Millfield House

Millfield House provides accommodation and support for eight younger adults who have a learning disability and who live with autism. It is a detached Edwardian House with accommodation for six people in the main house and with a two bedroomed self contained annex that provides accommodation for two people. The service is close to the centre of Colsterworth, Lincolnshire. 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.

At our last inspection in March 2016, we rated the service good. It was rated good for safe, effective, caring and responsive and requires improvement in well led. At this inspection we found the evidence continued to support the rating of good and 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.

At this inspection, the service was rated good in all five domains and good overall.

People were protected from abuse and avoidable harm, by staff who understood their responsibilities for this. Staff identified risks to people’s health and safety and managed the risks without unnecessarily restricting people’s freedom. Staffing levels were planned to provide agreed levels of support and sufficient staff were available to maintain safe levels of care.

Medicines were managed and administered safely and people received their medicines as prescribed. The premises and environment were well maintained and the required safety checks were completed. Infection prevention and control was effectively managed.

Staff reported incidents and accidents and the registered managers ensured they were reviewed and learning identified to minimise the risk of recurrence.

Care was delivered by staff who were well trained and knowledgeable about people’s care and support needs. The registered managers carried out observations of practice and staff were provided with regular supervision and an annual appraisal.

People were provided with a varied and nutritious diet. Most people had very good appetites, however, we discussed the advantages of using a structured nutritional risk assessment when people lost weight.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. When people were unable to make decisions about their care and support, the principles of the Mental Capacity Act (2005) were followed.

The service remained caring. People were unable to express themselves verbally, however, we saw they were relaxed and comfortable with staff and had positive relationships with them. Relatives praised staff for their kindness and the way they cared about their family members. They spoke about the staff team’s patient and understanding approach.

People continued to receive care that was responsive to their individual needs and wishes. Staff communicated with them very well and offered them choices on an ongoing basis. People had access to a wide range of activities based on their interests and wishes. They led full and active lives. A relative told us they felt their family member had a fantastic quality of life which went beyond anything they could have expected for their family member.

The management team provided good leadership and support for staff. They made themselves available for people and their relatives and treated everyone with fairness and without discrimination. The views of staff and people using the service were actively sought and listened to. Quality audits were completed to monitor the quality of the service provided and promote continuous improvement.

Further information is in the detailed findings below

Millfield House can provide accommodation and care for eight people who have a learning disability and who live with autism. There were seven people living in the service at the time of our inspection. All of them had special communication needs and used personal versions of sign assisted language and symbols to express themselves. The accommodation was a main house and an annex where two people had a self-contained flat.

There were two registered managers who job-shared. 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.

Staff knew how to respond to any concerns that might arise so that people were kept safe from abuse including financial mistreatment. People had been helped to avoid the risk of accidents and medicines were managed safely. There were enough staff on duty to give each person the individual support they needed and background checks had been completed before new staff were appointed.

Staff had received training and guidance and they knew how to support people in the right way including how to respond to people who had special communication needs. People had been supported to eat and drink enough and they had been assisted to receive all of the healthcare assistance they needed.

Staff had ensured that people’s rights were respected by helping them to make decisions for themselves. The Care Quality Commission is required by law to monitor how registered persons apply the Deprivation of Liberty Safeguards under the Mental Capacity Act 2005 and to report on what we find. These safeguards protect people when they are not able to make decisions for themselves and it is necessary to deprive them of their liberty in order to keep them safe. In relation to this, the registered managers had worked with the relevant local authorities to ensure that people only received lawful care that respected their rights.

People were treated with kindness and compassion. Staff recognised people’s right to privacy, promoted their dignity and respected confidential information.

People had been consulted about the support they wanted to receive and they had been given all of the assistance they needed, including people who could become distressed. People had been helped to enjoy a wide range of interests and hobbies. There was a system for resolving complaints.

Quality checks had not always been effective because they had not identified the need to tell us about certain important events that had occurred in the service. Good team work was promoted and staff were supported to speak out if they had any concerns because the service was run in an open and inclusive way. People had benefited from staff acting upon good practice guidance.

At our earlier inspection we found that improvements needed to be made to the way in which people were protected from the risk of financial mismanagement. This was because some of the provider's records were not robust and did not effectively demonstrate how people's personal spending money had been administered by staff.

We said that this shortfall needed to be addressed so that people could be confident that their funds had been managed in the right way.

After our inspection dated 28 May 2014 the provider wrote to us and said that they had made the improvements that were necessary to address our concerns.

Our inspection dated 14 November 2014 examined the way in which people were supported to manage their personal spending money. We found that the provider had introduced all of the improvements that are necessary to protect people from the risk of financial mismanagement.

We considered our inspection's findings to answer questions we always ask: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led? This is a summary of what we found:

Is the service caring?

All of the people who used the service had complex needs for support. They used a combination of words, sounds and gestures to communicate. People said and showed us by their relaxed manner that they considered staff to be caring and attentive. We observed staff speaking to people in a courteous and polite way.

Is the service responsive?

We saw that people's individual needs for support had been assessed and met. Staff knew about each person's individual support needs, choices and preferred routines. People received the assistance they needed to do personal and household tasks. In addition, they were being supported to participate in social and occupational activities and to access the community. However, the service had not fully responded to people's special communication needs. This was because written information about the service and about the support people received was not always presented in a user-friendly way. This shortfall reduced people's ability to contribute effectively to decisions that affected them. In addition, some communal areas of the accommodation were not well presented and so did not provide people with a homely and welcoming space in which to receive support. Some parents thought that people who used the service would benefit from participating in a wider range of occupational and social activities that would engage their interests and provide them with more structure to their days.

Is the service safe?

Staff understood their roles and responsibilities to ensure that people were protected from the risk of abuse. However, the provider did not have robust systems to ensure that people were protected from financial abuse. This was because it was not possible to accurately check how some people had been supported by staff to spend their money. This had not created any immediate problems for people but it did increase the risk of financial abuse. We told the provider that it needed to put this matter right because it had a minor impact on people's wellbeing. People were protected against the use of unlawful or excessive control or restraint because the provider had made suitable arrangements. There were safe and reliable systems for ordering, administering and disposing of medication. However, some medicines were not stored in the right way to provide a high level of security.

Is the service effective?

The provider had employed enough staff and had ensured there were sufficient staff on duty to enable people to receive the individual attention they needed. People's needs for support had been kept under review so that their changing requirements could be met. The service had arranged for people to receive all of the healthcare they needed. Staff had kept in touch with parents so that they could continue to contribute to the support their sons and daughters received.

Is the service well led?

People who used the service and their parents had been consulted about how well the provision was meeting their needs and expectations. There was a clear line of management. This meant that important decisions about organising people's support were made by managers. At the same time staff who provided support could use their own judgement to provide a flexible service. Quality checks had been completed to ensure that important measures such as the management of medication, food hygiene and infection control were in place. Most of the necessary fire safety checks had been completed. However, some of them had not been completed in the right way and this reduced the level of fire safety protection provided in the service. There was an effective system for responding to incidents and accidents so that lessons could be learnt to reduce the likelihood of them happening again.

We found people received care and support that met their needs. We asked a person who used the service if they were able to do things they wanted to do and they answered, 'Yes.'

We found there were systems in place to keep people safe, and protect them from any harm or abuse. any risk of abuse, so there had not been any safeguarding referrals made. We asked a person who used the service if they felt safe at the home and trusted the staff. The person answered, 'Yes all the staff are nice.'

We found the staff team were supported through training and the provider assessed and monitored the quality of the service. Staff told us they felt they were provided with the training they required.