Archived: Millway

Millway is a supported living service which provides care and support to people living in a ‘supported living’ setting so that they can live in their own homes as independently as possible. At the time of inspection, the provider was supporting 11 people within three different properties, however only two people in one property were being supported with their personal care needs.

People’s experience of using this service:

Improvements were required to the way people’s care was recorded and audited.

Improvements were required to the way care and staffing arrangements were planned.

People had risk assessments in place and staff were knowledgeable about people’s risks.

Safeguarding systems were in place and reported appropriately.

Staff were trained to meet people’s needs and supported.

People consented to their care and the registered manager had a good understanding of the Mental Capacity Act.

People were supported to have their healthcare needs met.

People were treated well and staff encouraged people’s independence.

People were able to maintain their privacy and dignity.

People had care plans in place which reflected their care needs.

Systems were in place to record and investigate complaints, though no complaints had been received since the last inspection.

The registered manager promoted a culture of openness and encouraged people to provide feedback on the quality of the service they received.

Rating at last inspection:

The last comprehensive inspection was rated, Requires Improvement (published 5 June 2018) with breaches. A follow up focussed inspection was rated Requires Improvement (published 9 October 2018) with breaches of Regulation 12 (Safe care and treatment) and Regulation 17 (Good governance) of the Health and Social Care Act 2018 (Regulated Activities) Regulations 2014 (Part 3).

Why we inspected:

This was a planned inspection, based on the rating of the previous inspection.

Enforcement:

We identified a breach of the Health and Social Care Act (Regulated Activities) Regulations 2014 relating to governance systems. Details of action we have asked the provider to take can be found at the end of this report.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Millway on our website at www.cqc.org.uk”

We undertook an unannounced focused inspection of Millway on 14, 15 and 20 August 2018. We visited the location office and one of the supported living houses on the 14 August, visited a person who used the domiciliary care service at their home on the 15 August and spoke to their relative on the telephone on the 20 August.

The team inspected the service against three of the five questions we ask about services: is the service well led, safe and effective. This is because the service was not meeting some legal requirements.

No risks, concerns or significant improvement were identified in the remaining key questions through our ongoing monitoring or during our inspection activity so we did not inspect them. The ratings from the previous comprehensive inspection for these key questions were included in calculating the overall rating in this inspection.

This service provides a combination of support as a domiciliary care agency and supported living service. It provides personal care to people living in their own houses and flats in the community and specialist housing. The supported living service provides care and support to people living in ‘supported living’ settings, so that they can live in their own home as independently as possible. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people’s personal care and support.

People using the supported living service lived in one ‘house in multi-occupation’. Houses in multiple occupation are properties where at least three people in more than one household share toilet, bathroom or kitchen facilities. At the time of our inspection, there were three people in total receiving support with personal care; one person was receiving domiciliary care and two people were receiving the supported living service. The service provides support to younger and older adults with physical and mental health support needs.

Not everyone using Millway receives the regulated activity of ‘personal care’; CQC only inspects the service being received by people provided with 'personal care'; help with tasks related to personal hygiene and eating. Where they do, we also take into account any wider social care provided.

At the last two comprehensive inspections in January 2017 and March 2018 this service was rated requires improvement. At this focussed inspection the service continues to be rated as requires improvement.

There was a registered manager in post; they were also the provider. A new manager had also been recruited and they were preparing to register as manager for the service. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the service is run.

The provider had made some improvements to the systems in place to assess, monitor and improve the quality and safety of the service. However, further improvements were required to ensure that audits were in place for all areas necessary and that required actions were taken in response to audit findings.

The arrangements in place to ensure that risks to people’s health and well being had improved. However, the provider had not ensured that the necessary documentation was in place to provide staff with information on environmental risks in people’s homes and guide them how to support people safely in an emergency. Although regular checks of equipment were in place, staff did not always take appropriate action when concerns were identified.

Where people required their medicines to administered via a specialist route, staff had not carried out necessary risk assessments to ensure they were following safe practice. The arrangements in place for medicines record keeping had improved and appropriate arrangements were in place for the storage of medicines.

Improvements were required to ensure staff working for the domiciliary part of the service consistently attended visits when people expected them. Within the supported living service, there were sufficient numbers of experienced staff that were supported to carry out their roles to meet the assessed needs of people.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People were safeguarded from harm as the provider had effective systems in place to prevent, recognise and report concerns to the relevant authorities. Staff knew how to recognise harm and were knowledgeable about the steps they should take if they were concerned that someone may be at risk.

Staff received training in areas that enabled them to understand and meet the care needs of each person. Recruitment procedures protected people from receiving unsafe care from care staff unsuited to the role.

People were supported to maintain good health and had access to healthcare services when needed. People were protected from the risk of infection by staff that were trained in infection control and complied with infection prevention procedures.

People and staff had sufficient opportunities to provide feedback and contribute to the running of the service. Surveys of people’s views and meetings had been carried out. People were supported by a team of staff that had the managerial guidance and support they needed to carry out their roles.

The provider and registered manager were still working on an action plan to achieve and embed the improvements required from the previous inspection.

