Archived: Millfield House

Updated 10 August 2016

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 27 June 2016. The inspection was conducted by one inspector due to the small size of the service.

Prior to the inspection we asked the provider to complete a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We looked at the information provided in the PIR and used this to help inform our inspection. We reviewed the records we held about the service, including the details of any safeguarding events, the previous inspection report and any statutory notifications sent by the provider. Statutory notifications are reports of events that the provider is required by law to inform us about.

We observed six of the eight people who live in the service; some people had communication difficulties so we spoke in more depth with three. We also observed how people interacted with each other and with staff over a lunch period using the strategic Short Observational Framework for Inspection (SOFI); SOFI is a way of observing care to help us understand the experience of people who could not talk with us. We observed staff carrying out their duties and how they communicated and interacted with each other and the people they supported.

Following the inspection we contacted relatives to ask for their views and received feedback from two. We also contacted four health and social care professionals who visit or represent people living in the service and the local commissioning team.

We looked at three people’s care and health plans and risk assessments, medicine records, staff recruitment, training and supervision records, staff rotas, accident and incident reports, servicing and maintenance records and quality assurance surveys and audits.

Updated 10 August 2016

The inspection was unannounced and took place on 27 June 2016. The service is small residential service for up to eight people with physical disabilities. People have their own bedrooms which are located over the ground, first and second floor; the service is accessible for people with mobility difficulties and all areas of the home other than the basement can be accessed using a shaft lift. This service was last inspected on 29 April 2015 when we found the provider was not meeting all the regulations. We asked the provider to tell us how and in what timescale they intended to address these issues. This inspection highlighted that the majority of previous requirements had been addresses with only one relating to staff training where progress had not been sufficient to meet the requirement and this remains outstanding.

There was a registered manager listed for the service but they had been absent for some time. A registered manager is a person who is 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.

Interim arrangements to manage the service by the deputy manager with support from senior managers had been in place throughout the registered manager’s absence and this had worked well.

Improvement was needed to the way in which support for people with diabetes was recorded to ensure all staff could recognise deterioration and knew the actions to take. Since the previous inspection access to regular physiotherapy exercise sessions had tailed off and this left people at risk of losing flexibility and muscle tone.

Staff said they felt supported, valued and listened to, they said communication was good and there was always opportunity to discuss things with the deputy manager in relation to work issues but these were not formally documented and formal supervision to look at staff training, development and performance were infrequent and not in keeping with company policy.

People said their needs were attended to by staff when and if they required it. People respected each other’s privacy. People were supported to maintain links with the important people in their lives and relatives told us they were always consulted and kept informed of important changes. Observations showed staff behaved in a kind patient manner with people, treating them with dignity and respect.

Relatives told us they had no concerns about the service and were satisfied with the overall standard of support provided. They felt confident in the quality of care and said they were kept fully informed by the service and that communication was good. Professionals we contacted about the service also commented positively about the service and raised no concerns.

There were sufficient staff to meet people’s needs. People said they thought there were enough staff, and existing staff were covering gaps in shift to ensure people received consistent familiar support, staff knew this was only for a short while and that further recruitment was well underway.

Recruitment processes ensured only suitable staff were employed. New staff completed a probationary period and received induction into their role and the organisation, a range of training was provided to give them most of the knowledge and skills they needed, but there were gaps in this. Staff told us that they felt listened to and supported, they said there were always opportunities to share information with each other.

People’s medicines were well managed by trained staff. Staff were able to demonstrate they could recognise, respond and report concerns about potential abuse. The premises were well maintained and all necessary checks tests and routine servicing of equipment and installations were carried out. Fire arrangements were satisfactory and staff attended regular drills and practiced evacuation.

People ate a varied diet that took account of their personal food preferences. Their health and wellbeing was monitored by staff that supported them to access regular health appointments when needed. Staff understood how people communicated and ensured they received technological support where possible to aide their communication and retain independence to share their thoughts and views. Risks were appropriately assessed to ensure measures implemented kept people safe.

People were encouraged by staff to make everyday decisions for themselves, but staff understood and were working to the principles of the Mental Capacity Act 2005 (MCA). The MCA provides a framework for acting and making decisions on behalf of people who lack mental capacity to make particular decisions for themselves. People and relatives told us they found staff approachable and felt confident of raising concerns if they had them. The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. No one at the home was currently subject to a DoLS but the provider understood when an application should be made and the service was meeting the requirements of the Deprivation of Liberty Safeguards.

People and relatives were routinely asked to comment about the service and their views were analysed and action taken where improvements could be made. Quality assurance audits were undertaken on a regular basis, with regular visits also under taken by the provider representative to look at aspects of service quality and highlight shortfalls and timescales for addressing these.

We have made two recommendations

We recommend that the registered manager seek from a competent person guidance regarding the frequency of staff practice around use of evacuation equipment.

We recommend that the registered manager reviews and implements fully relevant company policy in regard to the required frequencies of staff supervisions and staff meetings.