Millview short stay respite service is a care home that offers a short breaks service to people who have a physical disability, a learning disability or both. The home is managed by Stockport Disability Services who are part of Stockport Metropolitan Borough Council. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.Millview is a purpose build unit registered to accommodate 4 people for respite care and support. At the time of inspection, the service was providing respite care to 42 people. Milllview is part of a wider provision of supported accommodation for people with learning disabilities which included supported housing.
The first day of inspection took place on the 30 July and was unannounced. We returned to the service on 1, 6, 17 August 2018.
The service was previously inspected in March 2016 and at that time was rated good overall. The service was rated as being good in the four domains of effective, caring, responsive and well-led and rated as Requires Improvement in the Safe domain. This was because we found the provider to be in breach of Regulation 12, safe care and treatment. The provider was not taking reasonably practicable steps to reduce risks in relation to good infection control processes.
Following the last inspection, we asked the provider to complete an action plan to show how they would ensure they met the regulations. The action plan detailed the arrangements made to ensure the service was compliant with Regulation 12.
At this inspection we found the service continued to be in breach of this Regulation. This was because effective infection control policies and procedures were not in place to ensure the cleanliness of equipment, and health and safety and environmental checks were not being completed consistently. We also found new breaches of this regulation relating to how the service managed risk.
We identified breaches of three further regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to Regulation 11, Need for consent, Regulation 17,Good Governance and Regulation 18, Staffing.
We identified two breaches of the Care Quality Commission (Registration) Regulations 2009. These were a failure to submit notifications of incidents, accident and safeguarding concern and failure to have a registered manager in post.
It is a condition of registration that the service has a registered manager in place. At the time of inspection, the service did not have a registered manager. 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. The CQC had not received an application from the registered manager to deregister when they had left their post in April 2017. We advised the current manager to begin the process of registering with CQC as a matter of urgency and we took action to deregister the previous manager from the location.
The service kept records of accidents and incidents and these were investigated and monitored within the service. We could see that action was taken to reduce the risk of accidents reoccurring.
We looked at how people were supported to take their medicines safely. We found that people were supported appropriately with this but that checks were not being completed to ensure medicine that required storage at low temperatures could be stored safely.
We saw records that demonstrated staff received training, supervision and spot checks. However, the records indicated that some training needed updating
The service had systems for governance in place but these were not sufficiently robust to provide quality assurance. The management team had identified this as an area for improvement and we saw this was documented within the service action plan.
People had their needs assessed prior to attending the respite service and had care plans developed in line with these support needs. The service had identified improvements to be but these were not yet in place.
Care plan records and risk assessments were in place. They required reviewing and updating to ensure peoples current care needs were being met.
We looked at peoples care records and found that people were not supported to have maximum choice and control of their lives. We saw that people were subject to a number of restrictions but these had not been assessed under the Mental Capacity act (MCA) and Deprivation of Liberties Safeguards (DoLS).
We saw that the service was working in line with the values that underpin the 'Registering the Right Support' and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.
Systems to support the safe recruitment of staff were in place. We saw references and Disclosure and Barring Service (DBS) checks were being completed before a member of staff began working for the service.
There were policies and procedures in place to safeguard people from harm. Staff were trained to respond to safeguarding concerns.
People and relatives told us that staff were kind and respectful. We saw that people’s privacy and dignity was respected.
There were records of peoples’ eating and drinking needs including preferences and support plans readily available within the kitchen. Staff had a good understanding of how to meet peoples’ dietary needs and promote independence.
There was a complaints procedure in place and the unit manager told us how they work with people and their families to address concerns when they are first raised.
The service had good links to other agencies and worked closely with people and services to enable them to deliver tailored package of care.
The rating from the last CQC inspection was displayed in the reception area.
Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.