Milford Del Support Agency

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

Well-led – this means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture.

At our last assessment we rated this key question Requires Improvement. At this assessment the rating has improved to outstanding.

This meant service leadership was exceptional and distinctive. Leaders and the culture they created drove and improved high-quality, person-centred care.

The provider was previously in breach of the legal regulation in relation to the governance of the service. We found the service had significantly improved and was no longer in breach of regulation.

This service scored 93 (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 had a very clear shared vision, strategy and culture. This was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and an exceptional understanding of the challenges and the needs of people and their communities.

The culture of the service had significantly improved since our last inspection. The provider had implemented and embedded a person-centred culture, where people were supported to live fulfilled lives. A person told us, “Milford del is like a totally different place, my staff and my manager help me, I am less anxious and distressed, and my mental health has improved, this wouldn’t have happened before the new management team took over”.

Our previous inspection found the service was using outdated practices. Staff received expert training, support and mentoring from qualified leaders., This was an improvement since the last inspection and had led to a complete shift in the staff culture. Previously, staff were trained to focus on controlling people’s behaviour, instead of using a supportive approach. This change had contributed to a significant reduction of restraint, and increased people’s quality of life.

Staff and leaders now demonstrated a positive, compassionate, listening culture that promoted trust and understanding between them and people using the service.

For example, leaders and staff helped people to increase their independence and live full, active lives. People were supported to make their own daily choices. The team worked closely together. Feedback showed people felt in control and happy with their support.

People and families took part in regular meetings about their support. These meetings helped people stay involved in planning and decision-making. Feedback showed open, honest communication. Concerns were handled quickly, and ideas were shared.

The service completed daily audits for people who were supported by the MDT. These looked at any incidents and made changes when needed, with help from families and clinical teams. We saw many examples where peoples’ communication and self-calming skills had improved. This meant people no longer required 3:1 staff support to go out, they were able to go out anytime they chose as the support they needed was readily available.

A staff member said, “The co-production and working together ethic of Milford Del is refreshing to see, there is no 'us and them' culture, more an 'all as one' culture through the company. Managers actively seeking to engage support staff in all aspects of care for our people supported, not just the hands on side that would typically be the expectation of a support worker. The company strove to encourage staff to develop on their skills and progress to levels they want to achieve.”

The provider had exceptionally inclusive leaders at all levels who understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation. Leaders had the skills, knowledge, experience and credibility to lead effectively. They always did so with integrity, openness and honesty.

The leadership team had changed since our previous inspection. The current leadership team were experts in their field and shared their knowledge and experience with each other and with the staff. This had enabled them to turn around a failing service and fully embed outstanding practices, where staff felt empowered and supported to make a difference to people’s lives. A staff member told us, “…I knew of Milford Del’s previous CQC rating and so knew there would need to be a lot of hard work for the company to be brought back up to a satisfactory standard. What I have seen since working for the company is not a satisfactory standard, because it does in fact, far exceed satisfactory standards. The management team have worked tirelessly to bring the company up and along the way have continued to support the teams to a very high standard.”

People shared very positive feedback about the improvements made since the last inspection. They said the service became stronger, with excellent support for people. Staff talked about outstanding person-centred care, more life opportunities and stronger reporting. A staff member told us, “I left the company two years ago and came back a year ago and the changes that have been put in place now is amazing it is such a great company to work for... it's such a pleasure to work here especially with our wonderful management team at [name]”, Another staff member said, “The whole vibe around Milford Del has changed since [nominated individual] has taken over. Everyone appears to be singing from the same sheet, and this is reflected within the support delivered.”

There was an effective on-call system in place and staff who were on call knew people well. We observed the registered manager respond to an emergency whilst we were on site, they were very efficient and arranged for additional support. This meant the person and the staff were supported quickly and this prevented a potential hospital admission. A staff member said, “It's always refreshing to see such a hands on management team… Managers, Registered Managers who will drop everything to support on the floor when needs arise.”

The provider was exceptional at fostering a positive culture where people knew they could speak up and their voice would be heard.

The provider supported people to take part in human rights training at the office, which covered abuse, hate crime, and mate crime. People said they learnt how to speak up if they felt something was not right or if they felt unsafe. One person proudly showed us a certificate and said, “It was really good, I learnt so much and feel safer.”

The service created an app for people to give feedback, which people said was simple to use. The leadership team checked the app often and replied quickly. The nominated individual said people were more willing to speak up, both to raise concerns and to thank staff.

The service used creative tools to help people with multiple needs speak up. They used assistive technology and personal methods like stickers, pictures, and games. One person used a picture board with staff photos and pictures to show how they felt. The feedback was recorded and shared with the manager. Families and advocates were involved when appropriate.

