Millfield House

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 remained Requires Improvement. This meant the management and leadership was inconsistent. Leaders and the culture they created did not always support the delivery of high-quality, person-centred care.

The service was in breach of legal regulation in relation to good governance.

This service scored 61 (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 shared vision, strategy and culture. This was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding challenges and the needs of people and their communities.

There was a positive culture at the service where leaders and staff had a collective vision of the care they aspired to deliver, to support people in having a positive quality of life. Although some areas of service remained below the standard expected and exposed people to risk, all people, relatives and staff we spoke to had observed significant improvements and were confident that this would continue. The service promoted people’s independence, freedom and ability to live life on their own terms in a way that brought them meaning and supported their diverse needs. One staff member told us “Improving people's lives is the primary goal of this home and that's from what I've seen. It's about their emotional wellbeing as well as their physical care”. A relative added “If you had asked in autumn I would have raised concerns. Things have improved. The new manager does what she says and has my relative’s best interest at heart.”

Leaders embodied the culture and values of their workforce and organisation, however had not always ensured delivery of high-quality care.

Although all people we spoke to had noted significant improvements in the quality of care, there remained breaches in regulation and areas of care delivery which remained unsafe. Some of these areas had not been proactively identified through appropriate monitoring before the inspection or fully embedded in practice. For example, ensuring that staff had the knowledge they needed to perform their jobs safely. Leaders had not always ensured these risks were mitigated or monitored.

However, we received praise for the impact the new manager had on the service and people expressed confidence in their leadership. Most of the issues we identified were known beforehand and a plan in place to address them. The concerns we raised were responded to openly and used as an opportunity to improve. One person told us, “Since she's come the whole house has gone up from 10 notches.” Another person described how the manager had helped them resolve an issue and stated “The manager sorted it and I am a biggest fan. She's like a Mama bear fighting for her cubs”.

The provider fostered a positive culture where people felt they could speak up and their voice would be heard.

Staff told us they were confident in raising issues with the new manager. When asked about how staff felt about reporting concerns, one staff member told us, ‘They were very responsive, I felt like I was heard. I felt like because the manager is here, I had someone that would support me. In the past, if I said anything it would come back to us and it was almost as if we were the bad ones for speaking up. Things changed this time. Another staff member added “I would go the manager…no questions are off limits”. Although staff felt able to speak up, we noted that issues at the service had not always been consistently identified or addressed.

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.

The workforce at Millfield House was diverse, and staff told us of leaders supported them to share and celebrate their culture through their work. This included Nepalese New Year celebrations and a day of staff going into the service to cook Nepalese food for everyone. Another person told us the manager supported them with a change in role. They said, ‘I have a religious faith… it doesn’t affect my work because of the hours I work.’

Staff who had their own health conditions or were neurodiverse and told us the manager was very understanding and supportive. One staff member told us the manager adjusted their working pattern following open conversations together.

The provider did not have clear responsibilities, roles, systems of accountability and good governance. They did not act on the best information about risk, performance and outcomes.

Governance systems were not consistently robust to ensure people received care that was safe or were being supported by a staff that had an appropriate level of knowledge and training. Regular audits and checks were taking place which were effective in some regards, however they had not ensured that appropriate risk management or staffing systems were always in place.

Leaders stated that regular out of hours visits or spot checks had not been taking place because management time and resource. This meant there was not appropriate oversight of care provided throughout the day, including times where risks might be greater because of staffing levels being lower.

A lack of detail recorded in people’s care notes meant it was not always clear that people’s care was being provided safely or in line with best practice and prevented appropriate monitoring. The manager had identified and raised this as a concern prior to our inspection.

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

Partner organisations told us they had positive and open relationships with the provider and information was shared collaboratively to support the best outcomes for people. The provider participated in a local network of care homes who fell under the same group of GP practices (known as a primary care network), where they shared best practice and training opportunities. They also participated in the local Skills for Care Network to share learning and ideas with other care providers. One stakeholder told us “I feel that service have been highly proactive in their approach, particularly in seeking out training opportunities and signposting to the appropriate services when needed. They have been thorough in identifying risks that had previously gone unnoticed”. Another person who worked with the home added “The service appears to work very well with residents, staff are very supportive and seem to know individual’s very well and provide good care. The person I am working with is very happy there and has lived there many years. The new manager is very proactive in looking at community activities and new ways to engage the residents”.

The provider did not always focus on continuous learning, innovation and improvement across the organisation and local system.

The provider remained in breach of legal regulations, and risks to people living at the service remained evident during the inspection. However, the provider responded to all concerns raised openly, including making immediate changes address concerns about staffing levels and competency. Staff and stakeholders stated that leaders were committed to learning and had a clear vision for longer term improvements.

There had been a significant number of whistleblowing allegations which lead to the inspection. We found that robust processes were used to investigate these with openness and candour to drive improvements. There were systems in place to share learning with staff, for example regular staff meetings which discussed people’s needs. The manager attended local groups and was proactive at seeking additional training to support the delivery of care and worked collaboratively to share learning with other organisations.