Mill Hayes

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

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.

This service scored 66 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People told us they felt safe living in the home. Relatives told us people received safe care. One relative told us about a concern they had raised with the provider. They said this was quickly resolved.

Staff told us lessons learnt from incidents were shared openly. One staff member said, “After an incident we have a debrief with staff involved and management. Lessons learnt are shared with the team.” We discussed a recent review from visiting professionals where concerns were raised around the care and support people received. The provider told us about the actions they had taken in response to these concerns. However, we found similar issues over care monitoring and record keeping. This meant further improvements were ongoing.

Lessons learnt from incidents and accidents were recorded and trends examined. However, 1 incident was not safeguarded in a timely manner and follow up to incidents were not always recorded in detail. Lessons learnt from feedback from professionals were not always actioned in a timely manner.

People told us about their goals and how staff were supporting them to achieve their goals. One person was due to move into a more independent home. However, this was delayed due to extenuating circumstances.

Staff told us they helped people to achieve their goals. One staff member told us, “We ask people about their goals and help them to achieve these. We help people to gain skills. For example, we encourage people to do their own laundry.” Another staff member told us about the achievements of two people, who were gaining vital skills with an aim to become more independent. However goals were not always recorded in detail in care plans or daily records.

Visiting professionals raised concerns about how the provider monitored people’s health needs. They told us monitoring of people's health needed improvement in order to ensure any prompt referrals to health professionals when needed.

People’s needs were assessed appropriately prior to moving into the home and there were plans in place for people to move into more independent living homes. People’s plans were recorded in care plans. However, some goals lacked detail such as expected achievement dates or progress made towards the goal. Daily notes did not always record the actions taken by staff to promote people’s independence.

People told us they felt safe living in the home. One person said, “I feel safe here. I am happy.” Relatives told us they felt people received safe care. One relative said, “It’s good the care [my family member] receives. I have no concerns.”

Staff told us they received safeguarding training and they knew how to report safeguarding concerns. One staff member said, “We have all completed safeguarding training. I learnt about how we can keep people safe. We can report concerns to the manager or local authority. The safeguarding policy has the number we can call.”

We observed people being supported safely. People who were supported on a 1:1 basis received the appropriate level of support.

The provider raised safeguarding concerns. Although professionals told us some incidents of distressed behaviours were not recorded as incidents and therefore these incidents were not reviewed as potential safeguards. We reviewed 2 incidents where safeguarding referrals should have been considered. The manager raised 1 of these as a safeguard with the local authority. The other incident was reviewed, a safeguarding referral was not required. However, the decision making process regarding whether a safeguarding referral was or was not required needed further detail to make the follow on actions and rationale clear.

People told us they were able to make their own decisions and take risk. One person told us about an activity they were taking and how staff were supporting them to keep safe on this activity.

Staff told us they respected people’s decisions to take risks. One staff member said, “We encourage people to make their own choices and talk to them about the risks of their decisions.” However, one person attended an activity without an appropriate risk assessment in place. The provider responded to our feedback and completed the risk assessment retrospectively.

We observed staff speaking to people about risks surrounding their choices and decisions. However, these discussions were not always recorded in records or risk assessed accordingly.

We reviewed examples of people taking their own risks such as choosing to smoke, drink alcohol or engage in community activities. However, where people spent long periods of time in their rooms, staff did not record how they encouraged people to engage in activities or take positive risks. Behaviour management plans were in place for most people who demonstrated distressed behaviours and risk management plans were in place for people with health conditions. However, the risk management plans did not always describe specific action for staff to take to manage the risk and respond safely.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

People told us staff supported them on a 1:1 basis. Relatives told us there was enough staff on duty to support people safely.

Staff told us they supported people safely. One staff member said, “I think there are enough staff on duty. When someone is distressed, we can support them safely.”

The service had enough staff, including for 1:1 support for people to take part in activities and visits when they wanted.

Staff were recruited safely. Recruitment files showed all pre-employment checks had been made to ensure only staff who were suitable to work with people were employed. People received care and support from experienced staff who had completed their mandatory training. However, staff had not completed diabetes training despite people living in the home with this condition. In addition, staff had not always completed training in other health conditions people experienced. The manager responded to our feedback by enrolling staff on diabetes training and identified dates for staff to complete the missing training. The manager told us only staff who had completed the relevant training supported the people concerned.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

An observation of medication administration showed how people received medication in a safe way. Staff told people what medicines they were taking.

Staff told us they received safe medicine administration training and competency checks. One staff member said, “The provider carries out regular checks to make sure I am administering medicines safely.” However, one person’s risk management plan recorded they required regular blood checks due to the medicine they were taking and detailed the person received a 'when required' medicine. This person was no longer receiving these medicines, although the risk assessment had not been updated to reflect this. Following the site visits, the provider told us this had been updated before we arrived, although the new risk assessment had not been printed off. We commented the information remained outdated on both site visits. Information recorded in care documents should be reflective of people's changing needs, detailing current support plans and mitigating against the risk of confusion within the staff team.

Medication Administration Records (MAR) matched the correct quantities of medicines and people were offered pain relief medication, in accordance with their preferences and health professional guidance. However, medicines were not always stored safely. Medicines require storing in a location which is monitored for safe temperatures. Whilst temperatures were being taken, there were numerous gaps in the recordings. This meant the provider could not be assured temperatures remained within the safe limits. Risk assessments did not always document people’s current medicines and required updating. The provider responded to our feedback by ensuring risk assessments reflected people's current needs.