About the service:

Home Alternative Limited provides personal care and support to people who live in their own homes. The service supports older people and those living with dementia. This service was formally known as Millennium House. People who used the service all knew it and referred to the service as Home Alternative Limited.

The Care Quality Commission (CQC) only inspects the regulated activity of ‘personal care’ being provided to people who use the service. However, we do take into account any wider social care provided. At the time of our inspection the service was providing personal care to 37 people.

People’s experience of using this service:

The service had improved since the last inspection. People’s care plans were more detailed, so staff had clear guidance on how to support people who use the service and the registered manager was submitting notifications to the CQC when required so we were aware of any incidents, so we could take action where appropriate to keep people safe.

People supported told us they felt safe with the staff that supported them. Staff understood their role and responsibility to keep people safe from harm.

People’s care records contained guidance for staff about how to support people safely and minimise risks to people.

Recruitment processes were robust and thorough checks were completed before staff started working at the service. Staff supported people safely with their medicines.

There were enough staff employed to ensure people received consistent and timely care. People told us they knew which staff would be visiting them, staff arrived at their agreed times and stayed and provided support for the agreed length of time.

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 supported spoke very positively about the staff who supported them and the office team including the registered manager. People told us staff treated them with dignity and respect and were kind and caring.

Staff had received training and supervision to ensure staff had the knowledge to provide people with appropriate care.

People received personalised support from staff who knew them well. Staff had built positive relationships with the people they cared for and supported. Staff supported people to retain their independence and to remain involved in planning and reviewing their care. This helped to ensure care was provided in accordance with people’s preferences.

Staff worked closely with a range of community healthcare professionals to promote good outcomes for people. Feedback from healthcare professionals involved with the service was very positive.

The service was consistently well-led. People felt able to raise any concerns with the registered manager or provider and were confident they would be addressed. Staff felt well supported by the registered manager.

The registered manager and senior staff coordinated a wide range of quality checks and audits of the service to make sure the care and support provided was of high quality. People’s feedback was regularly sought, so they could contribute to ongoing improvements within the service. This supported the continuous improvement of the service.

The service met the characteristics for a rating of "good" in all the key questions we inspected. Therefore, our overall rating for the service after this inspection was "good".

More information is in the full report:

Rating at last inspection: At the last inspection the service was rated requires improvement (published 4 March 2018).

Why we inspected:

All services rated "requires improvement" are re-inspected within one year of our prior inspection report being published. This inspection was part of our scheduled plan of visiting services to check the safety and quality of care people received.

Follow up:

We will continue to monitor the service to ens

Millennium House provides personal care and support to people who live in their own homes. The service supports older people and those living with dementia. At the time of our inspection the service was providing personal care to 52 people.

There was a manager at the service who was registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the 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 and associated Regulations about how the service is run.

Our last inspection at Millennium House took place on 4 October 2016. The service was rated Requires Improvement overall. We found one breach in the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, in regard to regulation 12, Safe care and treatment. We identified a number of issues with the management of medicines which meant that people were not fully protected against the associated risks. The registered provider sent us an action plan detailing how they were going to make improvements. At this inspection we checked the improvements the registered provider had made. We found sufficient improvements had been made to meet the requirements of this regulation.

At this inspection we found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the registered provider to take at the back of the full version of the report.

People’s needs had been assessed before their care package commenced and people who used the service told us they had been involved in formulating and updating the care plans. The information included in the care records we saw was individualised and identified people’s needs and preferences, as well as any risks associated with their care and the environment they lived in. More detail was needed in people’s care plans and risk assessments so staff had clear guidance on how to care and support people who used the service. However, we found care staff were knowledgeable about people’s needs and the lack of detail in care plans and risk assessments had no negative impact on people using the service. We recommended people’s care plans and risk assessments include more detail.

