Millies Care and Support Agency Limited

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question Good. At this assessment the rating has changed to Requires improvement.

This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

The service was in breach of legal regulations relating to safe care and treatment, medicines and safeguarding people from abuse and improper treatment.

This service scored 47 (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 have a proactive and positive culture of safety based on openness and honesty. Staff did not always listen to concerns about safety and did not always investigate and report safety events. Lessons were not always learnt to continually identify and embed good practice.

There was no tracker in place for incidents that had happened. This meant when incidents occurred, there was no record of what actions had been taken or whether further action was required or if the incident had been resolved. This meant the provider could not demonstrate that lessons were always learned or that actions were taken to prevent similar incidents from happening again, increasing the risk of recurring safety issues and reducing assurance that improvements were embedded.

We also found the Provider had not responded appropriately to a concern regarding a staff member. Instead of initiating a formal management process at that time, the provider told us they had decided to move the staff member as an informal resolution to address the issues that had been identified. This lack of investigation meant important lessons about the staff member’s conduct were not learned and no structured improvement plan was implemented. As a result, the provider was unable to ensure the concerns had been addressed or that people were adequately safeguarded from future occurrences.

However, people and staff knew how to raise concerns outside of the management team. All staff told us what they would do to help prevent the development of a closed culture. For example, if staff witnessed unsafe practices when delivering care, they told us they would raise a concern with their line manager. Comments included: “Safeguarding people and upholding their rights is really important.” Staff knew who to contact outside of the organisation in the event of identified concerns not being effectively addressed by leaders.

The provider did not always work effectively with people or healthcare partners to establish and maintain safe systems of care. They did not consistently manage or monitor people’s safety, nor did they always ensure continuity of care when individuals moved between different services.

For example, one person was referred to the service by the local authority (LA) with a needs assessment that identified potential risks. However, not all relevant information from the LA assessment was transferred into their care plans.

The Local Authority had identified another person as being on the dementia pathway. However, the provider had not transferred this information to the person’s care plan. Staff had reported in daily notes some issues with their abilities. Inspectors compared the two plans and spoke to staff about the different information. When inspectors mentioned the person might be struggling with their memory because of a condition, staff replied “oh really, that explains a lot”.

This meant staff did not always have access to all of the information required to help keep people safe from harm.

Despite this, people told us they felt safe. Comments from people included: “I have no safety issues when carers are there” and relatives confirmed this by telling us “My relative feels safe from any risks”.

The provider did not work well with people or healthcare partners to understand what being safe meant to them or how to achieve this. They did not focus on improving people’s lives or protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. Safeguarding concerns were not shared quickly or appropriately.

There was no effective system to track or monitor safeguarding concerns. For example, a person was allegedly exposed to harmful online content by care staff. Although the staff members involved were suspended, the safeguarding outcome remained unclear, and staff were re-instated without confirmed conclusions or effective oversight of risk mitigation.

When we asked about this, leaders were unsure of the outcome, and the manager advised they would seek urgent clarification. There were no performance related requirements for the member of staff set out by the registered manager. This meant the provider could not demonstrate that people were being protected from potential abuse, that risks had been properly assessed or mitigated to prevent similar incidents from happening again.Following the assessment the provider introduced a tracker for safeguarding concerns.

Another person had no heating in their home throughout the winter. The provider had not safeguarded this. The provider told us they did not think they were “responsible for sorting out housing issues”.

This meant the provider failed to ensure people were effectively safeguarded and to report issues under their duty of care to the appropriate authorities.

Although one of the managers had completed a safeguarding lead qualification, this level of training was not reflected in the provider’s overall safeguarding practice or the effectiveness of their systems and oversight arrangements. The shortfalls identified demonstrated that leadership knowledge had not cascaded into processes or consistent implementation across the service.

People told us they felt safe in their homes and that staff actively supported their safety. All staff we spoke with demonstrated a clear understanding of safeguarding principles and shared practical examples of how they keep people safe during care delivery. Comments included “I would report and document anything that was out of the ordinary” and “I would submit a form of concern,” Staff spoke confidently about recognising signs of abuse and explained the steps they would take to protect people.

The provider did not work effectively with people to understand or manage risks, and staff did not always have the information they needed to deliver safe and supportive care.

Several people were prescribed blood‑thinning medication, yet there was no information outlining the associated risks or the actions staff should take if concerns arose.

