About the service:

Millennium Forge is a Domiciliary Care Service and Extra Care Housing Services providing personal care to older people, people with learning disabilities or autistic spectrum disorder, people with mental health concerns, physical disability, sensory impairment or younger adults at the time of the inspection. 76 People were using the service at the time of the inspection.

People’s experience of using this service:

Some people and their relatives told us they felt that the level of staffing required improvement and there was concern around the numbers of agency staff used. Medicines were mostly given as expected, but staffing issues had impacted on when they were given. Risk assessments were in place to minimise any potential risk to people’s wellbeing

People felt that not all staff assisting them knew their needs. Staff did not receive regular supervisions. Staff received adequate inductions and training. People were supported to maintain their health.

Not everyone knew the acting manager, but those who did felt they were approachable.

People were supported to have choice and control over their lives and staff understood that they should support them in the least restrictive way possible; the policies and systems in the service supported this practice.

People's care plans reflected their needs and preferences and staff could explain specific care that people required. People knew how to complain and that any concerns would be listened and responded to by the provider. Actions were taken as a response to complaints.

Quality monitoring systems included audits, checks on staff practice and checks on people’s satisfaction with the service they received, using questionnaires. The provider has systems in place to ensure they kept up to date with developments in the sector and changes in the law.

Rating at last inspection: The rating for the service at our last inspection was ‘Requires improvement’ with our last report published on 10 May 2017.

Why we inspected: This was a planned comprehensive inspection that was due based on our scheduling targets.

Enforcement:

No enforcement action was required.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

Our inspection was announced. It took place on 13 March 2017.

The provider is registered to provide personal care to adults. People received their care and support within their own flats within three extra care facilities within the community. Supported living enables people who need personal or social support to live in their own home supported by care staff instead of living in a care home or with family. On the day 55 people received a service.

At previous inspection of 13 and 14 July 2014. We judged that four of the five questions we ask, Is the service safe? Is the service effective? Is the service caring? and Is the service responsive as being good, the remaining questions, is the service well-led? we judged to be ‘requires improvement’. This was because the provider the audit systems were not sufficiently robust. During this, our most recent inspection, we found that some improvement had been made regarding the quality monitoring of the service.

Since our previous inspection of July 2014 we received a number of notifications from the provider to inform us of medicine errors. Because of this our pharmacist undertook a focussed inspection on 19 February 2016. The pharmacist found the provider had implemented actions to improve the medicine systems and that these had started to decrease the number of medicine errors.

The previous registered manager had left the service in September 2015. Following this another manager had been employed who had not been registered with us. It is a breach of the law not to have a registered manager. A new manager had been employed shortly before our inspection and the senior manager told us that this new manager was going to apply to us for registration as is required by law. The new manager was not available on the day. 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.

Sufficient staff were not always available to meet people’s needs. Medicines were not always given to people at the correct times. Risk assessments to maintain the safety of the people who used the service had been undertaken. The provider had policies in place and staff had received training on the procedure they should follow to ensure that any risk of harm and/or abuse was prevented. Staff were recruited safely to prevent unsuitable staff being employed.

Staff had received the training they required to give them the knowledge they needed to support people safely. The staff knew that people must receive care in line with their best interests. People were encouraged to make decisions about their care. The staff supported people appropriately with their nutritional needs. Meal options were offered to ensure that people’s food and drink preferences were catered for. Input from external healthcare professionals was secured to meet people’s healthcare needs.

People and their relatives told us that staff were kind and caring. People’s privacy, dignity and independence was promoted and maintained.

People’s needs were assessed and reviewed. Provider feedback forms were used to enable people and their relatives to give their views on the service provided. Complaints systems were in place for people and their relatives to raise their concerns or complaints if they had the need to.

A lack of consistent management had resulted in a lack of confidence of people and staff in the leadership of the service. A new manager had been employed in order to promote better leadership. Audits and checks were undertaken to ensure that the service was operated in the best interests of the people who used it.

The provider is registered to deliver personal care to adults. The personal care and support was provided to people who lived in their own flats or bungalows within this extra care facility.

We carried out an unannounced comprehensive inspection of this service on 13 and 14 July 2015. After that inspection we had concerns as the provider had notified us over a number of months that medicine errors had occurred that included, staff not ensuring that people had the correct dose of their medicine or that people had not been supported by staff to take their medicine as it had been prescribed. As a result we undertook a focused inspection to look into those concerns. This report only covers our findings in relation to those/this topic. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Millennium Forge on our website at www.cqc.org.uk.

