Milligan Road

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. 'Right support, right care, right culture' is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

About the service

Milligan Road is a residential care home providing personal care to 7 people with a learning disability and or autism at the time of the inspection. The service can support up to 8 people.

People's experience of using this service and what we found

Right Support: Risk management and oversight had improved. People’s support plans had been reviewed and rewritten to ensure guidance for staff was detailed and up to date.

Improvements had been made to how incidents were recorded and responded to. Further action was required to ensure documentation and management oversight was consistently completed. incidents were analysed and there was evidence of lessons learnt and action taken to reduce reoccurrence. However, further action was required to ensure patterns and trends were fully considered and debrief meetings were routinely completed to support learning opportunities.

Improvements had been made to how medicines were managed and administered. People received their prescribed medicines as prescribed and safely. Staff had detailed guidance to support them to administer medicines safely. There had been a reduction in the use of prescribed 'as required' (PRN) medicines, used for agitation and heighten anxiety.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Right Care: Improvements had been made to ensure people received care and support that met their individual care and support needs. People were protected from the risk of abuse and avoidable harm. Any restrictions and conditions imposed by DoLS authorisations, were documented, regularly reviewed and monitored.

People were supported to access health care services and support. Information was shared with external health care professionals in a person’s ongoing care. People received sufficient to eat and drink.

There were sufficient skilled and competent staff to meet people’s individual care and support needs. Staff clearly knew people well. People received opportunities to lead active and fulfilling lives, social inclusion and independence was promoted as fully as possible.

Right Culture: Improvements had been made since the last inspection and these were ongoing. Whilst sufficient actions had been completed to meet previous breaches in regulation, further time was required for new and improved systems and processes to become fully embedded and sustained.

The new management team had worked hard to make improvements; they were open and honest during the inspection and showed a commitment to further develop the service.

Staff were positive about the improvements made and felt well supported. Staff received ongoing training and opportunities to discuss their work, training and development needs.

Feedback from people and relatives were positive about how well staff met people’s individual care and support needs.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rated inspection for this service was requires improvement (published 11 March 2023). Breaches in regulations relating to safe care and treatment, safeguarding, consent and good governance were identified. The provider completed an action plan after the inspection to show what they would do and by when, to improve and meet the breaches in regulation related to consent. Warning Notices were served for the breach relating to safe care and treatment, safeguarding and governance.

At this inspection, we found sufficient improvements had been made, and previous breaches in regulation had been met.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection. The overall rating for the service has remained requires improvement based on the findings of this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Milligan Road on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

About the service

Milligan Road is a residential care home providing personal care to 8 people at the time of the inspection. The service can support up to 8 people.

People’s experience of using this service and what we found

Right Support: Risks were not always identified or assessed which put people at risk of harm. Incident forms were not always completed when staff had used chemical restraint on people. There was no analysis of these incidents to identify trends or prevent re-occurrence. People did not always receive their medicines as prescribed. Protocols for ‘as required’ (PRN) medicines used for agitation were not always detailed to provide staff with guidance. which put people were at risk of not having their medicines as prescribed.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

Right Care: Systems and processes were not operated effectively to ensure safeguarding incidents were investigated or outcomes completed to assess the safety of the service and prevent future occurrences. The provider failed to identify or manage risks posed by people's health conditions. People living with diabetes did not have care plans that reflected their current needs or inform staff how to mitigate known risks associated with the person's diabetes.

The service had enough appropriately skilled staff to meet people's needs and keep them safe. Good relationships were noted between people and staff and positive engagement was seen. All bedrooms were of single occupancy with communal areas available. People were seen choosing where they wanted to spend their day either in their own rooms or communal areas.

Right Culture: There had been a lack of consistent oversight at the service. We identified a number of shortfalls at the inspection. These included investigations, audits and monitoring and the operation and management of the service. The atmosphere in the service was homely and people and staff fed back that it was a family. Staff had received training for working with autistic people and people who have a learning disability. Staff meetings and supervisions were held and provided an opportunity to raise concerns and ask questions.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 6 March 2019).

