Date of assessment 22 April to 07 May 2025. We carried out this assessment to gain an up-to-date view of the service. The provider was previously in breach of the legal regulations in relation to safe care and treatment, safeguarding people from abuse, staffing and good governance. The provider employed a new nominated individual and registered manager following our previous inspection and significant improvements were found at this inspection and the provider was no longer in breach of regulations. We assessed the service against “Right support, right care, right culture” guidance to make judgements about whether the provider guaranteed people with a learning disability and autistic people respect, equality, dignity, choices, independence and good access to local communities that most people take for granted. We found there was overwhelming evidence that the core values of choice, promotion of independence and community inclusion were at the centre of people's day-to-day support. The provider had a positive learning culture where people could raise concerns and feel confident, they would be heard. The management team investigated incidents thoroughly to learn and improve outcomes for people. People were supported to live fulfilled lives and take positive risks. Staff understood their safeguarding responsibilities to ensure people were protected from abuse. There was a genuine person-centred culture, where staff displayed empathy and worked with people and their family members to understand how best to support them. The attitude and knowledge of staff and management clearly had a positive impact on people and their families. There was a strong emphasis on continuity of care to maximise the opportunities for people. Training and guidance for families was provided free of charge to assist with their understanding and to support their relative to have continuity of care. People were provided with core staff teams to help provide them with continuity of care and develop trusting relationships. People were supported by staff who were highly skilled, and knowledgeable in caring for people with additional needs. Staff were skilled in helping people to express their views and communicated with them in ways they could understand. Staff understood and followed the principles of the Mental Capacity Act 2005 (MCA) and were aware of people's rights to refuse care. The management team and staff worked to ensure that people's choices and wishes were respected.
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Milford Del Support Agency received a 'Requires Improvement' rating following a focused inspection in March 2023, with warning notices served for breaches of Regulations 12 and 13 relating to unsafe risk management, insufficient restraint oversight, and inadequate staffing and training. The service deteriorated from its previous 'Good' rating due to rapid organisational growth, senior team instability, and governance failures, though staff were noted to be caring and committed and people reported positive experiences.
Concerns (10)
criticalSafeguarding: “People were not protected from unnecessary control and restraint. There was a breach of regulation 13 (Safeguarding service users from abuse and improper treatment)”
criticalStaffing levels: “There were not always sufficient staff deployed to ensure people's assessed needs were met. There was a breach of regulation 18 (Staffing)”
criticalStaff training: “Most staff had not undertaken specialised communication training after a short session on their induction.”
criticalGovernance: “Systems to monitor the quality and safety of people's support were not effective. There was a breach of regulation 17 (Good Governance)”
moderateIncident learning: “Investigations into incidents and accidents did not always involve robust analysis of the root cause. This meant actions taken were not always sufficient.”
moderateCare planning: “Risk management strategies in place to support people when they were distressed were not always applied consistently.”
moderateConsent / capacity: “Oversight of DoLS within the service had not been robust and the status of applications was not known within the senior team.”
moderateRecord keeping: “Complete and accurate records in respect of people's care and support had not been maintained.”
moderateStaff competency: “Risks associated with the support people needed to move safely had been assessed, however the competency of staff undertaking this support had not been reviewed after their initial training.”
minorSupervision / appraisal: “Staff told us they had experienced mixed support. We heard reflections on changes at manager level leaving staff uncertain about their support.”
Strengths
· Staff were respectful, knew people well and were committed to working with them as individuals
· Robust recruitment processes including appropriate checks and references
· Effective infection prevention and control measures
· Medicines stored safely and audits undertaken regularly
· Staff advocated for people and worked with families and professionals to ensure access to healthcare
Quality-Statement breakdown (14)
safe: Assessing risk, safety monitoring and managementRequires improvement
safe: Staffing and recruitmentRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseRequires improvement
safe: Preventing and controlling infectionGood
safe: Using medicines safelyGood
effective: Staff support: induction, training, skills and experienceRequires improvement
effective: Ensuring consent to care and treatment in line with law and guidanceRequires improvement
effective: Assessing people's needs and choices; delivering care in line with standards