Millies Care and Support Agency Limited

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated this key question Good. At this assessment the rating has changed to Requires Improvement. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

This service scored 58 (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 did not always ensure the effectiveness of people’s care and treatment. Care plans and case notes were not consistently reviewed or updated when people’s health, wellbeing or communication needs changed.

Staff did not always complete care notes relating to people’s agreed care interventions. Managers agreed and said: “Staff need to be more descriptive with their notes – we will discuss the importance of this with all staff”. This meant the provider did not have the evidence to show all care tasks had been completed with people. Although some care plans were updated when a change in need occurred, there was limited assurance of ongoing review. This did not ensure information remained accurate and reflective of people’s assessed and current needs. Following our assessment, the provider ensured team meetings reflected the importance of accurate record keeping.

However, the provider assessed people’s care and support needs before they started using the service. This included discussions about how they would like their care delivered. People told us: “They sat down with me and asked me questions about what I need help with and when”. Another person told us: “they were good, when they visited, I told them I cannot go out, and since then there has not been any pressure to do so”.

The provider did not always work effectively across teams and services to support people. They did not consistently share assessments or key information about people’s needs when individuals moved between services or when staff were required to provide ongoing support.

Carerecordslackedinformation about specific medical conditions that could significantly affect the person’s ongoing care and treatment. This included their history of depression or addiction. This meant staff lacked critical information required to deliver safe and effective care, increasing the risk of inappropriate support, missed needs and avoidable harm.

There was no guidance or supporting documentation to help staff support a person living with diabetes to make safe and healthy meal choices. This was not in line with the National Institute of Care Excellence (NICE) guidance, which emphasises the importance of personalised dietary advice to support safe diabetes management. The lack of clear information increased the risk of unsafe food choices and meant staff could not provide consistent or informed care. The provider did not have any evidence to demonstrate that healthy choices were a topic of conversation, and daily notes for the person did not reflect low sugar alternatives were being discussed.

Staff communicated well with people and there was a relaxed relationship between people and staff supporting them. Staff knew people’s needs and preferences. People were relaxed with their support and engaged in the activities they had chosen. One person told us they were supported to leave their house for a short walk, but they would not feel confident to do this if they did not have support from staff.

The provider worked effectively with other teams and services to ensure people received coordinated and seamless care. Staff shared relevant information when people moved between services, meaning individuals only needed to explain their needs once. This supported smooth transitions and reduced the risk of important details being missed.

Professionals reported positive working relationships with the service. They told us the provider regularly shared ideas and discussed how best to manage complex or difficult situations. Feedback from partners was complimentary, describing the staff as going “above and beyond”.

Other professionals described the provider as helpful, approachable and well-organised. They told us the staff team acted professionally, were knowledgeable, and always willing to offer advice and support. One professional told us, “I would have no hesitation in recommending the service”.

There were examples of practical support between services. For example, when another provider ran low on PPE, staff from this service delivered supplies the same day. This demonstrated effective collaboration and a shared commitment to people’s wellbeing. This meant people benefited from joined up, coordinated care delivered by services that communicated effectively, supported one another and worked together to achieve the best outcomes for people.

The provider did not always support people to manage their health and wellbeing, which meant people could not always maximise their independence, choice or control. Staff did not consistently support people to live healthier lives or, where possible, reduce their future care and support needs.

For example, one person with a diagnosis of autism had a known dislike of the dentist and regularly declined to brush their teeth. Their care plan identified this, but documentation did not consistently record whether staff had prompted or supported the person to brush their teeth, or whether they had declined. There was no guidance for staff on how to approach the person, provide reassurance, or explain the benefits of maintaining good oral hygiene in a way that was meaningful and accessible to them.

This meant staff did not have the information they needed to provide consistent support, and opportunities to promote the person’s health and independence.

However, we saw staff encouraging people to take an active role in maintaining their physical and mental health. People were supported to attend GP appointments, manage long‑term conditions and develop routines that promoted overall wellbeing. Staff worked sensitively with people who found it difficult to engage with healthcare services, offering reassurance, practical assistance and encouragement. One person told us, “They help me understand what I need to do to stay well.”

The provider did not always routinely monitor people’s care and treatment to ensure it was effective or continuously improving. They did not consistently check whether people were achieving positive outcomes, or whether the care delivered met expectations and the outcomes that mattered to people themselves.

For example, the provider had reviewed some people’s care and support needs with them. However, none of the reviews contained opportunities for people to comment on the times of their care or any late or missed visits. This meant the provider did not always capture people’s experiences of care visits. This limited their ability to identify patterns and make improvements based on people’s feedback.

Although the provider told us they were supporting people and recognising their progress, they were not evidencing that there had been improvements in their lives. This meant the provider did not have reliable systems to record progress or evidence whether people were being supported to achieve meaningful and person-centred outcomes. As a result, the effectiveness of care could not always be assured.

One person had been commissioned by the Local Authority (LA) because they required support to wash daily. However, records did not show why this was not being provided. When we spoke to leaders, they told us, “It’s alright though because they refuse to shower and bathe, it is their choice and they have the right to refuse… the available water is not hot anyway”. The provider told us they would raise a safeguarding for self-neglect.

However, during the inspection we observed a telephone conversation between a person using the service and the office team. The office team explained the person had contacted the office for support, something they had not felt confident to do previously. This showed the person was happy with the service they received and that it had a positive impact on their life.

The provider informed people about their rights in relation to consent and respected these when delivering person centred care and treatment.

We saw documentation during the inspection that confirmed people had given consent appropriately. Staff had received training in the Mental Capacity Act (MCA) and understood consent. We saw consent to care documents signed by people or where this was not possible, by people’s relatives.

Staff understood their responsibilities, including the need to follow the best interest decision making process when a person lacked capacity to make a specific decision.
This meant people could be confident that their rights were understood, upheld and protected, and that decisions about their care were made lawfully and in line with their best interests.