We carried out an announced comprehensive inspection of this service on 5, 20 and 21 March 2018. Breaches of legal requirements were found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches. We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Millway on our website at www.cqc.org.uk”
We undertook an unannounced focused inspection of Millway on 14, 15 and 20 August 2018. We visited the location office and one of the supported living houses on the 14 August, visited a person who used the domiciliary care service at their home on the 15 August and spoke to their relative on the telephone on the 20 August.
The team inspected the service against three of the five questions we ask about services: is the service well led, safe and effective. This is because the service was not meeting some legal requirements.
No risks, concerns or significant improvement were identified in the remaining key questions through our ongoing monitoring or during our inspection activity so we did not inspect them. The ratings from the previous comprehensive inspection for these key questions were included in calculating the overall rating in this inspection.
This service provides a combination of support as a domiciliary care agency and supported living service. It provides personal care to people living in their own houses and flats in the community and specialist housing. The supported living service provides care and support to people living in ‘supported living’ settings, so that they can live in their own home as independently as possible. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people’s personal care and support.
People using the supported living service lived in one ‘house in multi-occupation’. Houses in multiple occupation are properties where at least three people in more than one household share toilet, bathroom or kitchen facilities. At the time of our inspection, there were three people in total receiving support with personal care; one person was receiving domiciliary care and two people were receiving the supported living service. The service provides support to younger and older adults with physical and mental health support needs.
Not everyone using Millway receives the regulated activity of ‘personal care’; CQC only inspects the service being received by people provided with 'personal care'; help with tasks related to personal hygiene and eating. Where they do, we also take into account any wider social care provided.
At the last two comprehensive inspections in January 2017 and March 2018 this service was rated requires improvement. At this focussed inspection the service continues to be rated as requires improvement.
There was a registered manager in post; they were also the provider. A new manager had also been recruited and they were preparing to register as manager for the service. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 provider had made some improvements to the systems in place to assess, monitor and improve the quality and safety of the service. However, further improvements were required to ensure that audits were in place for all areas necessary and that required actions were taken in response to audit findings.
The arrangements in place to ensure that risks to people’s health and well being had improved. However, the provider had not ensured that the necessary documentation was in place to provide staff with information on environmental risks in people’s homes and guide them how to support people safely in an emergency. Although regular checks of equipment were in place, staff did not always take appropriate action when concerns were identified.
Where people required their medicines to administered via a specialist route, staff had not carried out necessary risk assessments to ensure they were following safe practice. The arrangements in place for medicines record keeping had improved and appropriate arrangements were in place for the storage of medicines.
Improvements were required to ensure staff working for the domiciliary part of the service consistently attended visits when people expected them. Within the supported living service, there were sufficient numbers of experienced staff that were supported to carry out their roles to meet the assessed needs of people.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.
People were safeguarded from harm as the provider had effective systems in place to prevent, recognise and report concerns to the relevant authorities. Staff knew how to recognise harm and were knowledgeable about the steps they should take if they were concerned that someone may be at risk.
Staff received training in areas that enabled them to understand and meet the care needs of each person. Recruitment procedures protected people from receiving unsafe care from care staff unsuited to the role.
People were supported to maintain good health and had access to healthcare services when needed. People were protected from the risk of infection by staff that were trained in infection control and complied with infection prevention procedures.
People and staff had sufficient opportunities to provide feedback and contribute to the running of the service. Surveys of people’s views and meetings had been carried out. People were supported by a team of staff that had the managerial guidance and support they needed to carry out their roles.
The provider and registered manager were still working on an action plan to achieve and embed the improvements required from the previous inspection.
During the inspection, concerns were raised with us about the standard of care and support provided to one person. In response to these concerns a safeguarding referral has been raised with the local safeguarding authority; this is currently under investigation.
At this inspection, we found the service continued to be in breach of two regulations of the Health and Social Care Act 2008 (Regulated activities) Regulations 2014. The actions we have taken are detailed at the end of this report.