Milliner House

Milliner House is a residential care home providing personal care to up to 40 people. The service provides support to older people and people with mental health support needs. At the time of our inspection there were 39 people using the service.

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

People received safe support from staff and told us they felt safe within the service. Staff were trained in safeguarding procedures and understood how to report any concerns.

Medicines were safely managed and administered by staff who were trained to do so. Staff were recruited using safe recruitment procedures.

Any accidents and incidents that occurred were managed appropriately and documented for lessons to be learned.

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.

People and staff felt the service was well managed and felt confident to raise concerns if they had them. Staff were well supervised and understood their roles well.

Systems and processes were in place to ensure that quality remained consistent and action was taken as required in a prompt manner.

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

Rating at last inspection

The last rating for this service was good, published 23 June 2018.

Why we inspected

This inspection was 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.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Milliner House on our website at www.cqc.org.uk.

Follow up

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

We found the following examples of good practice.

Staff were checking people’s temperatures daily to see if people had COVID-19 symptoms. The registered manager made sure staff had daily COVID-19 tests. Staff promoted social distancing when possible and amongst themselves.

Staff wore personal protective equipment (PPE) correctly. The registered manager completed a weekly PPE stock check to ensure they had enough for the staff. The staff had received additional training on PPE and infection prevention and control (IPC). The registered manager and management team completed PPE and IPC competency checks on staff to assure themselves staff were acting in accordance with good PPE and IPC practice.

The registered manager had developed safe entry processes for professionals, suppliers and visitors. They had taken effective action when individuals did not adhere to this.

The home looked clean and there were no malodours. There was enough staff who supported people in a calm and kind way. The registered manager had created a ‘user friendly’ COVID-19 policy and plan for staff to follow.

Milliner House is a ‘care home without nursing’. 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.

Milliner House accommodates up to 40 people in one purpose built building across two separate units. One unit is primarily for people with needs related to their mental health, and the second is for people who are living with dementia. At the time of the inspection there were 35 people living at the home.

At the last inspection in January 2017 the service was in breach of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014. At this inspection we found that the necessary improvements had been made and the service met the standards required by law.

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.

Medicines were administered safely and people were supported to access health and social care services when required.

The provider had effective recruitment processes in place. Although we identified some gaps in the employment history for some staff recently employed, information was obtained and records were rectified during the course of the inspection. There were sufficient staff to support people safely.

Staff understood their roles and responsibilities in relation to the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Staff gained people’s consent before they provided any care or support to them.

People were supported to have choice and control of their lives and there were risk assessments in place that gave guidance to staff on how risks to people could be minimised without compromising people’s independence.

Staff supervision was provided regularly and training to enable staff to support people well was all up to date.

Staff were kind and respectful to people and we saw some very positive interactions during the inspection. People were supported to pursue their interests and to maximise their independence.

Care plans took account of people’s individual needs, preferences, and choices and were reviewed regularly.

The provider had a formal process for handling complaints and concerns. They encouraged feedback from people and acted on the comments received to continually improve the quality of the service.

The provider had a clearly defined set of values to underpin the service that were known and understood by staff. The registered manager promoted a person centred culture within the service.

The provider had robust quality monitoring processes in place to ensure they were meeting the required standards of care and these were used effectively to support continuous improvements to the service.

Milliner House provides accommodation, personal and nursing care for up to 40 people, some of whom may be living with dementia or physical disabilities. The service also supports people who require palliative and end of life care. At the time of our inspection, there were 35 people using the service.

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.

During our inspection we found the service was in breach of several regulations. You can see what action we’ve asked the provider to take at the end of the report.

There were systems in place to keep people safe, although we were consistently told that staffing levels were too low and that people’s needs could not always be met. Staffing dependency had been assessed but at the time of our inspection there was additional staffing required to ensure that people were receiving a good standard of care and support. The service had recently had a number of safeguarding referrals and we saw that appropriate action was being taken in response to these. Risk assessments were up to date and reflective of people’s changing needs, and there were robust systems in place to record and analyse data in respect of falls, accidents or incidents.

People’s dietary requirements were identified and the service were able to meet people’s specific dietary needs. However the menu had not been developed with people’s individual choices and preferences in mind, and we received poor feedback in relation to the quality and consistency of food. People’s medicines were managed safely although some people told us that the use of agency staff meant that there was sometimes a lack of consistency with the way in which they were administered. People’s healthcare needs were identified and they were supported to attend appointments and access healthcare professionals as required. People had care plans in place which were detailed, person-centred and responsive to their changing needs.

