Mill Hayes

We assessed a limited number of quality statements in the safe key question and found some areas of good practice and some areas of concern. The scores for these areas have been combined with scores based on the rating from the last inspection, which was good. At this assessment, the rating has remained good. This meant people were safe and protected from avoidable harm. However, we raised concerns over managing and recording risks to people effectively, storing medicines safely and ensuring staff were trained in all health conditions people experienced.

People told us they felt safe living in the home with the staff who supported them, and relatives told us there were enough staff on duty to support people safely. However, where risks to people were identified, such as risks from engaging in community activities, these were not always risk assessed. This meant the provider could not be assured people risks to people were managed safely.

Staff told us they received safeguarding training, and they told us how they would raise safeguarding concerns. However, where people’s condition posed a risk to their health, for example diabetes, staff had not received the required training. In addition, where people experienced swallowing difficulties or other conditions, not all staff had completed the training in a timely manner.

People received their medicines in a dignified way. However, medicines were not always stored in a safe, temperature-controlled environment. The manager was new to the service, they responded to all our feedback and completed the relevant risk assessments and ensured staff were enrolled onto the relevant training courses.

We assessed all of the quality statements in the effective key question and found areas concern. The scores based on the rating from the last inspection, was good. At this inspection the rating has changed to requires improvement. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent. We found 1 breach of the legal regulations in relation to safe care and treatment.

People told us they received care and support from visiting health professionals. However, visiting social care professionals shared their concerns over the monitoring of people’s health care needs. Where people needed their health monitored such as weights, fluids or nutrition, these were not always clearly recorded or monitored in accordance with people’s assessed needs. In addition, care plans or risk assessments did not document when and how risks were to be escalated. This meant the provider could not be assured people received effective care and treatment. This meant there was an increased risk that people could be harmed.

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. However, the assessments and systems in the service did not always support this practice. Where people’s choices were restricted, there was not always a mental capacity assessment or best interest decision record in place.

People told us they could make their own choices and decisions and we observed staff talking to people about their health and encouraging people to make healthier choices.

We assessed a limited number of quality statements in the caring key question and found areas of good practice. The scores for these areas have been combined with scores based on the rating from the last inspection, which was good. At this inspection the rating has remained good. This meant people were supported and treated with dignity and respect.

People were supported by kind and compassionate staff, who treated them with dignity and respect. However, at times staff used infantilised language to describe people’s responses to various activities.

People told us how staff encouraged them to be independent. We observed staff encouraging people to engage in a wide range of activities in the home and in the community. Staff respected people’s privacy and asked for people’s permission before supporting them.

We assessed a limited number of quality statements in the responsive key question and found areas of good practice and some areas of concern. The scores for these areas have been combined with scores based on the rating from the last inspection, which was good. At this assessment the rating has remained good. This meant people accessed care in ways that met their personal circumstances and protected equality characteristics.

People told us they were involved in their care planning and future goals. However, care plans did not record how and when these goals would be expected to be achieved. People told us how staff supported them to maintain relationships and how staff encouraged them to express their sexuality.

People told us about recent activities they had enjoyed. However, where people chose to spend time alone in their bedrooms, daily records did not always record the interactions or attempts from staff to engage with people.

We assessed a limited number of quality statements in the well led key question. The scores for these areas have been combined with scores based on the rating from the last inspection, which was good. At this assessment the rating has changed to requires improvement. This meant the services management and leadership was inconsistent.

We found 1 breach of the legal regulation in relation to good governance. Quality monitoring and record keeping did not always support the delivery of high-quality, person-centred care.

Staff told us the culture of the service focused on people’s safety. However, some staff told us further improvements were needed when promoting people’s independence skills and addressing conflicts between staff.

Quality auditing processes were taking place. However, these audits had not always identified the discrepancies found during this assessment. Monitoring of people’s health needed further improvement to ensure records were kept up to date. Further improvement was needed to ensure risks to people were assessed, monitored and concerns escalated in accordance with people’s assessed need.

The manager was new to the service and in the process of registering with us. The manager responded to all our feedback and introduced new systems and processes to audit the care and support provided. We will review the success of these new systems in the next assessment.

Staff told us the new manager was approachable and supportive.