2 Millbrook Way

2 Millbrook Way provides personal care and accommodation for up to six people with learning disabilities and/or autism. Accommodation is provided in a combination of single person and shared housing. At the time of inspection there were five people living in the home.

People's experience of using this service and what we found

People were not always safe because some of the risks in relation to people's behavioural support needs had not been reviewed and updated regularly. Learning from incidents which included physical intervention and restraint had not been fully recorded or analysed to avoid reoccurrence and improve practice. It was not clear what the procedure was for reporting any concerns about minor injuries received during physical interventions and restraint. We were not assured all staff had received suitable training to support people with physical intervention and restraint.

People were supported by enough staff who had been recruited safely. Staff appeared knowledgeable about the people they supported and worked compassionately with them. One relative told us "I do believe that [name] is fully supported to be safe and secure at Millbrook and also out in the community." And "There is always enough staff on duty to support [name] and there are always familiar faces and staff with the knowledge of the special skills needed to support them at any given time."

People's needs and preferences had been assessed with their involvement, as far as possible, their relatives and other professionals. People's assessments provided enough information to guide staff. A relative told us, "The staff are fully equipped with the knowledge they need and they are learning every day. The new staff are supported by the more experienced staff and they gain knowledge and skills as they progress with the support of the senior staff and management team."

The management oversight of the quality of care records had not identified the issues we found during the inspection in relation to incidents, which included physical intervention and restraint when supporting people experiencing distress.

People were supported by a committed, caring and motivated staff team. Staff we spoke with said they could always ask managers for support and felt they would be listened to and responded to.

Mental Capacity Act

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

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture

Right support

Staff focused on people’s strengths and promoted what they could do, so people had a fulfilling and meaningful everyday life. Care records included good detail about what was important to the person and how they preferred to be supported.

Right care

People received compassionate and kind support from staff who were motivated to understand their needs and provide person-centred care.

Right culture

Care records and staff interactions we saw demonstrated respect and understanding about the people living in the home. We saw people appearing to be delighted when some staff approached them.

The service was supporting people in ways that considered their ability to be involved in decision making and sought to protect their rights as citizens.

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

Rating at last inspection

The last rating for this service was good (published 21 December 2020).

Why we inspected

The inspection was prompted in part due to concerns received about safe care and treatment and staffing. A decision was made for us to inspect and examine those risks.

We have found evidence that the provider needs to make improvements. Please see the safe, effective and well-led sections of this focused report.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

Enforcement

We have identified breaches in relation to safe care and treatment, safeguarding vulnerable people, staffing and management oversight of incidents, at this inspection. We have also made a recommendation in relation to the protocols for reporting incidents to other professionals.

You can see what action we have asked the provider to take at the end of this full report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

People’s experience of using this service and what we found

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the guidance CQC follows to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture. People were supported in a person-centred way that upheld their rights and promoted choice and autonomy.

Right support:

• Model of care and setting maximises people’s choice, control and Independence

Right care:

• Care is person-centred and promotes people’s dignity, privacy and human rights

Right culture:

• Ethos, values, attitudes and behaviours of leaders and care staff ensure people using services lead confident, inclusive and empowered lives

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

Rating at last inspection

The last rating for this service was good (published 14 August 2018).

Why we inspected

We undertook this targeted inspection to follow up on specific concerns which we had received about the service. The inspection was prompted in part due to concerns received about infection prevention processes and care delivery. A decision was made for us to inspect and examine those risks.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

Follow up

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

This is the first inspection at 2 Milbrook Way following the providers registration with the Care Quality Commission (CQC) on 07 July 2017.

2 Millbrook Way is a six bedroomed specialist residential service supporting people with autism who may present behaviour which challenges. The home is set in one adapted building with two annexes accommodating two people with their own communal areas including a kitchenette and bathing facilities. One annex has a conservatory leading on to an enclosed garden. The main building accommodates four people in single occupancy rooms with ensuite wet rooms. Bedrooms were located over two floors. Communal space comprised of a lounge, kitchen and dining room located on the ground floor. Parking space is available for people visiting the home.

2 Milbrook Way is a 'care home.' People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

There was a registered manager in place. 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.

People who lived at the home told us they were safe, well cared for and enjoyed living at the home. Comments received included, “I love it here, it’s great.” And, “Yes I am happy here.”

Relatives spoken with during the inspection told us they were happy with the care provided and had no concerns about their family members safety. Comments received included, “I am happy with [relatives] care and have no worries about anything.” And, “The home is absolutely amazing. I cannot praise the staff high enough.”

Procedures were in place to record safeguarding concerns, accidents and incidents and take necessary action as required. Staff had received safeguarding training and understood their responsibilities to report unsafe care or abusive practices.

Risk assessments had been developed to minimise the potential risk of harm to people during the delivery of their care. These had been kept under review and were relevant to the care provided.

Staff had been recruited safely, appropriately trained and supported. They had skills, knowledge and experience required to support people with their care and social needs. These included daily outings, shopping, going to the library and playing football.

All staff had been trained in positive behaviour support and physical intervention to support people who may challenge the service.

The service had sufficient staffing levels in place to provide support people required. People had one to one support to enable them to pursue activities of their choice.

Staff responsible for assisting people with their medicines had received training to ensure they had the competency and skills required.

We saw there was an emphasis on promoting dignity, respect and independence for people supported by the service. They told us they were treated as individuals and received person centred care.

We looked around the building and found it had been maintained, was clean and hygienic and a safe place for people to live. We found equipment had been serviced and maintained as required.

The design of the building and facilities provided were appropriate for the care and support provided.

The service had safe infection control procedures in place and staff had received infection control training.

Meal times were relaxed and organised around people’s individual daily routines. We saw people had access to the kitchen to make snacks and drinks as they wished. People were able to choose what they wanted to eat and prepare their own meals.

People were supported to have access to healthcare professionals and their healthcare needs had been met.

People told us staff were caring towards them. Staff we spoke with understood the importance of high standards of care to give people meaningful lives.

The service had information about support from an external advocate should this be required by people they supported.

The service had a complaints procedure which was made available to people and their family when they commenced using the service. The people we spoke with told us they were happy with the service and had no complaints.

The registered manger used a variety of methods to assess and monitor the quality of the service. These included regular audits and satisfaction surveys to seek their views about the service provided.

Further information is in the detailed findings below.