Millwater

Millwater is a residential care home that provides accommodation and personal care for up to 19 people with learning disabilities and/or autism. The home is split into three separate units which share a court yard garden area. At the time of the inspection 13 people lived at the home.

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

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.

Right support

People’s care and support was personalised. The accommodation met people's needs and plans were in place to refurbish some areas of the building. People were supported to have maximum choice and control of their lives. Staff supported people in the least restrictive way possible and in their best interests, the policies and systems in the service supported this practice. People's independence was promoted and their right to privacy was respected.

Right Care

Some aspects of medicines management needed to be improved. People felt safe living at Millwater. Staff had been recruited safely and they completed training to help them carry out their roles effectively. Staff knew people well and people and staff had developed positive meaningful relationships. Risks had been assessed and care records contained information which helped staff to provide safe care. People had access to a range of healthcare professionals which supported them to remain healthy and well.

Right culture

The registered manager demonstrated a good understanding of their role and regulatory requirements. However, some of the provider's governance systems were not always effective. The culture at the service had improved since our last inspection. People were empowered and their feedback was welcomed and listened to. Staff felt valued and the registered manager had a good overview of the care and support provided to people. People were supported to maintain relationships that were important to them which had a positive impact on their lives. People followed their chosen religions and were supported to embrace their cultural traditions.

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 requires improvement (published 08 July 2019) and there were 2 breaches of the Regulations. At this inspection we found the provider remained in breach of 1 regulation.

The service remains rated requires improvement and we have found evidence the provider needs to make improvements. Please see the safe and well-led section of this full report. This is the second time the service has been rated requires improvement.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection and was also prompted by a review of the information we held about this service.

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.

Enforcement

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

Follow up

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

About the service:

Millwater is a residential care home that was providing personal care for up to nineteen people living with learning disabilities and/or autism. The home is split into three separate units, Swan, Wren and Dove. At the time of the inspection 13 people lived at the home.

People’s experience of using this service:

The service should be developed 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. This should ensure people with learning disabilities and autism using this service can live as ordinary life as any citizen. The culture within the home had not always reflected the values that underpin the Registering the Right Support and other best practice guidance. Feedback from people, staff and relatives demonstrated the service was working to improve. This included choice, promotion of independence and inclusion so people with learning disabilities and autism using the service can live as ordinary a life as any citizen.

The management and recording of people’s medicines required improvement. Risks to people’s health and safety were assessed to ensure both the home environment and outings in the community were safe. However, they were not always up to date and reflective of people’s needs. Staff understood how to protect people from risk of harm. There were enough numbers of safely recruited staff. Staff had access to equipment and clothing that protected people from cross infection.

Staff had completed induction training that included safeguarding, medication, health and safety and moving and handling and felt they had the skills and knowledge to meet people’s care and health needs. Although training on some health conditions was required to ensure staff were aware of the current best practice to keep people safe. People were supported to access healthcare services. People, as much as practicably possible, had some choice and control of their lives and staff were aware of how to support them in the least restrictive way. We found people’s legal rights were protected and decisions, where appropriate, had been made in peoples’ best interests and recorded appropriately. However, some records could not be found to determine when applications made to restrict people in their best interests expired and new applications to be made. Most people’s nutritional needs were being met, although improvement was needed to ensure those at risk of moderate malnutrition were effectively monitored and offered appropriate foods.

There were missed opportunities for meaningful engagement with people although staff were seen to be kind, caring and had built good relationships with the people receiving care and support. Staff encouraged people’s independence, where possible and protected their privacy and treated them with dignity.

People were supported by staff who knew their preferences although more could be done to have information in a more accessible format to encourage people’s participation and choice. We were unable to review complaints made since the last inspection as paperwork could not be found. However, there was an easy read complaints policy and processes in place to investigate complaints and monitor for trends. Relatives knew who to contact if they had any complaints. We found care was tailored to meet people’s varying needs although reviews had not been completed for over six months. Activities were varied and person-centred.

The service was currently without a registered manager. There was improvement required to the monitoring of the service to ensure audits were completed and up to date. We received positive feedback from staff and the relatives of people living at the home on how the home had improved since the provider had introduced a new management structure. Staff were knowledgeable about their roles and spoke passionately about the people they supported. Staff felt supported by the management team. Relatives and staff were happy with the way the service was now being managed. The service worked well with partner organisations to ensure people’s needs were met.

Rating at last inspection:

Good overall with Requires Improvement under the question of is the service well-led (published 07 July 2017).

Why we inspected:

This was a planned inspection that had been brought forward due to the service being suspended.

Enforcement: Full information about CQC’s regulatory response to the more serious concerns found in inspections and appeals is added to reports after any representations and appeals have been concluded.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

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

Millwater HSCA is a registered care home providing accommodation for up to 19 people who require support with personal care. At the time of our inspection there were 14 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 2008 and associated Regulations about how the service is run.

Relatives and staff weren’t always confident about approaching the manager if they needed to.

People and relatives views on the quality of the service were not consistently gathered and used to support service development.

People were kept safe and secure, and relatives believed their family members were safe from risk of harm. Potential risks to people had been assessed and managed appropriately by the provider.

People received their medicines safely and as prescribed and were supported by sufficient numbers of staff to ensure that risk of harm was minimised.

Staff had been recruited appropriately and had received relevant training so that they were able to support people with their individual care and support needs.

Staff sought people’s consent before providing care and support. Staff understood when the legal requirements of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards (DoLS) should be followed.

People’s rights to privacy and confidentiality were respected by the staff that supported them and their dignity was maintained.

People had a variety of food, drinks and snacks available throughout the day. They were able to choose the meals that they preferred to eat.

People were supported to stay healthy and had access to health care professionals as required. They were treated with kindness and compassion and there were positive interactions between staff and the people living at the location.

People’s choices and independence were respected and promoted. Staff responded appropriately to people’s support needs. People received care from staff that knew them well and benefitted from opportunities to take part in activities that they enjoyed.