The risk of flammable emollient creams had not been assessed in 6 out of 7 people’s care plans we viewed. This meant the provider had not recognised or planned for risks of ignition posed by residue on soft furnishings. This resulted in shortfalls in available guidance for staff and the person using the creams.

When people’s care plans listed a range of different allergies, risks relating to these allergies had not been assessed which meant staff would not know what level of reaction allergies posed to people. This meant people were exposed to potentially serious health risks, including delayed or inappropriate responses to allergic reactions, as there was a lack of guidance on management of allergies. These gaps were highlighted during the inspection, and the provider told us they would update the relevant care plans.

Although care plans noted addiction and neglect, the provider had not risk assessed these during the inspection. 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 provider had assessed manual handling risks and staff demonstrated a sound understanding of how to move and handle people and the checks required to ensure equipment was safe and fit for purpose.

The provider did not always detect and control potential risks in the care environment.

Although people had environmental risk assessments, the provider’s health and safety policy stated that risk assessments must be completed as part of a person’s assessment of need and then reviewed regularly. The provider had failed to regularly review risk assessments. The policy also required that risk levels were routinely monitored to ensure ongoing safety. This meant risks may not have been accurately understood or effectively managed, and people were potentially exposed to avoidable harm because staff did not have up‑to‑date information to guide safe practice.

The provider did not always make sure there were enough qualified, skilled and experienced staff. They did not consistently follow safe recruitment processes to ensure staff were suitable for their roles and able to deliver care that met people’s individual needs.

We observed one applicant who had gaps in their employment history, and another applicant who did not have appropriate references. Although the provider had risk assessment procedures in place to support safer recruitment, these were not applied consistently. Where recruitment risk assessments were completed, they did not always identify or record the mitigating actions required, and there was no evidence of follow-up or managerial sign off.

This meant that while people’s feedback about staff was mainly positive, the provider could not demonstrate that recruitment decisions were safe or in line with their own recruitment and selection policy.

Staff told us they received regular training. During the assessment, we viewed training documents which demonstrated staff had all attended required training. However, the provider was supporting an autistic person but had not ensured that staff had completed specialist training in line with the requirements of Right support, right care, right culture.
This meant staff were not equipped to understand autistic people’s communication styles, sensory needs and preferred ways of receiving support, enabling more consistent, person centred care and support. Following the assessment, the provider ensured staff ahd undertaken training specific to autistic people and people with a learning disability.

The provider’s registered office had a training room for first aid. We saw examples of in-house training which included manual handling and first aid. Managers had training certificates which enabled them to provide training for staff. This training was delivered by the provider using specialist equipment which was intended to simulate real life situations. The training was delivered in line with Lifting Operations and Lifting Equipment Regulations 1998 (LOLER). This meant training for staff was personalised to the people who received a service from the provider.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies in a timely way. The provider had an infection control policy, and staff had completed relevant training.

People told us staff demonstrated good standards of hygiene in both domestic and personal care tasks and consistently wore the required Personal Protective Equipment (PPE). One staff member told us, “We put PPE on as soon as we enter the property, whether it’s for personal care, domestic tasks or giving medicines” and “If someone has flu, we always carry a mask in our pocket for every visit”.

The provider had a well-stocked cupboard of PPE. Staff comments included: “I can collect what I want when I need” and “The manager says we can keep extra in our cars for people”. This meant the provider had effective systems, training and guidance and staff practice to minimise infection risks and protect people from the spread of infection.

The provider did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff did not always involve people in planning.

Although people were receiving their medicine and staff were signing Medication Administration Records (MAR), the provider had not ensured that topical creams had been adequately applied. Five out of seven people’s care plans did not have any instructions of where to apply cream to people’s bodies., This meant the provider had not ensured people received their prescribed creams correctly, as staff were required to make assumptions about where creams should be applied.

Further, six out of seven people’s medication profiles did not contain information related to the risk of paraffin based flammable emollients. The Health and Social Care Act (2008) states: “Providers are legally required to assess and mitigate risks to service users, including the fire hazards associated with the use of emollient creams”. This meant the provider was not working in line with their legal obligations.

People did not have documentation in their care plans that outlined their individual preferences for taking medicines. This included important details such as when they preferred to take their medicines, what drinks they preferred to take them with, and whether medicines should be dispensed into their hand, onto a spoon, or into a pot. The absence of this information meant staff did not always have the guidance needed to support people safely and in accordance with their personal preferences.

However, one person told us, “I safely take medication with the carers present,” indicating they felt supported and safe during medicines administration.