Mickleboro Lodge

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• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

Responsive – this means we looked for evidence that the provider met people’s needs.

This is the first assessment for this newly registered service. This key question has been rated Good. This meant people’s needs were met through good organisation and delivery.

This service scored 75 (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 made sure people were at the centre of their care and treatment choices and they decided, in partnership with people, how to respond to any relevant changes in people’s needs.

People’s care and support was planned and delivered in a personalised way which ensured their health, social, emotional and psychological needs were centred around their specific needs and consistently met. Relatives told us they were regularly involved in planning and making shared decisions about their family members care and support. One relative commented, “We are invited to all the care planning meetings, the provider is also involved. I now feel I am listened to”. Another relative told us, “Whenever there is a need to change the care plan, my (Person) and I are invited to review the changes, and we always agree to them.”

People were supported to understand their condition, care and treatment options, including any associated risks and benefits. People’s records showed they were regularly involved in reviews of their care, including section 117 after care plans. Section 117 of the Mental Health Act 1983 refers to after-care services provided to individuals who have been detained under specific sections of the Mental Health Act and subsequently discharged from hospital. These plans are designed to help people stay well and avoid readmission to hospital. People were empowered to have a say in their care and support. Each person using the service had an allocated keyworker whose role was to meet with them on a regular basis to review their health and wellbeing, the effectiveness of their care plan and make any adjustments as needed.

People’s care plans held relevant and important personalised information to guide staff. Staff were aware of people’s individual needs and social histories which helped them to understand the person and deliver the right care and support. Where people needed support with their mental or emotional health, there was detailed information within their care plans to guide staff about triggers or de-escalation techniques they should follow to support people's wellbeing. Keyworker reviews reflected people’s behaviours were being managed well with a reduction in the use of PRN medicines to manage this.

The provider understood the diverse health and care needs of people and their local communities, so care was joined-up, flexible and supported choice and continuity.

People’s care and treatment was delivered in a way that met their assessed needs. Care plans were personalised, and they adequately showed how staff responded to individuals differing needs in terms of strengths, abilities, interests, social activities and meaningful interventions. People using the service were largely independent requiring prompts from staff rather than continuous support. We observed support from staff was always available and people were observed asking for help, if needed.

The provider was aware of the different needs of the people using the service, including those most at risk of harm in the community or at risk of poorer experiences in care. They ensured care and support was delivered and coordinated for people to ensure their needs and preferences, including those with protected characteristics were met. Some people were already receiving funding to receive additional staff support on a 1 to 1 basis to help manage their diverse mental health needs, both in the home and in the wider community. The provider told us because a person’s behaviour had stabilised since admission to the service, the local authority had wanted to cut their funding for additional 1 to 1 staff support. The provider had worked with the local authority to retain the additional funding to support the person when accessing the community for their continued safety.

The provider supplied appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

People received information in a timely way that met best practice standards, legal requirements and was tailored to individual to enable them to make informed decisions about their care and where required treatment. People using the service could access information in regular written formats. Alternatively, information was available in easy read, large print or pictorial format if required.

Hospital passports were in place for people which held very good detail about the person’s support and health needs, preferences and how they communicated. A passport is a personal document that provides important information a person wants to share with healthcare professionals about their disability, long term health condition, mental health issue or learning disability, how they communicate and any reasonable adjustments they may need.

The provider made it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. Staff involved people in decisions about their care and told them what had changed as a result.

People’s relatives told us communication between them and the service had improved. One relative said, “If I have an idea or an issue, I know I am listened to. I am also asked for my opinion”. Another relative told us, “Communication is very good, we are now invited to family meetings where we can give our views, opinions and suggestions.”

Information about how to raise a complaint was available to the people, visitors and staff in all communal areas with information on what to do and how to contact the provider, local authority, local government ombudsman (LGO) and CQC. People and their relatives told us they knew how to raise a complaint if they needed to, and were confident their concerns would be taken seriously and explored thoroughly.

Review of the compliments and complaints folder reflected 7 complaints had been made about the service since the service was registered under the new provider. These had been robustly reviewed, responded to and used to drive improvements in the service. There had been a range of compliments made about the service, which had been logged in the compliments folder and shared with the team during team meetings. These were aimed towards the changes in the service due to relocations and residents’ families noting how their family members overall presentation and care had improved.

The provider made sure that people could access the care, support and treatment they needed when they needed it.

People were supported by staff to access the care, support and treatment they need when they needed it, without delays and in a way that protected their rights. The provider told us people were supported to be in control of their own care. Where people experienced barriers accessing services the provider had taken action to tackle inequalities on their behalf. For example, where a person had a dual diagnosis of mental health and a learning disability, they had faced barriers where neither mental health learning disability services would get involved in their ongoing support. The provider told us following reassessment of their needs the person had now been diagnosed with a mental health condition as their primary need and was now being funded appropriately.

Staff were aware of potential barriers to people’s care and support and knew how to escalate concerns. Comments included, “People do have access to healthcare as needed, and annual health checks. The only restriction is if they refuse to attend. If they refuse their medication or access to treatment, we will refer the GP,” and “People might decline to go to doctor, or they might act in a way that would cause themself harm. I would report to the team leader as they may need medical help and have refused.”

Improvements had been made to the environment since the service had been registered under the new provider making the premises accessible to all, including the removal of barriers previously in place, such people’s access to the kitchen and their own medicines.

Staff and leaders actively listened to information about people who are most likely to experience inequality in experience or outcomes and tailored their care, support and treatment in response to this.

People had equal access to care, treatment and support because the provider complied with legal equality and human rights requirements, including avoiding discrimination, considering the needs of people with different protected characteristics and making reasonable adjustments. The provider was alert to inequalities in people’s transition between services which had the potential to disadvantaged them accessing the right level of care, treatment and support. They had proactively sought ways, including raising a safeguarding concern to the local authority to address barriers to improve people’s experiences and obtain appropriate resources and funding to ensure their diverse needs were met.

People and their relatives told us they were treated fairly and equally, and were empowered to share their views, experiences and understand their rights. The provider and staff were alert to discrimination and inequality that could disadvantage people living at Mickleboro Lodge. They understood the importance of promoting people’s equality and human rights and supported them to access the community and have the same opportunities any person would expect. One member of staff commented, “The main issue we have when we support people in the community is that the public to do not generally understand about mental health, especially when people we support can swear and shout. We have to advocate for people and explain that we are supporting them.”

The provider had systems in place to check if people’s life and experiences of living in the home could be improved upon in any way. Various forums gave people the opportunity to share their experiences and actions were taken to improve outcomes for them. Care, support and treatment was tailored in response to information about people who are most likely to experience inequality in experience and outcomes.

People were supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.

At the time of our inspection, no one was nearing the end of their life. Some work had taken place to address advanced care planning to enable people to make choices about future care, including planning for the end stages of their life. This had included discussions about what mattered to them and their preferences around funeral arrangements. People’s care plans had documented whilst attempts had been made to have discussions about planning for their end-of-life care, they had declined to participate. Reference had been made to reviewing end of life care plans with people on a regular basis whilst they still had capacity to do so. Planning ahead allows individuals to express their preferences for care, ensuring their wishes are honoured, and describe how staff are to manage symptoms, such as pain, and other challenges associated with end-of-life care for individuals with mental health conditions.