Millies Care and Support Agency Limited

On this page

• 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.

At our last assessment we rated this key question Good At this assessment the rating has changed to Requires Improvement. This meant people’s needs were not always met.

This service scored 64 (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 make sure people were at the centre of their care and treatment choices, and they did not always work in partnership with people to respond to any relevant changes in people’s needs.

There was a risk people were not consistently provided with person centred care because staff did not have access to all the information required about each person. Care plans were not always detailed or accurate, and although there was some evidence that care reviews were taking place, this did not ensure they were completed consistently.

People told us they were not always involved in the development or ongoing review of their care plans. One person said, “I imagine I have a care plan in place but my relative has the lead on that,” while another commented, “I believe I have a care plan, but I’ve never seen it.” This meant people were not always fully informed or empowered to participate in decisions about their care.

Care records did not always contain detailed information about how to support people and did not always reflect people’s individual preferences, routines, and personal histories. We found a shortfall in 5 out of 6 people’s care plans where essential information had not been transferred from the local authority support plan to the provider’s care plan.

Staff did not always demonstrate a strong awareness of the people they supported, with gaps in knowledge relating to people’s conditions and what their preferences were. Care plans did not always contain information about supporting people holistically with their known diagnosis’. This meant people may not receive person centred support that reflected how their conditions affected them day to day, which could lead to misunderstandings, increased distress or missed opportunities to promote comfort and predictability.Following the assessment, the provider has told us they have made changes to their systems and processes to address the concerns identified. We have not assessed these changes as part of this inspection, and these improvements will require time to become fully embedded in practice

However, the service did at times demonstrate a person‑centred approach by recognising and acting on what mattered to people in their daily lives. For example, one person’s support plan highlighted their strong interest in trains. Staff used this information meaningfully by arranging visits to old railway stations, enabling the person to engage in an activity that was deeply personal and enjoyable to them. This showed staff took time to understand people’s individual preferences and incorporated these into support in ways that enriched their experiences and promoted well-being.

The provider understood the diverse health and care needs of people and their local communities. Care was joined-up, flexible and supported choice but not always continuity of staffing.

Leaders gave examples of proactive contact with professionals when people’s needs changed. This included supporting an individual through a referrals process to access additional support and working closely with mental health teams to arrange ongoing support for another person’s well-being. This integrated approach meant people received joined-up care that supported choice, continuity and improved wellbeing.

Relatives and people felt if they needed to contact the office, they were always able to speak to someone without a long wait time. This was reflected as a positive experience.

However, people told us they would have benefitted from greater continuity in the care they received. Comments included: “I have different carers a lot of the time and while some are good, others I feel do not know how to support me”. The provider told us they would look at how staff were distributed to ensure people had improved continuity.

The provider did not always supply appropriate, accurate or up to date information in formats tailored to people’s individual needs.

People told us they did not always receive enough information from the provider around changes to their rota. People reported frequent changes in carers created confusion and made it difficult to know who would be visiting and when. One person told us: “I do not know who will turn up and so I do not know if the carer will know me well or not”. Relatives confirmed this by saying “Sometimes I speak to [relative], and they tell me they have had carers who do not know them” Another relative said “I don’t think [my relative] is asked who they would like to support them”. Managers told us they tried to match staff with people but did not have the evidence within care plans to support this.

The provider did not have accessible information available for people. One person told us: “my eyesight is failing”. When we asked managers if they had larger print documents for people who were visually impaired or easy read documents for autistic people, managers told us they did not, but they would produce them if asked.

This meant people could not always be confident that communication from the provider was reliable or consistent, or accessible to them in a way which met their needs.

However, some people told us their care plans were accessible. Comments included: “We have a care plan in place, and I am privy to it on a regular basis” and “My care needs and planning are open to review at any time”.

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.

During the inspection, we observed a telephone conversation between office staff and a relative who raised concern about how an aspect of their family member’s care was being documented. The office staff member responded appropriately, saying they would remind staff of the requirement to document all care tasks.

Staff told us they recorded any concerns raised by people or their families on the app and ensured management were informed. They said management would then contact the person and their family and follow up on any concerns. Managers confirmed this saying “We expect our staff to listen to people and we ensure issues are followed up.” The provider did however inform us that while they did this verbally they did not have a written record of this.

People told us they felt listened to. Comments included: “When I do speak to them, they listen to what I have to say” and “I never feel rushed when I telephone them”.

This meant people could be confident that feedback and concerns were acknowledged and acted on in a timely way.

The provider ensured people could access the care, support and treatment they needed in a timely way.

People told us they were able to access the care and support they needed in a timely way, and staff were allocated based on individual requirements, such as proximity and travel routes. This helped ensure visits could be completed effectively. Managers confirmed shifts were planned so non‑drivers could still reach people safely and reliably.

We saw that assessments, including environmental checks, were completed to identify any adaptations or equipment required. Staff worked in partnership with other professionals such as occupational therapists to support people’s access to coordinated care.

However, one person raised concerns about staff punctuality, with reports of carers arriving more than an hour late. This caused discomfort and inconvenience, particularly when waiting for support with personal care. This person also told us that carers did not always stay for the full duration of the visit or complete all planned tasks. However, two people said timekeeping was generally acceptable and that carers completed required tasks. The provider did not monitor call times or durations. Managers assured us they would assign a member of the office team to ensure the duration of future care visits were monitored.

This meant people were at risk of inconsistent care, and at times, the lack of information, punctuality and continuity sometimes affected people’s comfort, confidence and overall experience of the service.

Staff and leaders listened to people who may be at greater risk of receiving unfair or unequal care and treatment. They used this feedback to tailor the care and support provided, ensuring it met each person’s individual needs.

People said they were supported fairly and respectfully, and that staff listened to their needs in a way that helped ensure they received care suited to their individual circumstances. We saw that staff used equality and diversity training in practice and worked with other professionals and services to identify and reduce any barriers people faced in accessing consistent or inclusive care.

Managers confirmed they had policies to guide staff in delivering equitable and person‑centred care, and that reasonable adjustments were provided when needed so that people experienced fair and supportive outcomes.

This meant people were more likely to experience equal access to support, consistent care provision and outcomes that reflected their individual needs.

People were not always supported to plan for important life changes in a timely and informed way, including those approaching the end of their life.

At the time of the inspection, two people were receiving end of life care. The provider and staff had a clear understanding of their current needs and wishes and worked closely with community nursing teams and hospital discharge services. However, managers confirmed there were no end-of-life care planning documents and they could not evidence that people’s wishes at the end of their life were being followed. In addition, not all staff had completed training in end‑of‑life care. This meant there was a risk people were not supported in a person centred way for key stages of their lives, including end‑of‑life care.

The impact of this was that staff may not have been able to recognise when someone's health was changing, or to be confident to provide the sensitive support people need at the end of their life.Following the assessment, the provider has told us they have made changes to their systems and processes to address the concerns identified. We have not assessed these changes as part of this inspection, and these improvements will require time to become fully embedded in practice.