People were cared by staff who knew and understood their needs and demonstrated a kind, compassionate and patient approach. However a high turnover of staff and use of agency staff meant that people did not always receive a consistent quality of care. Pressures on time meant that people were not always supported to have their choices upheld or their views heard. There was an activity co-ordinator in post and people had access to activities, however on the day of the inspection we observed a lack of structured activity or stimulation for people.

Staff received a variety of training that enabled them to carry out their duties effectively, and were supported through on-going supervisions and appraisals. New staff were provided with a thorough induction into the service when they started. The service had a robust recruitment policy in place to ensure that staff recruited to work in the service were suitable.

There was a new registered manager in post and most staff were positive about them, although some expressed concerns about the decline in quality of the service. The service was subject to a number of quality audits which identified areas for improvement and suggested remedial actions to be taken. Staff were able to contribute to the development of the service through team meetings and understood the visions and values of the service.

We considered our inspection findings to answer questions we always ask;

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well-led?

This is a summary of what we found.

Is the service safe?

People were cared for in a safe and well maintained home. We found that the home was cleaned regularly and infection control checks were carried out by the home manager to ensure that people were protected against the risk of infection. Risk assessments had been put in place for people and staff were aware of the risks and how to manage them and protect people who used the service.

Is the service effective?

We observed the care provided to people and from our conversations with both staff and people using the service that people were happy in their surroundings and were able to move about the home freely. People we spoke with told us that staff "looked after us really well" and that the care they received was "beautiful and out of this world". Staff told us that they felt supported and were able to spend time with people. We saw that the care plans were regularly reviewed and contained detailed information about the person and their needs which meant that staff were kept aware of people’s needs and were therefore able to provide the correct care and support.

Is the service caring?

People told us that staff were caring, polite and courteous. One person said, “Staff keep us clean" and were good with us". We observed during our inspection that staff listened to people and responded to their requests quickly. We observed staff interacting with people. Staff told us that it was a "very good home" with "good Staff". We saw from feedback provided by families that they described the home as very friendly and that staff were always ready to talk about concerns the families may have. Staff also told us that the care provided was carried out in a person centred manner and people were given the choice of their daily routine.

Is the service responsive?

Care plans and risk assessments were reviewed regularly by the manager to ensure that they could respond quickly to any changes in people’s care needs. We saw that people’s needs were attended to by the staff and the home was quick to involve and consult with health professionals and other agencies to ensure that people received the right care and support. For example, doctors and mental health professionals.

Is the service well-led?

The home had a registered manager in place. Staff told us that since the arrival of the new home manager there had been a "big improvement" in the management of the home and the care that was being provided. We were told that the manager was "very supportive". Staff felt that they could "go to them with any problems". We were told that the manager was always available and at the end of the phone if required. We saw that the manager was continuously monitoring the effectiveness of the care through audits and daily checks. We saw evidence that the manager had received training in all areas of care and was able to provide support to people if required. We found that the manager was aware of people’s needs and background; and quickly responded to their concerns in order to put them at ease. People were comfortable to approach the manager with their concerns.

We observed that people were offered support at a level which encouraged independence and ensured their individual needs were met. Medication processes were monitored via an electronic system, and staff ensured people received their prescribed medication on time.

We noted that people who used the service were involved in making decisions about their care and support. Within the care files we saw that care documentation had been signed by the individual or a representative to confirm their involvement and agreement with their particular care needs.

There were systems in place to give staff support and guidance on an ongoing basis, and an e learning training programme was in place so that staff could update their mandatory skills, knowledge and competencies. There were also opportunities for staff to undertake training in more specialist subjects.

People who used the service and visiting relatives we spoke with, said they felt the manager was approachable, and they were confident any concerns or complaints they had would be addressed without delay.

We observed that people were offered support at a level which encouraged independence and assured that their individual needs were met. The staff were friendly and polite in their approach and interacted confidently with people, and there was a relaxed atmosphere in the home

We noted that people were encouraged to express their views and were involved in planning their care and making decisions about their support and treatment, and how they spent their time. One person said. "I'm very happy here I can go out with my daughter whenever I like". They also talked about the range of activities and entertainment that was available to them. Within the care files we saw that care documentation had been signed by the individual or a representative to confirm their involvement and agreement with their particular care needs.