Mill House

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question good. At this assessment the rating for this key question has remained good.

This meant people were safe and protected from avoidable harm.

This service scored 72 (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 had a proactive and positive culture of safety, based on openness and honesty. The manager listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

The manager and her senior team were experienced and hands on. Audits helped them respond to any shortfalls within the service delivery and ensuring people and their experiences were listened to. Incidents were reviewed to make sure staff acted appropriately to support people and lessons were learnt, and risks reduced as far as possible. We found however incident records did not always clearly show what actions had been taken or what lessons learnt. The manager took on board our feedback and documentation was vastly improved between our first and second visit.

Staff were supported with their professional development and training and direct observations of practice helped to ensure staff understood and were able to embed their training in their workplace.

Staff were trained to deal with emergencies and deal specifically with matters that could arise from people’s poor mental health. Staff felt well supported by the manager and deputy and on-call processes.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

Individualised care was provided and based round a clear assessment of people's needs. The service worked holistically with other services to try and enhance peoples lived experiences and give them opportunities they might not otherwise have such as support with benefits, employment and ongoing housing needs.

People were supported with their mental health using a ‘recovery model.’ This meant there was an integrated approach to supporting people with their aims and objectives and overcoming addictions and other barriers contributing to poor mental health. Some people had come from secure settings but in their recovery, Mill House offered the least restrictive environment which promoted people’s choices and well-being. We observed staff providing appropriate support and giving people meaningful engagement.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

Risks associated with people’s needs were clearly documented and everyone we spoke with were comfortable that they could raise concerns and these would be escalated if necessary. Staff received safeguarding training and there was clear information about how to raise safeguarding concerns. We asked staff about their understanding of safeguarding and their responses were robust. One staff member said, “My understanding of safeguarding is where you are protecting people’s health, well-being and human rights ensuring that they are safe from harm abuse and neglect. Try and make everyone including the people we support be safe.”

Safeguarding concerns were investigated if required and in conjunction with the local authority’s advice.

The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Risk assessments were completed, reviewed, and formed an integral part of people’s care. Risks were identified as part of the persons ongoing assessment and there was clear guidance for staff. Clear boundaries were established meaning people felt supported and knew what the expectations were as these were clearly communicated.

The whole service was relaxed and homely with low stress where people lived without restriction which helped them to feel safe and well. A relative told us, “They [family member] has self-harmed in the past, but now, they will go and sit with them. When they begin to feel low, they will go straight over. They recognise the signs. They are really good with them really good. It's definitely the right place for them. They know them really well. They can also say if they are feeling a bit down.”

The provider did not always detect and control potential risks in the care environment. They did not always make sure equipment, facilities and technology supported the delivery of safe care.

The environment clearly had its limitations due to its age and layout. We were able to see a clear building and environmental risk assessment and refurbishment had been completed including new floors and a new kitchen had been commissioned.

We identified areas of concern not addressed by the environmental risk assessment to show how risks had been reduced from uneven floors, internal stairs and low ceilings. We also identified uncovered pipes but could not assess if there was a risk as the heating was not on. Immediate steps were taken by the manager to address our concerns and ensure edges of steps and lower parts of the ceiling were highlighted. Where there was a risk pipes were covered.

We reviewed health and safety checks including fire and water safety, and these were in order.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

Safe staffing was maintained in line with people’s assessed needs which were reviewed regularly to ensure staffing levels remained appropriate. Staff had the necessary competencies and qualifications including opportunity for additional study and career advancement.

Relatives assured us there were enough staff, one said, “There's enough staff. There's always someone floating about.” Another relative told us, “They {X) is safe there. There's always enough staff on hand, and they're well trained. They know exactly what they need to do. I don't know if they use agency staff. I don't think they do. There is a continuity of staff. They’re lovely all of them, and so welcoming.”

We expressed concern about people’s one-page profiles which did not give enough detail about their experiences or qualifications. Whilst we accept agency staff were supervised, we were concerned about the appropriateness of using agency staff without knowing their specific skill set and level of experience when supporting people who had high needs and possible vulnerabilities. The manager said before any staff were recruited an onsite induction was completed and electronic checks including Disclosure Barring Service (DBS) were verified.

Staff recruitment records were sufficiently robust, and staff were well supported when first joining the organisation.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

The home was clean and well organised. Staff worked hard to support people to keep their environment clean and cleaning was a team effort. There was a housekeeper who ensured everything was in order and staff told us they completed training for infection control; Staff also had their competency assessed in this area. Staff told us there were ample supplies of personal protective equipment and they used this appropriately.

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened.

There were enough staff trained to give medicines, and the staff member observed was knowledgeable and competent taking their time and adhering to good procedures. People were asked for their consent and again everything was explained to them. Although medicines were held centrally, the actual administration was time sensitive and person centred. Risk assessments and best interest decisions around medicines were in place in line with people’s needs.

Medicines were reviewed to ensure correct administration and sufficient stock but also to ensure they remained appropriate to use and wherever possible reduced.

Medicines were well organised and there was clear guidance around medicines, when they should be administered, what it was for and any potential side effects. Medicine profiles included allergies or considerations, and information was shared on a need-to-know basis.