Millfield House

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated this key question Good. At this assessment the rating has changed to Requires Improvement. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

The service was in breach of legal regulation in relation to safe care and treatment.

This service scored 54 (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’s care and treatment were effective because they did not always ensure risks were appropriately documented or reviewed.

People’s care was regularly reviewed alongside them as their needs changed. Whilst care plans and risk assessments were generally up to date, in some situations they did not always reflect all risks to people or document appropriate measures to reduce them. This included around the risks posed to people who had chosen not to follow a prescribed diet, or around the risks to people who drank alcohol in larger quantities. After these concerns were raised, the provider ensured appropriate medical advice was sought for how to document or reduce these risks.

The provider did not always ensure delivery of evidence-based care and treatment

Staff we spoke to could not always clearly articulate people’s specific needs, or how they should be safely supported. Although care plans contained appropriate levels of information on the care people should receive, the lack of detail in people’s daily care notes meant we could not always be assured that this was being received. We found that daily notes on how staff supported people were supported each day lacked detail and we were not assured that people’s needs were met or that care plans were followed.

However, professionals who worked with the service spoke positively about how they sought and followed clinical guidance that they provided. One stakeholder told us, “We call the home weekly. There is nobody who is concerning me at the moment. They make 111 calls appropriately if needed and are good at making sure people with learning disabilities get annual health checks.”

The provider did not always work well across teams and services to support people.

Although staff expressed confidence in the teams they worked with, the care being delivered did not always demonstrate that it was meeting people's needs in a way that was safe or in line with best practice. There were not always enough staff who were trained in specialist tasks such as administration of medicines to meet people’s needs or to perform key tasks to ensure continuity of care.

The provider did not always support people to manage their health and wellbeing, so people could not always maximise their independence, choice and control. Staff did not always support people to live healthier lives, or where possible, reduce their future needs for care and support.

Whilst there was guidance on how people could be supported to live healthier lives, it was not always clear if this was being implemented. For example, one person had diabetes and had healthier eating guidance to maintain their health such as to encourage healthier meal choices. However, care notes showed no evidence that these were being offered despite the additional health risks posed by their diabetes and their diet choices. Another person would regularly drink alcohol and there was guidance for staff to encourage offer healthier drinks. It was not recorded that these were being offered. Staff were guided to encourage another person to take part in regular physiotherapy activities. These were also not recorded as being encouraged or undertaken. Therefore, the provider could not be assured that staff were supporting people to live healthier lives in line with their own guidance, or to document healthier choices were being offered even if people had the right to decline them.

However, people were supported to access regular appointments with health professionals including reviews of complex conditions including cancer screening and to review medications. One person told us “Staff contact the GP for me when needed. They arrange wheelchair reviews for me once a year when I remind them. I also attend the dentist regularly.” The service worked in partnership with local services to embed strategies to improve people’s health outcomes, for example one person frequently had concerns with the condition of their skin but this had since significantly improved.

The provider did not always routinely monitor people’s care and treatment to continuously improve it. They did not always ensure that outcomes were positive andconsistent, or that they met both clinical expectations and the expectations of people themselves.

Further improvements were needed to ensure leaders could appropriately monitor how risks to people were being managed, to make sure these met people’s needs and wishes. This related to a lack of consistent detail in recording of care notes. One person had to be repositioned to protect the integrity of their skin. However, where this was not taking place as scheduled, no clear reason was recorded. Where people had risks posed by their nutrition or hydration it was not recorded how healthier options were being offered. Most people were required to be weighed regularly; however this had not happened consistently, or readings which had been taken were later discovered to be inaccurate. One person was required to be weighed regularly but this had only taken place 3 times in the last year.

However, other elements of people’s care were being closely monitored, such as ensuring people were drinking enough fluids and that the risks to people with constipation were safely managed. There were informal processes for reviewing what social outcomes people wanted from their care, and people said these were discussed with them to ensure care continued to meet their wishes and preferences.

The provider told people about their rights around consent and respected these when delivering person-centred care and treatment.

People told us that staff always sought consent such as entering their private space or providing personal care. One person told us “Staff treat me with respect regarding my privacy and dignity. They always knock before entering my room.”

Where people lacked capacity to make decisions for themselves, best interest meetings were held which involved people’s representatives and other professionals involved in their care. These decisions were regularly reviewed to ensure they remained in people’s best interest.