks to people using the service. Staff could describe the procedures in place to safeguard people from abuse and unnecessary harm. Recruitment practices were robust and thorough, although not all of the documents relating to each staff members recruitment was held at the service. These were held at the providers head office.

People received their prescribed medication when they needed it and appropriate arrangements were in place for the storage and disposal of medicines. Staff were trained in medicines management.

People were cared for by sufficient numbers of suitably trained staff. We saw staff received the training and support required to meet people’s needs well. Staff spoke highly of their training and said this prepared them well for their role.

People’s needs were assessed and care and support was planned and delivered in line with their individual care needs and preferences. People had detailed, individualised support plans in place which described all aspects of their support needs.

Staff were trained in the principles of the Mental Capacity Act (2005), and could describe how people were supported to make decisions to enhance their capacity and where people did not have the capacity, decisions had to be in their best interests.

Health, care and support needs were assessed and met by regular contact with health professionals. People were supported by staff who treated them with kindness and were respectful of their privacy and dignity. Suitable arrangements were in place and people were supported and provided with a choice of suitable healthy food and drink ensuring their nutritional needs were met.

People participated in a range of activities both in the home and in the community and received the support they needed. People were able to choose how they spent their time and what they did.

Staff had good relationships with the people using the service. Staff were aware of how to support people to raise concerns and complaints. The complaints procedure was also available in a pictorial format. We saw the provider had received one complaint in the last 12 months.

There were effective systems in place to monitor and improve the quality of the service provided.

We found one breach of the regulations during our inspection. You can see what action we have asked the provider to take at the back of the report.

We also spoke with the registered manager and two of the support workers. The support workers said that they liked working at Millview with one of them having worked there for many years.

We looked at the care files and daily diaries for two of the four people who were having a short break at the time of our inspection. We found that they contained information to assist the care workers in carrying out their duties to meet the person's needs.

We did not look at personnel files to check on recruitment documentation as no one had been newly employed to work specifically at Millview for 15 years. However we were told that there were procedures in place should the need arise to recruit new staff that would ensure only suitable people were employed.

We spoke with an officer of the Stockport Social Services Quality Assurance team who told us that they had received no concerns regarding this service.

The visitor told us that the staff were "very good" and that the staff and the care they give "is excellent" and that they "couldn't fault it". They told us the staff always kept in contact and consulted with them when decisions were being made about the care of the person staying at the home.. The visitor also told us that their family member loved coming to Millview and that they "look upon it as a holiday".

We were told by family visiting the service that the staff were "very professional" and they always respected people's dignity and independence. We were also told that staff got to know the families well and always encouraged them to make regular contact so that they can be informed of changes that would make the persons stay more comfortable.

We spoke to one person who was visiting the service and they told us that they had been using the services at Millview for a long time and they told us they were "very happy" and the staff "are excellent".

We spoke to one person staying at the home at breakfast time and they told us they "liked it here". The person who was visiting the service told us that they used the service for respite and the staff tried to ensure that the person having respite had the same room each time they stayed so that they were familiar with the surroundings.