Mill House

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.

Good: This meant people were safe and protected from avoidable harm.

This service scored 69 (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.

Accidents and incidents were analysed and trends and patterns identified to mitigate future risks. The provider had a detailed protocol which guided staff on the correct action to take in the event of an accident. Lessons were learnt to improve practice and clearly communicated to staff in daily handovers, supervisions, weekly clinical risk meetings and staff meetings.

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.

People’s care plans included personal emergency evacuation plans (PEEPS) to ensure people were supported safely in an emergency. These plans were detailed and gave clear instructions to minimise disruption. When people attended hospital, they were given a copy of the front page of their care plan and a copy of their prescribed medicines.

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 were knowledgeable about recognising and responding to safeguarding concerns and were passionate about keeping people safe. The service engaged well with the community to ensure people were protected. One staff member said, “Abuse is very varied. Find out the nature of the abuse and we know what signs to look out for, we ask people and see what they say, how they are behaving. I’ve worked here for a long time, and experienced staff can pick up on things that are not right. We would record concerns and then we would escalate this to the manager.” The service had oversight of safeguarding concerns and complaints and investigated these appropriately.

The service did not always work well with people to understand and manage risks. They did not always provide care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Risks associated with people’s care and support were identified and managed to keep people safe. People’s freedoms were not limited, and staff supported people in their choices. People told us they felt safe living at the service. One relative said, "My [relative] feels safe." Staff knew how to minimise risks. One staff member said, “I manage risks by identifying potential hazards conduct risk assessments and keep up to date reading care plans.” However, we observed staff using incorrect moving and handling practices to assist a person to transfer from a wheelchair to a chair, this put the person at risk of harm. Staff had received training, and competency checks in manual handling. The regional director and deputy manager were informed of the observation and told us they would take action to prevent the incident from occurring again.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

The provider had recently completed a full refurbishment of the service including new carpets, paint and furniture. At the time of our assessment the provider had not received all of the décor for the top floor which was being planned as a specialist dementia unit. The provider ensured all actions had been taken to safely manage the risk of fire. People benefitted from an environment that was warm and clean. Radiators were covered, flooring was clean and free from obstruction. Window restrictors were in place and functional, both in communal areas and in people’s bedrooms. There were adaptable showers and bath equipment available so those using wheelchairs could bathe or shower. Records showed health and safety checks were carried out regularly. Care equipment, such as moving and handling aids, were serviced and records of maintenance kept. People’s bedrooms were clean and tidy; however not all bedrooms were personalised with people’s own furniture, photographs, books, and bedding. It was not clear if this was because of people’s choice or because they had not been encouraged to personalise their space.

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.

Staff received effective support, supervision and development, and worked well together to provide safe and effective care that met people’s individual needs. People, their relatives, staff and health care professionals told us the staffing level at the service was good, except for on the weekends. One relative told us, "The weekends there's no-one here, there's no-one on reception. I waited ten minutes to be let in. Others have waited a lot longer." There was no impact to people as a result of this. The regional director told us there were no weekend receptionists and therefore staff were not always aware of when the front doorbell rang. They had recently upgraded their intercom system to link to staff radios, which should decrease the amount of time people waited for staff to answer the door on the weekends. There was an effective staff training programme, and staff had received the training required to meet their role and responsibilities. Checks were made to ensure staff were recruited safely; all necessary checks had been completed, and documents were up to date. A robust induction and probationary period were followed, and all staff benefited from regular supervision and appraisal. One staff member told us, “I feel we’ve had sufficient training to do a good job; however, I would be happy to have more training on specific areas such as manual handling.” Agency staff were given clear handovers and important information about people when they started their shift.

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.

One person told us, “It’s a beautiful place.” A relative told us, “The standard of décor and overall cleanliness is very good.” We spoke with cleaning staff who told us they had the time and products needed to keep the service clean and tidy. Staff told us they had sufficient PPE (personal protective equipment) to provide safe care, and we saw this was available throughout the service. Staff had received infection prevention and control (IPC) training and were familiar with the IPC processes to mitigate infection risks. One member of staff told us, “We constantly observe the floors and make sure everything is in order. I observe the bathrooms, making sure they're kept clean. We work with housekeeping and kitchen staff. There’s enough PPE, and if we need more, we only have to ask the housekeeping staff. We have training in infection control.”

The provider did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff did not always involve people in planning.

Medicines were mostly given safely and in line with procedure. However, some staff did not administer medicines appropriately. For example, we observed one person being given medicine with their evening meal when the medicine was to be given on an empty stomach. We also found some gaps in the recording of the application of topical medicines (creams). The provider did not have body maps available with the Medication Administration Records (MAR) and staff had to rely on reading the label. Body maps were available on the electronic care plan system, however this had to be accessed separately by staff administering medicated creams and was not a smooth process. Additionally, some protocols for medicines to be given as and when required, often referred to as PRN, lacked some details such as when to offer PRN. There was a risk staff would not know when to administer these medicines. We shared this information with the deputy manager and regional manager, who told us they would address this. The provider employed a senior nurse who worked across several services and assisted the service with medicines optimisation processes and gave advice on how to support people and their medicines.