Why we inspected

We received concerns in relation to the medicines management, staff conduct and the management of the service. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Milligan Road on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to consent, safe care and treatment, safeguarding people from abuse and improper treatment and good governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Milligan Road accommodates up to ten people in one adapted building. At the time of the inspection there were nine people in residence, of which two people were in hospital. Milligan Road supports people with a diagnosed mental health need, learning disability and whose behaviour can be challenging. Some people also have Autism.

This inspection took place on 7 February 2019 and was unannounced. We returned, announced on 8 February 2019.

Milligan Road had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Milligan Road was previously inspected by the Care Quality Commission on 24 and 26 May 2017 and was rated good. This inspection found the key question is the service safe to have been revised to good. The service did not retain the rating of good to the key question is the service well-led and was found to require improvement.

The overall rating following this inspection remains good.

The provider had recently appointed a head of operations for adult services who had taken over the role of registered person. The registered person had undertaken a range of audits in key areas for the purposes of monitoring the quality of the service. The audits undertaken had identified key areas of improvement were required and an action plan had been developed by the registered person. As with the registered manager, a registered person has a legal responsibility to meet the requirements in the Health and Social Care Act 2008.

Improvements identified including the decorating and replacing of floor coverings in communal areas of the service. The work to bring about improvement had started.

Opportunities to learn from accidents and incidents to improve the support people received were not fully utilised. Some staff had not completed or renewed their training in key areas to promote people’s welfare.

People’s views and that of family members were sought through meetings and the completion of surveys. People’s comments were not always followed through to ensure they received a response to requests they had made.

We found one area in which people were not fully supported to have maximum choice and control of their lives. The registered person and registered manager said they would review the restriction placed on people’s access to the kitchen. People’s capacity to make informed decisions had been assessed. Referrals had been made to relevant organisations to deprive people of their liberty which complied with the Mental Capacity Act.

People’s safety was promoted. People received their medicine as prescribed. We recommended that the provider access good practice guidance in relation to use of medicine for people with a learning disability and or autism.

People accessed a range of health care services with the support of staff. Staff and people using the service worked together to improve and maintain the health of people. People’s dietary needs, including specialist diets were catered for.

People were supported by sufficient and skilled staff to meet their individual needs. Potential risks to people were assessed and information as to how to reduce the risk were in place. This covered a wide range of topics to ensure people’s needs were met safely. Risk assessments were understood and implemented by staff.

Staff had a good understanding of people’s needs and had developed positive relationships with people which meant they were able to respond when people became upset or anxious. People were supported by staff to access the community for health care appointments and recreational events and activities. Staff supported people to maintain contact with family members.

Staff supported people to gain independent living skills, which included cooking and cleaning. For some people this was to help them in to achieve their goal and aspiration to move out of the service and to live independently.

244 Milligan Road is a residential home which provides care to people with learning difficulties who also have mental health needs. It is registered to provide care for up to 10 people. At the time of our inspection there were 10 people living at the home.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

People using the service and relatives we spoke with said they thought the home was safe. Staffing levels were sufficient to ensure people's safety. Staff had been trained in safeguarding (protecting people from abuse) and understood their responsibilities in this area.

Staff were subject to checks to ensure they were appropriate to work with the people who used the service, but these had not been comprehensively followed up when issues of possible concern had been noted. People's risk assessments provided staff with information on how to support people safely, though some assessments were not in place.

People using the service told us they thought their medicines were given safely and on time.

Staff had been trained, in the main, to ensure they had the skills and knowledge to meet people's needs. Staff understood their main responsibilities under the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) to allow, as much as possible, people to have an effective choice about how they lived their lives.

People had plenty to eat and drink and everyone told us they liked the food served. People's health care needs were met by referrals to health care professionals when necessary.

People told us they liked the staff and got on well with them. We saw many examples of staff working with people in a friendly and caring way. People and their representatives were involved in making decisions about their care, treatment and support.

Care plans were individual to the people using the service and covered their health and social care needs. Activities were organised to provide stimulation for people and they took part in activities in the community if they chose.

People and their relatives told us they would tell staff if they had any concerns and were confident these would be followed up.

People, staff and most relatives we spoke with were satisfied with how the home was run by the registered manager. Management carried out audits and checks to ensure the home was running properly to meet people's needs, though not all essential areas had been audited.