We carried out a review of the data available to us about Mill House on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Mill House, you can give feedback on this service.
Mill House is a residential care home providing accommodation and personal care to up to 5 people. The service provides support to people aged between 16 and 30 who have a learning disability and/or autism. The service offers a transitional stage between children’s and adults’ services. At the time of our inspection there were 5 people using the service.
People’s experience of using this service and what we found
Right Support:
People were supported by staff to pursue their interests. Staff focused on people’s strengths and promoted what they could do, so people had a fulfilling and meaningful everyday life. Staff supported people to play an active role in maintaining their own health and wellbeing. Staff did everything they could to avoid restraining people. The service recorded when staff restrained people, and staff learned from those incidents and how they might be avoided or reduced. 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.
Right Care:
People received kind and compassionate care which supported their needs and focused on their quality of life. However, the provider did not always follow best practice guidance around helping people set and monitor goals to achieve their aspirations. We have made a recommendation about this. Staff protected and respected people’s privacy and dignity. They understood and responded to their individual needs. Staff understood how to protect people from poor care and abuse. The service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it. The service had enough appropriately skilled staff to meet people’s needs and keep them safe. People could communicate with staff and understand information given to them because staff supported them consistently and understood their individual communication needs.
Right Culture:
People led inclusive and empowered lives because of the ethos, values, attitudes and behaviours of the management and staff. People and those important to them, including advocates, were involved in planning their care. Staff ensured risks of a closed culture were minimised so that people received support based on transparency, respect and inclusivity.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
The last rating for this service was good (published 16 January 2018).
Why we inspected
This inspection was prompted by a review of the information we held about this service. We undertook a focused inspection to review the key questions of safe, responsive and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Mill House on our website at www.cqc.org.uk.
Follow up
We will continue to monitor information we receive about the service, which will help inform when we next inspect.
At our last inspection in May 2015 the service achieved an overall rating of ‘Good’. This inspection took place on 15 August and 5 September 2017. We also spoke with relatives and professionals on 21 August 2017. At this inspection we found the service remained Good overall and was rated ‘Outstanding’ in the responsive domain.
People received high quality person-centred care from staff who understood their needs. The service had in place a number of good practice systems which facilitated people being able to communicate to staff the type of care they wanted to receive.
Care documents were significantly detailed and accurately reflected to a high degree each person’s history and needs. Guidance given to staff on to how meet people’s needs was very specific. Regular reviews were carried out with people who used the service and included their relative’s voice to ensure people’s care provision was up to date and reflected their individual preferences.
The staff had extensively researched holidays abroad when the people using the service wanted to go on a group holiday. This included researching the needs of people with autism when using airports. Staff found and implemented autism passports at their departure airport which assisted people going through security checks and prevented any distress to the people from the service who were going on holiday.
We found people were enabled to live extremely fulfilling lives in which they were given choice about their activities. Staff supported people to carry out highly individual choices and suggested alternative activities, for example growing vegetables, to give people who used the service a broad spectrum of options. Staff had also introduced themed events around different cultures. This enabled people to learn about diversity and participate in events which were new and meaningful to them.
Risks assessments in the service were well-documented and were highly personalised. Staff demonstrated they understood the risks and the required actions to keep people safe.
Staff understood the needs of people with autism and the very individual needs of each person who lived at Mill House. We found when there was a transition to be made, people’s needs were considered in great detail.
We spoke to relatives who told us they had no concerns about the service and confirmed they had not made any complaints. The manager told us no one had made a complaint about the service. Relatives said they felt involved in the service and in the care of their family members.
Staff were supported through a programme of induction, training and appraisal. We saw staff recruitment was robust. Staff underwent pre-employment checks before they started working at the service. Managers in the service were due to start management development training.
Staff had been trained in safeguarding and were confident if they raised a concern with their manager they would respond appropriately. Relatives told us they had confidence in the management of the home.
We reviewed people’s medicines and found there were safe systems in place for their storage and administration. Guidance was available to staff to support them to give people medicines which were required on an ‘as and when’ basis.
Relatives and professionals alike told us they thought people who used the service were well cared for. We found staff respected people’s privacy and dignity. People’s independence was encouraged by staff.
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.
The service had systems and processes in place to monitor quality. Audits were regularly carried out. The service used an external auditor in addition to their own auditing processes to monitor the service. The manager had had action plan in place to address improvements and had told the Commission the improvements they intended to make when they were required to give us information about the service.
We found there was partnership working between the service and other agencies including health and social care professionals.
The registered manager attended external network meetings to bring learning back to the service to improve the outcomes for people using the service. The service has signed up to national initiatives including the Social Care Commitment designed to improve service delivery.
Further information is in the detailed findings below.
This inspection took place on 12 and 14 May 2015 and was announced. This meant the provider did not know we were arriving.
Mill House is a new service and has not previously been inspected.
The service provides accommodation for five people with learning difficulties and is set in a rural part of County Durham.
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. At the time of our inspection there was a registered manager in post.
We found people’s medicines were managed safely. Records showed how people preferred to take their medicines and staff were aware of people’s preferences.
We found all areas of the home including the laundry, kitchen, lounges and bedrooms and bathrooms were clean, pleasant and odour-free.
In people’s care records we found the numbers of staff required to care for each individual was described. These were included on the staff rota and we found the required number of staff were on duty.
The provider had carried out robust checks on staff before they started working in the home. This ensured people who were employed by the provider were assessed as being safe to work with vulnerable people
All of the staff had received safeguarding training and the staff on duty were able to articulate to us the different types of abuse.
The registered manager and staff understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). The registered manager had submitted applications to deprive people of their liberty.
We found staff were appropriately supported through the use of induction, supervision, appraisal and training.
Staff were aware of people’s eating habits and had put arrangements in place to support people who required special diets.
People had in place communication passports which contained information on the best ways to communicate with people who used the service. We saw the service used pictures and photographs to support people.
During our inspection we found involvement was a key theme of the home. We saw the provider had put in place arrangements to support people being involved in decisions about their home.
We observed people were comfortable in the presence of staff and staff worked with people in gentle ways whilst being firm and maintaining safe boundaries.
The service spoke up for people and used advocacy services to make sure any decisions taken about people were in their best interests.
We found the provider had in place a comprehensive set of care plans which described people’s needs, wishes, hopes, dreams and aspirations. We saw people met with their keyworkers and were involved in reviewing their care plans. Staff were given detailed guidance on how to care for people.
People were engaged in activities which they liked and staff looked for activities to help people achieve their goals.
The registered manager had in place a broad range of audits to monitor the service quality and produced a monthly report for the provider which detailed what had happened in the service.
The registered manager also maintained a number of logs from which she could monitor the service and check its progress.
Staff were confident in the registered manager’s knowledge and experience to lead the service.