We saw the registered provider kept a safeguarding log which documented all safeguarding incidents. However, there was no system in place to show quality standards and legal obligations were met. We saw the service had one safeguarding incident since the last inspection which we were not aware of. The registered manager must notify the CQC of all serious incidents in line with their legal obligations. We found the registered provider responded to risk and took appropriate action to safeguard people from harm. We recommended the registered manager implement a record keeping system for safeguarding incidents which includes details of how quality standards and legal obligations were met.

Staff told us they felt well supported and received an annual appraisal of their work performance. Staff had also received supervision sessions and spot checks to assess their capabilities and offer support. We saw evidence of regular supervisions taking place, however we found two thirds of the staff who worked at the service had not received an appraisal. Following the inspection the registered manager submitted an action plan showing that all staff had now received an appraisal.

We found people received a service that was based on their personal needs and wishes. Changes in people’s needs were identified and their care package amended to meet their assessed needs.

Where people needed support taking their medication this was administered by staff who had been trained to carry out this role. The service had clear medication policies to ensure staff could offer support to people safely.

We found the service

Millennium House provides personal care and support to people who live in their own homes. The service supports older people and those living with dementia. At the time of our inspection the service was providing personal care to 71 people.

This inspection took place on 4 October 2016 and was announced. The provider was given 48 hours’ notice because the location provides a domiciliary care service and we needed to be sure that someone would be in the location offices when we visited.

At the last inspection on 30 July 2014 the service was found to be meeting the Regulations assessed.

There was a registered manager in post. 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 registered manager had good oversight of the service and was experienced in their role. We found that quality monitoring systems were not always effective at identifying issues or identifying areas of practice that required improvement.

We identified a number of issues with the management of medicines which meant that people were not fully protected against the associated risks. This was a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the provider to take in the main report.

Staff were confident about how to protect people from harm and what they would do if they had any safeguarding concerns.

Risks to people had been assessed and plans put in place to keep risks to a minimum. An ‘out of hours’ service was in place so that people could contact a member of staff in an emergency.

There were enough staff available to make sure people’s needs were met. The provider had robust recruitment procedures to make sure staff had the required skills and were of suitable character and background.

People were cared for by an enthusiastic and caring staff group. Staff were supported through training, regular supervisions and team meetings to help them carry out their roles effectively. There was an open and accessible management team.

The manager and staff were aware of the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). DoLS are put in place to protect people where their freedom of movement is restricted. At the time of our inspection, there were no people who used the service under a DoLS authorisation.

People told us staff were caring and that their privacy and dignity were respected. Care plans were person centred and showed that individual preferences were taken into account. Care plans gave clear directions to staff about the support people required to have their needs met. People were supported to maintain their health and had access health services if needed.

People received support which met their current needs and the provider responded promptly to any changes. People knew how to complain and had opportunities to make comments about the service and how it could be improved.

Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes.

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. People who used the service told us that they were happy with the care and support they received at Home Alternative Limited. One person told us,“ [staff]are very good. They do the pots and are always asking me if anything else needs doing, very good, very nice.”

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

People were cared for, or supported by, suitably qualified, skilled and experienced staff.

The provider had an effective system to regularly assess and monitor the quality of service that people receive.

As part of our inspection we contacted four people by telephone to discuss the service they received from the agency. Where people were unable to speak to us over the telephone we spoke with their representatives.

People we spoke with told us they were very satisfied with the care and support they received. Comments included: "I am happy with the care and support. Staff are flexible to meet mum's needs. They have mum's interests at heart", "The care is very good, staff are charming" and " Really pleased with the care, the manager and staff deal with everything very well."

Evidence showed people’s privacy, dignity and independence were respected. We found people’s needs were assessed and care and treatment was planned and delivered in line with their individual care plan. People we spoke with confirmed they were involved in reviewing their care and treatment.

We found people who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

People were cared for, or supported by, suitably qualified, skilled and experienced staff. Evidence showed staff had received appropriate professional development, training and supervision. People we spoke with confirmed staff treated them with respect and had the skills to meet their needs.

We found the provider had an effective system to regularly assess and monitor the quality of service that people receive.