All inspections: Millbeck House - Care Quality Commission

We inspected Millbeck House on 14 and 15 November 2017. The first day of our visit was unannounced. This meant the staff and the provider did not know we would be visiting.

Millbeck House is located in Arnold, Nottinghamshire. The service provides care and accommodation for up to 32 older people with age related needs, including dementia and physical disability. Accommodation is provided on two floors with a number of communal areas and enclosed gardens available for people to use. On the day of our inspection there were 25 people living at the service. At the last inspection in March 2015, the service was rated Good. At this inspection we found that the service remained Good, though there was a deterioration in Safe.

The service had 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.

People did not always receive their medicines as prescribed by their doctor. Whilst there was a protocol in place for staff to follow when supporting people to take homely remedies such as paracetamol for pain relief, these were not in place for people who had medicines prescribed as and when required.

People using the service told us they felt safe living at Millbeck House. Relatives we spoke with agreed they were safe living there. People were kept safe from avoidable harm because the staff team understood their responsibilities. They knew what to look out for if they suspected that someone was at risk of harm and knew who to report their concerns too.

The risks associated with people’s care and support had been assessed and reviewed.

Appropriate pre-employment checks had been carried out on new members of staff to make sure they were safe and suitable to work there. An induction into the service had been provided and on-going training was being delivered. This enabled the staff team to gain the skills and knowledge they needed in order to meet people's needs. Whilst people’s needs were being met by the numbers of staff deployed at the service, there were times when people were left to sit and occupy themselves, or simply sleep.

People were provided with a clean and comfortable place to live. An on-going refurbishment plan was in place and improvements to the service were evident. There were appropriate spaces to enable people to either spend time with others, or on their own.

People’s needs had, whenever possible been assessed prior to them moving into the service to make sure they could be met by the staff team. Where people had arrived in an emergency, such as from hospital, as much information as possible had been obtained beforehand.

People told us the meals served at Millbeck House were good. Their dietary requirements had been assessed and a balanced diet was being provided. Monitoring records used to monitor people’s fluid intake did not always reflect that people were offered drinks in between the structured times provided.

People were supported to maintain good health. They had access to relevant healthcare services such as doctors and community nurses and they received on-going healthcare support.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People told us the staff team were kind and caring and treated them with respect. Observations made during our visit confirmed this. We observed the staff team treating people in a friendly, caring and considerate manner. They knocked on people’s bedroom doors before entering and if someone declined their offer of help, this was respected.

People were supported in a way they preferred because plans of care had been developed with them and with people who knew them well. The staff team knew the needs of the people they were supporting because the necessary information had been included within their plan of care.

People knew who to talk to if they had a concern of any kind. A formal complaints process was in place and this was displayed. People were confident that any concerns they had would be taken seriously and acted upon. Complaints received by the registered manager had been appropriately managed and resolved.

The provider had an end of life policy in place and this showed the staff team how to provide high quality care for people as they approach the end of life.

Staff members felt supported by the management team and told us there was always someone available to talk with should they need guidance or support. The views of the people using the service were sought. This was through meetings and the use of surveys. Systems were in place to monitor the quality of the service being provided and a business continuity plan was available to be used in the event of an emergency or untoward event.

Further information is in the detailed findings below.

We inspected Millbeck House on 19 March 2015. The inspection was unannounced.

At the last inspection on 19 December 2013, we asked the provider to take action to make improvements to the way they planned and delivered care and to the numbers of staff available to deliver that care. These actions had been completed.

Millbeck House provides personal care and support for up to 32 older people. 29 people were living in the home on the day of the inspection. The home is situated in the town of Arnold in Nottinghamshire.

There was a registered manager in post at the time of the 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.

CQC is required by law to monitor the operation of the Mental Capacity Act, 2005 Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way, usually to protect themselves. At the time of the inspection no-one who lived at the home had their freedom restricted and the provider had acted in accordance with the Mental Capacity Act, 2005 DoLS.

People were safe living in the home and they were treated with dignity and respect. They were involved in planning and making decisions about the care and support they received. Staff respected their views about the way they wanted their care delivered. Support was delivered in a kind and caring manner.

People had access to appropriate healthcare services and were provided with a diet that took account of their needs and preferences. Their medicines were managed safely. They were also supported to enjoy activities and interests of their choice.

People could voice their views and opinions and felt able to raise concerns or complaints if they needed to. Staff listened to what people had to say and took action to resolve any issues.

Staff were trained and supported to deliver a good quality of care for people and they understood how to manage any concerns for people’s safety and welfare. They were appropriately recruited to ensure they were suitable to work with vulnerable people.

There was a system in place to regularly monitor and improve the quality of the services provided within the home.

We spoke with ten people who lived in the home. They all told us that staff were very friendly and tried to help them as much as they could. There were comments from three people that sometimes they had to wait for up to twenty minutes before they were assisted to go to the toilet.

We spoke with a relative who stated he had been very satisfied with the service. He said that his mother's health had improved since she had been admitted; 'staff are very good. They are friendly and helpful at all times. I have never had any problems'.

This was a mixed inspection. People and a relative told us said that care that staff supplied was good. However, we found that care did not always uphold people's dignity and their right to choose what care they needed. Staffing levels did not fully meet people's needs on the afternoon shift.

There were a number of suggestions: to have tastier food, that staff should not be expected to do training in their own time, training was needed to cover all peoples health conditions, more input was needed from the manager, and for more staff meetings to be held.

We assessed people's wellbeing by sitting with them observing the care they received and level of staff interaction that took place.

We observed that the staff were attentive to people's needs. Staff interacted with people who used service in a friendly, respectful and professional manner. We saw that staff sought their agreement before providing any support or assistance. The people we saw were relaxed, engaged with their surroundings and interacted with each other.

We talked with some relatives and two of the people who lived in the service. The people told us that they liked living there, that the care staff showed them respect and looked after them well. They also told us that they were comfortable. One person told us that, 'I am comfortable and the staff are good to me.' One person's relative told us, 'We are very happy that (my relative) is here, we know they will be well looked after.'

We saw that staff were supported because they had supervision and that they received training essential for caring for older people.

The service had appropriate safeguards in place to protect people from abuse and people told us that they felt safe living in the service. We saw that complaints where taken seriously and investigated in line with the provider's complaints procedure. One person said, 'I have never needed to make a complaint.'

One person told us, 'I have a care plan and I was asked to tell staff information about myself so that it would be added to it. Staff told me that it would be used to get to know me better.'

One person commented, 'We are encouraged to be independent. At this home we get up when we want to and go to bed when it suits us. We are offered a choice of bath days. I find that bath times are made really pleasant as the staff make a fuss of you.'

Other comments on the meals included, 'We were asked to help select the menus at the monthly residents meetings.' 'We have a selection of two meals at each meal time and each time we were asked what we preferred.'

People told us they were offered choices in their day to day lives for the little things as well as the bigger things in their life.