Mill Hayes

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

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.

This service scored 58 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Care plans were in place for each person. People told us they had choice and control over their lives, and we observed staff discussing people’s choices with them. However, care plans were not kept updated with people’s changing needs. This increased the risk of potential mistakes and confusion over people’s care and treatment. The manager responded to our feedback and discussed new quality auditing processes they were planning to implement to keep care plans updated with people's changing needs.

Staff told us about people’s needs and risks and how they encouraged people to gain more skills and experiences. However, these actions were not always documented in the appropriate records.

Care plans were not updated with people’s changing needs and some care plans contained conflicting information.

People told us they were supported safely and could access health professionals if needed. However, we discussed daily recording with the manager, highlighting how daily records often lacked detail and on one day a person's daily record was blank. There were no details of any evidence based care and treatment. The manager investigated and discovered the reason for this. However, this had not been identified through any of the providers monitoring or handover systems.

Staff told us there were regular meetings where risks to people or people’s changing needs were discussed. Staff told us risks to people were passed on during handovers. However, handover documents were often brief and contained limited information. The manager explained they had recognised this and had introduced a new handover record. We will review the success of this new system in the next assessment.

Risk assessments did not always evidence how staff were to safely support people to manage their health conditions. Where people received a diagnosis such as diabetes there were no clear risk assessments in place to provide staff with clear guidance. Where information regarding diabetes was recorded in care documentation this was outdated and required updating. Where people required weights, fluid and/or nutrition monitoring there was inconsistency in the recordings and unclear auditing or monitoring. The provider responded to our feedback by updating records and producing a clear diabetes risk assessment. New recording and auditing systems were introduced to monitor people’s health conditions.

People told us they received support from visiting care professionals. One person told us they were receiving a visit from a health professional during the 2nd day of the site visit. We observed the health professional visit the service and attend to the person's needs.

Staff told us the provider worked in partnership with other professionals and we observed health professionals visiting the service. However, one person was not being supported in accordance with their SALT assessment as documented in the care plan. Speech and language therapists (SALT) assess difficulties with swallowing and communication. The manager told us the person had since been reassessed and showed us the most recent SALT assessment. However, the care plan had not been updated in a timely manner. The manager updated the care plan with this information and introduced a new monitoring system to ensure care plans are kept up to date with people’s changing needs.

Visiting professionals told us they had concerns over how the provider monitored people’s fluids. They told us people's fluids were not monitored safely or consistently. The manager shared their action plan. This highlighted how they planned to action the findings from the visiting professionals. However, we also found similar concerns with people's fluid monitoring.

The provider worked in partnership with agencies. However, records did not clearly record people’s care in accordance with health professional’s recommendations. The manager responded to our feedback by introducing new monitoring systems.

We observed people discussing their health with staff. One person discussed whether to smoke cigarettes. The manager printed off ‘easy read’ information relating to smoking and a staff member went through this information with the person. 'Easy read' refers to the presentation of text in an accessible, easy to understand format.

Staff told us they encouraged people to make healthy choices about eating and drinking, although they respected the person’s decision. One staff member said, “We try to encourage people to go on new activities and get fresh air and exercise.”

Records did not always detail how people were supported to live healthier lives. Some daily records detailed people had declined meals. However, the record did not detail what was offered or how staff encouraged the person to enjoy a meal. Some daily records did not explain what activities were offered throughout the day to engage the person and promote wellbeing.

People told us staff supported them when requested. One person told us about a recent injury they had experienced, and we observed staff checking on the injury and supporting the person appropriately.

Staff told us they monitored people regularly. However, they did not always record the care and support offered to people throughout the day. Staff did not always record people's fluid in take accurately. One person required their fluids monitored. On day 1 of the site visit, we observed the person accidently spill part of their drink down themselves. On day 2, we checked the records and noted the fluid intake recording had not reflected this spill. All fluid entries detailed the person had consumed the exact amount of fluid which was offered in every occurrence. We discussed this with the manager who was present during the accidental spill. They agreed this needed to be addressed and spoke with the staff team about recording fluid consumption accurately.

People's health was not monitored consistently. Where people required their care monitored such as fluid and nutritional intake, the monitoring records and daily notes were not always clear. Therefore, the provider could not be assured people were receiving care as assessed. The provider responded to our feedback by introducing new systems to monitor care tasks

People told us they made their own choices and decisions. One person told us, “I can do what I want.” We observed staff asking people what they wanted to do and respecting their choices.

Staff told us about people who lacked capacity over specific decisions. One staff member said, “Some people lack capacity in some way, such as needing us [staff] to support them in the community, but that doesn’t mean they can't make decisions about what they want to do.”

We checked whether the service was working within the principles of the MCA, and whether any conditions on authorisations to deprive a person of their liberty had the appropriate legal authority and were being met. Appropriate DoLS applications were submitted for people who required this level of protection to keep them safe and meet their needs. Assessments of people’s mental capacity and best interest meetings had taken place to ensure decisions made were appropriate and least restrictive for people’s decisions. However, for some decisions where restrictions were in place. A mental capacity assessment was not always completed and for 1 person a best interest decision had not been made. The provider responded to our feedback and completed the relevant assessments.