Millers Grange

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question Good. At this assessment the rating has remained Good.

This meant people were safe and protected from avoidable harm.

This service scored 72 (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 proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

Processes were followed to ensure all accidents, incidents, safeguarding concerns, and complaints were appropriately investigated and actioned.

Learning from incidents were shared with all staff in internal bulletins, these contained information on the incident, what actions had been taken and lessons learnt. For example, a person had developed pressure concerns, this information was shared via an internal bulletin. A unit manager provided extra training on how to care for this person’s skin. This meant this person’s skin was less likely to deteriorate in the future.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

Processes were in place to ensure safe systems were followed. A pre-admissions assessment was completed before people moved into the service to ensure people’s needs could be met.

Staff had access to information about people and their medical conditions. On the second day of inspection, we observed a staff member call the emergency services, they accessed information quickly and were able to provide the emergency services with up to date medical information.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

Staff we spoke with had a good understanding of how to safeguard people from abuse. One staff member said, “I would report it to the manager so they can refer. If I report to the manager there should be a follow up, if there isn’t I would report to CQC or the police, there are contacts we can contact within the company.”

Appropriate legal authorisations had been sought in relation to any restrictions imposed on people. People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the Mental Capacity Act (MCA). In care homes, and some hospitals, this is usually through MCA application procedures called the Deprivation of Liberty Safeguards (DoLS).

Processes were in place to safeguard people. This included policies and procedures for staff to follow and staff training. Records demonstrated safeguarding incidents were referred to the local authority and Care Quality Commission appropriately.

The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Information was available to support staff to communicate with a person who was unable to communicate verbally. Information detailed how the person expressed pain or discomfort. Systems were in place to manage people’s risks. For example, information was available on signs and symptoms to look for which may indicate potential health risks such as high or low blood sugars and documented the action staff should take.

The provider did not always detect and control potential risks in the care environment. They did not always make sure equipment, facilities and technology supported the delivery of safe care.

The building is a purpose-built care home and was well-maintained. On the day of inspection, the home was clean and free of malodours. It had been designed with wide corridors to accommodate wheelchairs and equipment. All rooms had en-suites, there were adapted bathrooms on each floor. There was level access throughout the building, including garden areas. Window restrictors had been fitted.

A range of health and safety checks were completed including fire drills, door checks, emergency lighting and water safety. The home had a maintenance manager who was responsible for carrying out regular safety checks.

Each unit had its own kitchenette. The provider told us staff supervised the kitchenettes and the use of the kettle. Kettles were readily accessible for anyone to use. Risk assessments were in place, however, we found these were not being followed, as kettles were left unattended. This meant people were at risk of burns and scalds if they used the kettle unattended.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

We received mixed feedback from people and staff on staffing levels. One person told us, “The [staff] are fine and look after me very well. Very nice carers. There are not enough staff. Only one on this morning and days often start like that. It’s very busy on this corridor with those who need a lot of attention. The buzzer can go on for quite a long time. They are respectful when they come. I am very conscious of the fact there are not enough of them.”

Staff told us, “Sometimes the staffing levels can affect how long people wait, it can make a difference”, “I don’t ever feel like I have to sacrifice the quality of care because I have to rush” and “We have enough staff to work which makes it easier to complete specific tasks. It means we can provide quality care to people.”

We spoke with the registered manager who told us they recently increased the number of staff deployed on one unit, after identifying people’s needs had changed and more staff were required to meet people’s needs.

The registered manager had a training matrix in place which evidenced most staff had completed all their statutory and mandatory training to ensure they were able to meet people's individual needs. The provider monitored people’s training compliance, where staff had not completed training, reminders were sent with a deadline to complete the training.

The provider followed safe recruitment practices and had ensured appropriate pre-employment checks were completed before staff were employed.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

The environment was clean and well maintained, a dedicated domestic team completed regular cleaning to ensure standards were maintained. The provider had recently introduced an infection prevention and control champion. This was an experienced member of staff who supported newer staff members to work in line with infection control policies and procedures.

On the first day of inspection the provider had additional infection prevention and control measures in place due to an outbreak in the service. The provider responded to changes promptly, on the afternoon of the inspection the controls measures in place had changed. When we asked why, the provider told us they had identified more robust measures were required and implemented these immediately.

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened.

Staff monitored the temperature of medicines rooms and fridges to ensure medicines were safe for use.

People’s medicines were managed so they received them safely. Procedures were in place and staff demonstrated knowledge and understanding of the processes. Staff recorded administration of medicines. Records were accurate and showed medicines had been appropriately administered.

Some people received ‘when required’ medicines. Individual protocols for these medicines are required so staff can recognise when medicines are needed and how it should be given.Most people had clear protocols in place. However, one person’s protocol did not contain sufficient guidance on when the medicine should be administered, the provider’s medication audit had not picked up on this. We informed the registered manager who was responsive to our findings.