CQC report explained · a residential care home
What the CQC found at Millbrook House
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
- Safe?
- Requires improvement
- There were enough staff and medicines were managed safely, but some staff did not understand safeguarding procedures and feared recriminations for reporting concerns. The positive behaviour support approach was not yet fully embedded.
- Effective?
- Good
- People's care was based on their needs, choices and goals. Staff received training, people were supported with food and healthcare, and the home worked within mental capacity and liberty safeguards requirements.
- Caring?
- Good
- People were treated with dignity and respect. Staff knew people well, communicated in ways they understood and involved relatives or advocates in care decisions.
- Responsive?
- Good
- Care was personalised and people had more choice and control. The home supported communication, activities, community involvement, relationships and complaints.
- Well-led?
- Requires improvement
- The manager had started a thorough improvement strategy, but governance and performance management were not always clear or effective. Incident reviews were not always documented clearly, and some staff did not feel involved or listened to.
What inspectors found, March 2020
Millbrook House was rated Requires Improvement; inspectors found kind, personalised care and positive changes, but safeguarding confidence and management oversight were not yet reliable.
This was an unannounced inspection on 28 January 2020. Inspectors spoke with people living in the home, relatives, staff and health professionals. They reviewed care records, medicines records, staff recruitment and supervision files, and management records.
The home supported seven young adults with learning disabilities and or autistic spectrum disorder. Inspectors found enough staff, safe recruitment, good medicines arrangements and clean surroundings. People received kind and respectful care, had choices, took part in activities and were supported to be more independent.
The home was not always safe or well-led. Some staff did not understand safeguarding procedures and feared reprisals for raising concerns. Records and oversight of incidents were not always clear. Positive behaviour support and the improvement plan were still being put into practice, so the overall rating fell from Good at the previous inspection to Requires Improvement.
Personalised care
Care planning considered each person's whole life, including their goals, skills and abilities. New positive behaviour support had increased choice and reduced behaviours that challenge.
“Care planning was focused on a person's whole life, including their goals, skills and abilities.” from the report
Kind and respectful staff
Inspectors saw people treated with dignity and respect. Staff knew people well and communicated in ways people could understand.
“We saw people were treated with dignity and respect in all their interactions with staff.” from the report
Activities and relationships
People took part in activities and kept up their hobbies and interests. They were supported to go out, meet people and stay connected with relatives.
“People took part in person-centred activities and the provider supported them to maintain their hobbies and interests.” from the report
Positive management changes
The manager had introduced a more proactive approach to risk assessment, training and learning from mistakes. Relatives and professionals reported positive changes.
“Since the manager had been in post there was a clear focus on continuous learning and improving the lives of people living there.” from the report
Safeguarding confidence
seriousSome staff did not understand the safeguarding process and said they feared repercussions if they raised concerns. This could discourage staff from reporting possible abuse.
“Some staff did not understand the safeguarding procedure and told us they would fear recriminations if they raised concerns.” from the report
Incident oversight
seriousThe provider and manager could not always show that incidents involving verbal or physical abuse had been properly reviewed. Records did not always show how future risks would be reduced.
“There was not always clear documentation to demonstrate the provider or manager had reviewed incidents where people and staff had been verbally or physically abused.” from the report
New support approach not embedded
needs fixingSome staff were still unsure how to use the new positive behaviour support plans. Some staff also remained worried about safety when supporting people.
“This showed the positive behaviour support the manager had put in place was yet to be fully embedded into the culture of the home.” from the report
Staff involvement
needs fixingSome staff felt isolated, undervalued or not listened to during the planned improvements. The provider said it would arrange meetings and training to address this.
“Some staff told us they felt isolated and not on board with planned improvements.” from the report
Manager registration
needs fixingThere was no manager registered with CQC at the inspection. A manager was in post and had applied to register.
“The service did not have a manager registered with the Care Quality Commission.” from the report
- 01What has been done to make sure every staff member understands the safeguarding procedure and can raise concerns without fear of recriminations?
- 02How are incidents involving verbal or physical abuse now recorded, reviewed and used to reduce future risks?
- 03How do you check that all staff understand and follow the new positive behaviour support plans?
- 04What support and supervision do staff receive if they feel unable to meet a person's needs safely?
- 05Has the manager's application to register with CQC been completed, and who has oversight of the home while this is being processed?
This was an unannounced inspection covering all five CQC questions, including the premises and care provided; Safe and Well-led fell from Good, while Effective, Caring and Responsive remained Good. This explanation was written from the published report of 17 March 2020 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, September 2018
Rated Good; inspectors found safe, kind and person-centred care, with some concerns about applying the Mental Capacity Act and the lack of a registered manager.
This was an unannounced, comprehensive inspection on 6 June 2018. One inspector reviewed records, staff files, training, rotas, meetings, complaints and quality checks. They spoke with staff and managers, and reviewed records for three people.
The home was rated Good overall and Good in all five areas. Inspectors found people were safe, medicines were handled properly, staffing met people's needs and the home was clean. Staff supported people's health, nutrition, choices, privacy and independence.
Care was described as kind, individual and responsive. People were supported to take part in activities and go out into the community. There was a complaints process and no outstanding complaints.
The report says the rating stayed Good, as it had at the previous inspection in May 2015. Inspectors noted that the Mental Capacity Act was not always being applied correctly. There was also no registered manager at the time, although a manager had been appointed and an experienced manager was covering in the meantime.
Safe staffing and risk support
Inspectors found enough staff to meet people's needs, including where people needed one-to-one or more intensive support. Risk assessments gave staff clear guidance while supporting independence.
“Staffing levels in place met the needs of people. Most people needed at least one to one care and some people needed more than one staff member to keep them safe.” from the report
Kind and respectful care
Staff understood people's moods, communication and behaviour. Inspectors saw staff treating people in a caring and non-patronising way.
“During our visit we saw staff engaging with people, they did so in a caring and non-patronising manner.” from the report
Person-centred daily life
People were supported to follow their routines, interests and choices. They took part in activities and went out into the community.
“People had a full and active life based on how they wanted to live their lives.” from the report
Good health and nutrition support
Staff supported people's diets and worked with health professionals when needed. Inspectors found that people could access healthcare and received enough to eat and drink.
“People's individual nutritional needs were supported and they received enough to eat and drink.” from the report
Mental Capacity Act practice
needs fixingInspectors found that the principles of the Mental Capacity Act were not always being used. This matters when decisions are made for people who may lack capacity.
“During our inspection we found the provider was not always using the principles of the Mental Capacity Act.” from the report
No registered manager in post
minorThere was no registered manager when inspectors visited. A manager had been appointed, while an experienced manager from another service provided interim support.
“The service did not have a registered manager at the time of the inspection.” from the report
- 01How do you make sure every decision made for someone who may lack capacity follows the Mental Capacity Act?
- 02Is there now a registered manager, and who is responsible for the home if that person is absent?
- 03How are risk assessments reviewed while still supporting each person's independence?
- 04How will my relative's communication needs, routines, activities and preferences be recorded and followed?
- 05How are complaints, accidents and incidents reviewed, and what changes have been made as a result?
This was an unannounced comprehensive inspection covering all five rating areas; the report says end-of-life care was not being provided and was therefore not assessed. This explanation was written from the published report of 14 September 2018 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of Millbrook House
3 rated inspections over 4 years: the service has slipped, from Good to Requires improvement.
- March 2020Requires improvementcurrent ratingdown from GoodSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- September 2018Goodstayed GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- October 2015GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- October 2013
Registered with the Care Quality Commission on 8 October 2013.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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