Millenium Care Limited - 1 Old Park

Millennium Care Limited – 1 Old Park is a residential care home providing accommodation and personal care for up to ten people with learning and physical disabilities. At the time of the inspection there were nine people living at the service.

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

People living in the home had lived there for several years and staff knew them and their needs well.

People were supported to have maximum choice and control of their lives within the limitations posed by lockdown restrictions due to the COVID-19 pandemic. Staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, 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 providing support to people with a learning disability and/or autistic people.

The service was able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture. People were supported to live stimulating lives within the confines of the national lockdown. People had been restricted from taking part in their usual leisure activities during the lockdown but had recently started going out again and told us they had been to a day service, for walks, shopping and out for coffee. Activities provision was individualised to some extent to people’s likes, hobbies and interests and promoted choice, control and independence.

The registered manager had worked at the home for many years and was respected by staff who told us they felt well supported and could approach the registered manager for advice at any time.

Safe staff recruitment processes were in place but checks were not robustly completed to ensure staff were appropriately assessed as safe to work with vulnerable adults. In one case references did not match the information in the interview record and application form and in two others there was no evidence on file that the references were verified as being from employers.

We have made a recommendation that the provider follow safer recruitment practice.

Records showed a lack of full understanding of the Mental Capacity Act (MCA). Where a person was not able to consent to an important decision, for example to staff giving them prescribed medicines or having a COVID-19 vaccination, records did not show that a best interest decision process had been properly followed.

We have made a recommendation that the service seek further training on best practice in following the MCA.

Staff understood safeguarding and how to keep people safe from abuse and knew how to report any concerns. Staff received training and supervision to support them in their role.

People received their medicines safely and as prescribed. They were supported with maintaining a balanced diet which met their individual dietary needs.

Relatives’ feedback about the registered manager and staff team was overall positive. The manager and quality assurance manager carried out regular audits of records, medicines management and health and safety of the premises.

Rating at last inspection and update

The last rating for this service was requires improvement (published 20 June 2019). The registered manager had made improvements in all areas since then and the rating has improved to good.

Why we inspected

At the last inspection there was a breach of regulation as there remained a lack of suitable handwashing facilities and failure to use personal protective equipment when serving food. Although we had carried out monitoring calls with the registered manager and received assurance that improvements had been made, we needed to inspect to ensure the risks had been addressed.

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 coronavirus and other infection outbreaks effectively.

The overall rating for the service has improved to good.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Millennium Care Limited – 1 Old Park on our website at www.cqc.org.uk.

Follow up

We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

People’s experience of using this service:

People living in this home were settled and happy. They had mostly lived in the home for a long time and knew each other and staff very well. They had good support with their health needs.

The provider had made significant improvements in all areas since the last inspection. However, medicines were still not always being managed safely and infection control practices were not sufficient to protect people from the risk of infection in the home.

Staff knew people’s needs and preferences and behaved in a caring way towards them. Most relatives were happy with the support that people had in the home. The service provided people with support for their leisure and religious needs. People told us they enjoyed going out and got on well with each other and with staff.

Staff said they felt supported and enjoyed their work. They had regular supervision and training.

The provider had improved the management of the home since our last inspection. There were more effective audits taking place and the management team had worked hard to implement improvements.

The service worked well with other professionals since the last inspection and were following guidance from occupational and speech and language therapists which had improved the safety of the service for people with physical disability and those with eating and drinking difficulties. These people were now receiving a better standard of care.

Rating at last inspection: Inadequate. The last inspection report was published on 5 February 2019.

Why we inspected: This was a planned inspection based on the rating at the last inspection.

Enforcement: At the last inspection we found eight breaches of legal requirements. We served three warning notices on the provider for breaches of fundamental standards. We also issued five requirement notices. At this inspection we found one continued breach of legal requirements as infection control in the home was not satisfactory. The other legal requirements were now being met. This was evidence of significant improvements.

We have made one requirement notice about infection control and two recommendation about keeping records of food eaten by each person so the provider can be assured that people's varying medical and religious dietary needs were being fully met and about following best practice with medicines given covertly.

The service is no longer inadequate. It now meets most of the characteristics for a service which requires improvement.

Follow up: Going forward we will continue to monitor this service and plan to inspect in line with our re-inspection schedule for those services rated Requires Improvement.

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

Millennium Care – 1 Old Park Road is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The care home accommodates 10 people in a converted Victorian building across two floors. People had access to a large garden at the rear of the building.