We undertook this focused inspection on 19 February 2016. The inspection was carried out by one pharmacist inspector.

We found that systems had been implemented by the provider in relation to how medicines were managed and how staff supported people to take their medicines aimed to prevent further medicine errors.

We found that the management of medicines by the service had improved but further improvements were required to ensure that people were protected against the risks associated with medicines.

To find out about people’s experiences and what it was like to receive care from this provider we spoke with six people who were using the service and two relatives. People we spoke with told us positive things about the care and support that they had received. One person told us,” I have lived here for years and I like it”. Another person said, “I tell my friends to move into Exon Court as it so good”.

We saw that there was a good relationship between staff, people using the service and their relatives.

People told us that their needs had been met by a range of health professionals including doctors, the chiropodist and the optician.

We found that provisions and practices were in place to prevent malnutrition and dehydration.

We found that improvements were needed concerning medication recording and administration. These improvements are needed to make sure that people are given their medication as it had been prescribed by their doctor to promote good health.

Evidence we gathered did not identify that staffing levels were inadequate. People told us that there were enough staff to meet their needs.

We found that that service offered an adequate complaints process which responded to complaints people made.

This extra care housing scheme is owned and managed by Accord Housing Association Limited. The scheme comprises of three different units; Millennium Forge, Exon Court and Swallowfields. All three units are situated very close to each other. The scheme is managed by one registered manager.

People living within the scheme have their own individual flat or bungalow. The support they receive is varied ranging from prompting and monitoring to complex personal care provision.

To get an overview of the service provided we visited two of the three units Millennium Forge and Swallowfields. We spent time in the communal lounge in Millennium Forge where we could indirectly observe people and staff interaction and engagement.

In total we spoke with seven people living within the scheme. People were very complimentary about the scheme in general and the care they received. People told us that staff consulted with them about the care they needed and that the staff provided care in a way that met their needs and capabilities. Below are a few comments people made;

“It is wonderful here, I can not believe it. The staff are lovely and kind. I can still go out when ever I want. I have got my own flat but above all I feel safe”.

“I have got no complaints”.

“It is an excellent place we are free to do what we want to but we are still cared for and can live together”.

Staff we spoke with were very positive about the scheme in general, the care provided and their job roles.

One staff member told us;”I have worked in nursing and residential homes but after working here I know where I want to live when I am old it will be extra care. It is amazing that people can still have their independence but be cared for to this level”.

Our overall findings were that this scheme is providing a good service. People were happy and content. Managers and staff were motivated and committed to providing a good service to the people in their care.

Our inspection was unannounced and took place over two days on the 13 and 14 July 2015. Our inspection team included two inspectors, a pharmacist and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

The service offered personal care and support to adults who lived in their own flats or bungalows within this extra care facility. The extra care facility had three units located within a mile radius of each other. The units are called Millennium Forge, Swallowfields and Exon Court. We visited two of the three units; Millennium Forge and Swallowfields. At the time of our inspection, across the three units, 54 people received personal care from the provider.

At our last inspection of September 2014 the provider was not meeting one of the regulations that we assessed. This concerned the quality monitoring of the service. During this, our most recent inspection, we found that some improvements had been made. However, although not sufficient to determine a breach of the law we found that further improvements were required.

Our inspection findings assured us that there were enough staff to keep people safe. However, at times contingency to cover staff sickness meant that senior care staff or the registered manager had to cover the care calls. This had a negative effect on the systems the registered manager had implemented as some audits and staff supervision had been delayed when this happened.

Staff told us that were felt adequately supported on a day to day basis in their job roles. However, they and the registered manager told us that they were aware that some improvement was needed as the formal supervision and appraisal of staff was lacking.

The manager was registered. 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.

All people and their relatives that we spoke with told us that the service was good. They also told us that they felt safe and this was confirmed by their relatives. People who used the service described the staff as being nice and kind.

We found that a complaints procedure was available for people to use. People and their relatives told us that they were confident that any dissatisfaction would be looked into or dealt with effectively.

Staff had understanding and knowledge regarding the Mental Capacity Act and the Deprivation of Liberty Safeguarding (DoLS). This ensured that people who used the service were not unlawfully restricted.

We saw that there were systems in place to protect people from the risk of abuse and staff followed the systems to prevent people from being placed at risk of abuse and harm.