Millers Grange

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 supportachieved 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 remained Good.

This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

This service scored 67 (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 made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

The provider had effective processes in place to assess people’s physical, emotional, and social care needs before they moved into the home. One person told us, “They came to see me in hospital before admission”.

A resident of the day process is in place which ensures people’s care needs are reviewed monthly. However, care plans did not always contain clear guidance on how to support people and some guidance was contradictory on how people were supported.

The provider did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them.

People’s nutrition and hydration needs were assessed and recorded in their care plan. If people were at risk of malnutrition, this was identified with details on what support staff needed to provide. For example, if people required a modified diet this was recorded. The registered manager shared weekly updates with the kitchen staff on people’s nutritional needs.

People’s feedback about food provision was mixed. One person told us, “Food is OK sometimes. Sometimes it’s cold and I do like hot food. I’m not one for spicy food so I don’t eat that. There’s always plenty and some choice.”

Staff recorded food and fluid intake to ensure people had sufficient fluids and nutrition. However, people had routinely been given a fluid target of 1500mls each day. This was not personalised, and there was no guidance in place detailing what action should be taken if the target was not met. We discussed this with the registered manager who advised they would review fluid charts.

Where additional support was required, staff made referrals to relevant health care professionals.

The provider worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

Staff worked in partnership with each other and healthcare professionals from local health teams, for example community nurses visited daily to administer a person’s insulin. Changes in people’s health and needs were discussed in daily meetings and other health professionals were contacted where appropriate.

There was effective communication within the staff team and staff told us the team worked well together, to meet people’s needs.Staff told us, “We are all listened to and heard. We have an open environment where we can discuss any concerns we have” and “Together we achieve more.”

The provider supported people to manage their health and wellbeing to maximise their independence, choice and control. Staff supported people to live healthier lives and where possible, reduce their future needs for care and support.

The service had weekly visits from the local GP, making it simple for people to access healthcare. Weekly seated exercise classes were held, care plans contained guidance on how to support people to go for walks outside.

The provider offered activities that supported healthier choices, staff responded effectively to people’s health needs and risks, helping prevent further deterioration.

The provider routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

There were systems in place to monitor people’s needs such as food diaries, fluid charts, weight charts and repositioning charts.

People were encouraged to be as independent as possible. The registered manager had introduced a ‘wish tree’ where people wrote down something they wished to do, and the provider supported them to achieve this. For example, one person had written they would like to go shopping, people told us shopping visits had happened.

The provider did not always tell people about their rights around consent and did not always respect their rights when delivering care and treatment.

Implementation of the Mental Capacity Act required further attention to ensure people were acting in people’s best interest and had the right to do so.

Whilst staff involved in completing Mental Capacity Assessment (MCA’s) and best interest decisions were trained in the Mental Capacity Act 2005, we found some of the Mental Capacity Assessments viewed were not always decision specific.

Where people had limited capacity, there was not always supporting capacity assessments in place to evidence how decisions had been made, and if support was provided within their best interest.

The provider had obtained consent from families to people having flu vaccinations. However, mental capacity assessments and best interest decisions were not completed. This is not in line with the principles of the Mental Capacity Act 2005.

The provider had identified in an internal audit that mental capacity assessments needed to be more person centred and contain more detail but did not identify the concerns we found during inspection.

Staff told us they respected people and gained consent before providing care. One staff member told us, “I would explain everything as I’m going through, ask them if it’s ok, explain what I’m doing and why I’m doing it.”