Millbrook House

Updated 17 March 2020

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

Inspection team

This inspection was carried out by one inspector and one Specialist Professional Advisor. A specialist advisor is someone who has current experiences of working in this type of care setting. In this case they were a qualified and practicing Learning Disability Nurse.

Service and service type

Millbrook House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service did not have a manager registered with the Care Quality Commission. Having a manager registered with the Care Quality Commission means they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided. A manager was in post and had submitted an application to register with CQC.

Notice of inspection

This inspection was unannounced.

What we did before inspection

We reviewed information we had received about the service since the last inspection, including when people had got in touch with us to share their concerns. We sought feedback from the local authority and professionals who work with the service. We used all of this information to plan our inspection. The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.

During the inspection

We spoke with three people who used the service, however, people did not always have the capacity to express their views, so we also spoke with three relatives about their experience of the care provided. We spoke with eighteen members of staff including the manager, assistant manager, senior care workers, care workers and nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider. We reviewed a range of records. This included four people’s care records and all medication records. We looked at three staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.

After the inspection

We continued to seek clarification from the provider to validate evidence found. We spoke with two professionals who regularly visit the service.

Updated 17 March 2020

About the service

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.