People and families had regular meetings and felt safe sharing concerns. They said they could speak openly with the manager and leadership team. Concerns were dealt with quickly. A family member said, “We meet with the manager every week. Communication is open, and I fully trust Milford Del—they are always responsive and honest.”

When staff raised concerns, these were investigated, and actions were taken to maintain people’s safety and wellbeing. After any investigation, feedback was provided and lessons learnt were shared.

A staff member told us “The company is very responsive with any concerns that both the clients [people] and staff have and will implement any changes needed at the earliest opportunity- immediately if the situation requires it.”

The provider valued diversity in their workforce. They worked towards an inclusive and fair culture by improving equality and equity for people who worked for them.

Most staff said they felt supported and trusted the management team. Staff described the CEO and managers as inclusive, and reasonable adjustments were made to support staff to carry out their roles well. Staff were given chances to grow in their roles. There was a staff app with updates about policies, support options, and wellbeing. Staff also had access to a counsellor and employee assistance programme and were helped to use them when needed. A staff member said, “…at Milford Del, I've found a company that truly recognises the importance of invisible challenges. That level of empathy and understanding doesn't just stop at staff—it's embedded in the way we deliver care.”

We saw evidence that leaders took steps to ensure equality of opportunity and experience for the workforce within their place of work.

Our previous inspection found the service was using outdated practices, the provider developed new creative systems to improve and continuously monitor the effectiveness of the support being delivered.

The provider had effective quality assurance procedures to monitor quality of care. This included accident and incident analysis, behaviour records analysis, use of ‘when required’ medicines, health monitoring records and daily records. This had helped the staff record effectively and helped the team provide holistic support that safeguarded people from abuse. The weekly report was shared with the person, or their families. A family member told us “The care core teams are providing to individuals is incredible, granted there will always be obstacles to overcome through daily living however I feel Milford Del Support services strive to continually develop and better themselves. “Another family member said “... The data [quality manager] provides really helps with a client like [person] who is so busy and behaviours constantly changing, it means we have the longer term and wider picture and can see what is really happening, rather than trying to make decisions from anecdotal day to day views where sometimes you can lose sight of the wood for the trees”.

The service completed robust quality assurance audits that were completed regularly by the quality team and the management team which provided feedback on their findings and ongoing learning and development. They developed an action plan which was monitored and continuously developed. The service had up to date and appropriate policies in place to aid with the running of the service. For example, there was a whistle-blowing policy in place which provided details of external organisations where staff could raise concerns if they felt unable to raise them internally. The registered manager understood their responsibilities and was aware of the need to notify the Care Quality Commission (CQC) of significant events in line with the regulations. The rating from the previous inspection report was displayed prominently in the service and on the provider's website.

A staff member told us, “A whole new quality framework has been implemented to audit the level of care and support being provided. Previously quality assurance appeared non-existent.”

The provider clearly understood and carried out their duty to collaborate and worked in partnership, and services worked seamlessly for people. They always shared information and learning with partners and collaborated for improvement.

The provider had a strong working relationship with a local care agency. The provider ensured the agency staff worked with the same teams and received training specific to their needs, so as to ensure people had consistent support. This also enabled the provider to take on emergency care packages for people with multiple support needs.

The provider worked closely with local housing associations and spoke up for people when their needs changed. As a result, we saw housing associations made changes to people’s homes to prevent them from having to move and they could stay safe and comfortable in the future.

The service held fundraising events for a local charity that supported disabled people and their families. The charity told us,” ,,,,,, this has enabled us to provide support to hundreds of disabled children and their families across the island. Milford Del’s director is going to complete a 9,000 mile bike ride to raise additional funds…”

The service helped another local provider without charging them when there was an emergency evacuation of vulnerable people. The management team arrived at the scene within five minutes. They quickly found emergency accommodation for five people, helped them collect their personal belongings, and made sure they were safe. The people were happy with the support they received.

We saw numerous examples of where staff and leaders engaged with people to share learning that resulted in continuous improvements to the service. For example, regular audits and monthly engagement meetings.

The provider focused on continuous learning, innovation and improvement across the organisation and local system. They encouraged creative ways of delivering equality of experience, outcome and quality of life for people. They actively contributed to safe, effective practice and research.

The provider engaged people, their families, professionals and staff in the running of the service and invited feedback through informal chats, regular meetings and specific focus groups. Staff were also encouraged to regularly feedback via an online portal about the service delivery and share ideas and suggestions on how the service could be improved. Anonymous quality assurance questionnaires were sent to people, their families, staff and professionals once a year, and we saw the provider used this feedback to make improvements.

We also saw that the service had developed a multi-disciplinary team which had identified innovative ideas, resulting in better outcomes for people.