During the inspection, concerns were raised with us about the standard of care and support provided to one person. In response to these concerns a safeguarding referral has been raised with the local safeguarding authority; this is currently under investigation.

At this inspection, we found the service continued to be in breach of two regulations of the Health and Social Care Act 2008 (Regulated activities) Regulations 2014. The actions we have taken are detailed at the end of this report.

This service provides a combination of support as a domiciliary care agency and supported living service. It provides personal care to people living in their own houses and flats in the community and specialist housing. The supported living service provides care and support to people living in ‘supported living’ settings, so that they can live in their own home as independently as possible. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people’s personal care and support. People using the supported living service lived in two ‘houses in multi-occupation’. Houses in multiple occupation are properties where at least three people in more than one household share toilet, bathroom or kitchen facilities. At the time of our inspection, there were ten people in total using the service; one person was receiving domiciliary care and nine people were receiving the supported living service. The service provides support to younger and older adults with physical and mental health support needs.

Not everyone using Millway receives the regulated activity of ‘personal care’; CQC only inspects the service being received by people provided with 'personal care'; help with tasks related to personal hygiene and eating. Where they do, we also take into account any wider social care provided.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At the last comprehensive inspection on 16, 18 and 19 January 2017 we found the service to be rated ‘Requires Improvement’ and the provider was in breach of two regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We asked the provider to take action to make improvements in relation to the governance of the service and the completion of medicines records. The provider submitted an action plan detailing the improvements that they would make to comply with the regulations; they stated that they would be compliant by 5 May 2017.

This is the second announced comprehensive inspection of the service and the service continues to be rated overall 'Requires Improvement'. The provider had not taken sufficient action to meet the breaches of regulation.

There were insufficient systems in place to assess, monitor and improve the service. Where the provider had identified issues with the quality of the service they had failed to implement the changes required.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible; the policies and systems in the service did not support this practice.

People were not always adequately assessed for their risks or have plans of care to mitigate their known risks. There was no system in place to assess people using current standards or evidence based guidance. People’s care plans and risk assessments were not reviewed regularly and contained out of date information.

Staff recruitment procedures needed to be strengthened to ensure that all necessary checks had been completed as part of the staff selection process.

People's medicines were administered as prescribed; however, the medicines administration records were not always fully completed.

Arrangements in place to ensure that staff had sufficient skills and knowledge to provide people with appropriate support required strengthening. Not all staff had received the training they required to provide people’s care. There was a lack of oversight of staff training. Staff received an induction into the service and did not work with people on their own until they understood the care needs of each person.

People and staff did not have sufficient opportunities to provide feedback or contribute to the running of the service. Surveys of people’s views and meetings had not been carried out as planned.

Sufficient numbers of staff were deployed effectively to provide people’s care and support.

People felt safe with staff and said that they had confidence in the ability of staff to support them safely. Staff understood the need to protect people from harm and abuse and knew what action they should take if they had any concerns. However, the registered manager had not completed safeguarding investigations as required by the local authority in the appropriate timescales.

Staff treated people with kindness and compassion. They spent time getting to know people and their specific needs and wishes. Staff were aware of the importance of managing complaints promptly and in line with the provider's policy. Staff and people were confident that issues would be addressed and that any concerns they had would be listened to.

People were protected from the risk of infection by staff that were trained in infection control and complied with infection prevention procedures.

There were systems in place to ensure people with a disability or sensory loss could access and understand the information they were given. These complied with the Accessible Information Standard.

Staff supported people to access health care services when required, to make sure people received appropriate healthcare to meet their needs. People at risk of malnutrition had their nutritional needs assessed to ensure that they were supported to maintain an appropriate diet. People were provided with the support they required to prepare their meals.

At this inspection, we found the service to be in breach of four regulations of the Health and Social Care Act 2008 (Regulated activities) Regulations 2014. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

There was a registered manager in post at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The provider had no systems in place for monitoring the quality of the service. The lack of oversight from the provider who is also the registered manager culminated in lack of supervision and appraisals for staff, inadequately maintained medication records and lack of formal records relating to the Mental Capacity Act and staff meetings.

People were supported to take their medicines as prescribed. However, records relating to the administration, ordering and stock control of some people’s medication were not fit for purpose. People were supported to maintain good health and had access to healthcare services when needed.

People had care plans that were personalised to their individual needs and wishes. Care plans reflected the support people required and care staff delivered care and support according to people’s preferences.

People received care from staff that were kind, caring and passionate about providing the care and support people wanted to enable them to stay in their own homes. Staff had the skills and knowledge to provide the care and support people needed. People told us that they felt safe in their own home and we observed people to be happy and relaxed around the staff that supported them.

Staff understood the need to protect people from harm and knew what action they should take if they had any concerns. Staff understood their role in caring for people with limited or no capacity under the Mental Capacity Act 2005. Documents relating to the MCA had not always been formalised.

Staffing levels ensured that people received the support they required safely and at the times they needed. The recruitment practice protected people from being cared for by staff that were unsuitable to work in their home.

Staff had good relationships with the people they supported. Complaints were appropriately investigated and action was taken to make improvements to the service when this was found to be necessary.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.