Millennium Care – 1 Old Park Road had been built and registered before Registering the Right Support (RRS) had been published. The provider had not developed the service in response to the values that underpin RRS or changes in best practice guidance for providers of learning disability and autism services. These values and guidance includes advocating choice and promotion of independence and inclusion, so people using learning disability or autism services can live as ordinary a life as any other citizen. We found the service did not always conform to this guidance and values when supporting people.

There was a registered manager in place at the time of the inspection. However, they were not present in the home in the two months preceding the inspection. A deputy manager was overseeing the running of the service with support from senior management at provider level. 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.

The premises and equipment were not always maintained in a safe condition. Areas of the home were unclean. People were not adequately protected from the risk of infection as staff were not always adhering to basic infection control procedures.

People's health, safety and wellbeing was at risk because management at home level and above failed to adequately assess risk and provide sufficient guidance to staff on how to keep people safe from harm. We observed poor moving and handling practices during the inspection.

Medicines were not stored, documented and administered safely.

The provider did not always adhere to the Mental Capacity Act 2005. Where restrictive practices were in place, such as use of video monitoring and administering medicines covertly, documentation was not in place to ensure this was in the person’s best interests.

People were not consistently supported by staff in a respectful and kind manner. Care records contained insensitive terminology regarding people’s behaviours due to their learning disability or mental health condition.

People were not always receiving care in line with their needs and preferences. Although reviewed regularly, some care plans contained inaccurate or insufficient information. There was a lack of meaningful activities observed for people who remained at the service during the day.

People were not always supported to eat and drink. There was a lack of drinks at mealtimes and some people did not receive support to eat and drink in a timely manner.

There were not always enough staff deployed in the service to consistently meet people's needs. Care staff were deployed to non-care tasks such as cooking and cleaning. Staff were safely recruited.

Overall governance of the service was ineffective. Despite regular quality checks completed at both service and provider level, these had failed to identify the concerns identified on inspection. Where these checks had identified concerns with aspects of care delivery, sustained improvements had not been made.

Staff had received regular training, supervisions and an annual appraisal. However, we found that not all staff were competent in areas such as ensuring infection control and assisting people with moving or transfer.

People were supported to access medical services such as the GP and district nurse. However, we found instances of a lack of timely referrals to specialist health professionals.

There was a complaints procedure in place which included oversight at provider level. People told us they would speak to staff if they had any concerns.

Overall, we found significant shortfalls in the care provided to people. We identified seven breaches of regulation of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also found one breach of Care Quality Commission (Registration) Regulations 2009. Warning notices were served on the registered provider and registered manager for breaches of Regulation 12 (safe care and treatment), Regulation 15 (premises and equipment) and the registered provider was served with a warning notice for breach of Regulation 17 (good governance).

The overall rating for this service is 'Inadequate' and the service is therefore in 'Special measures'. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

At the last inspection on 26 June 2015, the service was rated ‘Good’. At this inspection we found the service remained ‘Good’.

All staff had completed training in safeguarding adults and demonstrated an understanding of types of abuse to look out for and how to raise safeguarding concerns.

Detailed current risk assessments were in place for people using the service. Risk assessments in place were reviewed and updated regularly.

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

There were systems in place to ensure medicines were handled and stored securely and administered to people safely and appropriately.

The home maintained adequate staffing levels to support people.

We saw friendly, caring and supportive interactions between staff and people and staff knew the needs and preferences of the people using the service. Care plans were person centred and reviewed regularly.

People had regular access to healthcare professionals such as doctors, dentists, chiropodists and opticians.

We saw evidence of a comprehensive staff induction and on-going training programme. Staff had regular supervisions and annual appraisals. Staff were safely recruited with necessary pre-employment checks carried out.

People were supported to engage in regular activities.

Quality assurance processes were in place to monitor the quality of care delivered.

Further information is in the detailed findings below.

We observed that staff spoke to people in a manner that showed respect. People were calm and relaxed in their interactions with staff. One person said they felt, "safe and secure here." People knew how to raise concerns about issues that affected their well-being. People said that staff knew how to meet their needs. We saw that staff understood people's needs and how to support them. One person said, "staff know how to help me."

We reviewed all the information we hold about this provider, observed how people were being cared for, looked at records of people who use the services, talked to staff, reviewed information from stakeholders and talked to people who use the service.

We observed that people were involved and consulted about decisions affecting their care. Staff knew how to communicate with people and spoke with them in a manner that showed respect. People were treated well by staff. A relative said, There are always enough staff, the home is never short staffed, it has an excellent standard of care.

People get the care they need here. We saw that staff understood people's needs and knew how to support them. Staff were well supported with relevant training and supervision. Suggestions from visiting professionals, staff and people using the service were used as the basis to improve the care provided by the home on an ongoing basis.