Millbrook House

Millbrook House is a residential care home providing accommodation and personal care for up to eight young adults with learning disabilities and, or autistic spectrum disorder. At the time of the inspection there were seven people living there.

The service is an adapted manor house. There is one main communal lounge. Every bedroom is en-suite and some people had their own lounges and kitchens. The building sits in the same grounds as a children’s service. Some people transition from the children’s to the young adults service.

The service had not been designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/ or autism to live meaningful lives that include control, choice, and independence.

The service was within a campus style setting and was linked to a children’s service in the same grounds. However, the size of the service having a negative impact on people was mitigated by the building design fitting into the residential area and the other large domestic homes of a similar size. There were deliberately no identifying signs, intercom, cameras, industrial bins or anything else outside to indicate it was a care home. Staff were also discouraged from wearing anything that suggested they were care staff when coming and going with people.

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

Governance and performance management were not always clear or effective. The manager was in the process of implementing an improvement strategy but not all staff felt this had been explained to them effectively. Relatives spoke highly of the manager and told us they were involved and supportive of the improvements.

Some staff did not understand the safeguarding procedure and told us they would fear recriminations if they raised concerns. Since the manager was appointed four months before the inspection, they had implemented a proactive approach to risk assessment. This included encouraging people to take positive risks to develop their independence.

Care planning was focused on a person’s whole life, including their goals, skills and abilities. Before the manager took their role there was a reliance on restrictive practice which the manager had identified as requiring immediate improvement. The manager has since implemented positive behaviour support with the assistance of appropriate healthcare professionals.

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.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

We saw people were treated with dignity and respect in all their interactions with staff. Staff knew people well and knew how to communicate in a way that people understood. Staff demonstrated an understanding of the importance of people’s relatives or advocates being actively involved in their lives.

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 rating for this service was Good (published September 2018)

Why we inspected

The inspection was prompted in part due to concerns received about staffing and safety. A decision was made for us to inspect and examine those risks.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the Safe and Well-led sections of this full report.

At our last inspection we rated the service as Good. At this inspection we found the evidence continued to support the rating of Good. There was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection in May 2015. The home was registered for eight people, at the time of our inspection seven people were living at Millbrook House.

The service continued to keep people safe. Staff knew how to keep people safe and what to do should there be a problem. Risk to people was assessed and where possible actions taken to mitigate risk. People were cared for by sufficient numbers of staff who were trained to meet their needs and wishes. People’s medicines were administered and stored as prescribed. The service was clean and fresh and there were systems in place to prevent the spread of infection. The provider had systems in place to review incidents and to ensure actions were taken to where possible prevent re-occurrence.

People’s needs were assessed prior to moving to the service and there were systems in place to ensure people had their care effectively delivered in line with current legislation. This included working to ensure people had their right under The Mental Care Act (MCA) promoted. The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

People’s nutrition was promoted and people had a varied and balanced diet. The service worked closely with health and social care professionals to ensure people had optimum physical and mental health. People lived in an environment that suite their needs.

People were cared for by staff that treated them with kindness and compassion. People’s dignity was respected and where possible people were encouraged to be as independent as possible. People had an input into how their care was delivered and they were given a voice in how the service was managed.

The care of people was person centred and was responsive to their needs and wishes. People had a full and active life based on how they wanted to live their lives. People’s views were captured in a variety of ways. There was a complaints process in place. There were no outstanding complaints at the service.

The service was managed and run in the best interests of people. There was an open and empowering culture throughout the service. While there was no registered manager, a manager had been appointed and in the interim the home was being managed by an experienced manager from another service run by the provider.

There was a quality assurance system in place to identity and action any issues raised. Accidents and incidents were recorded and a system was in place to ensure lessons were learned and safety promoted. The provider ensured the service put people’s welfare first by working with other health care and social care agencies.