Mill House

Mill House is a residential care home providing personal and nursing care to up to 24 people in one adapted building. The service provides support to older people some of who are living with dementia. At the time of our inspection there were 24 people using the service.

People’s experience of using this service and what we found

Risks to people were not safely managed. Risks had not always been assessed or monitored and staff were not consistently provided with guidance to reduce those risks.

People were not receiving safe care. Staff did not have sufficient information to be able to ensure they understood how to manage risks to people from distress and anxiety, falls, pressure injuries and specific health conditions.

Incidents of potential abuse were not investigated and reported to the appropriate body for investigation. Where potential abuse had been identified by staff this had not been acted upon to ensure people were safeguarded from the risk of harm.

There was insufficient staff to ensure people had their needs met when they required support. We saw people were left unsupervised when they should have monitored continually by staff to keep them safe.

The service was not in good repair and there were concerns with infection control measures in place. People's medicines administration was not consistently documented.

When incidents and accidents occurred staff were recording these but there were no actions taken to review these and prevent reoccurrence.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

People were supported to access health professional visits however where guidance was given to support people with their health needs this was not always clearly documented within people's care plans.

People did not consistently have their needs assessed and care plans put in place to meet their needs.

Staff training was not consistently up to date and there was inconsistent evidence of checks on staff competency.

There was limited management oversight in the service and quality and safety systems were not robust. Issues were not always identified in a timely manner which meant actions were not taken leaving people at risk of harm.

Governance systems in place to manage the service had not identified all the concerns we found during the inspection. CQC had not been notified of significant events as required.

People received enough to eat and drink and told us they enjoyed the food. Recruitment processes were safe to ensure only suitable people were employed.

Rating at last inspection and update

The last rating for this service was requires improvement (published 8 February 2022)

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found the provider remained in breach of regulations.

Why we inspected

We received concerns in relation to medicines, infection control and staffing. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to inadequate based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe, effective and well-led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We have identified breaches in relation to safe care and treatment, protecting people from abuse, consenting to care, staffing and governance at the home at this inspection.

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.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Mill House is a care home providing support with personal care needs to a maximum of 24 older people. Accommodation is provided in a purpose built two storey building and at the time of the inspection, 22 people were using the service, some of whom were living with dementia.

People's experience of using this service and what we found

Risks to people's safety and well-being were not fully considered and plans to mitigate risks were not in place. Infection prevention and control procedures did not ensure people would be protected from the risk of infection. People were not protected from harm when using equipment at the home.

Systems in place to monitor the quality and safety of the service were not effective. The provider had failed to act on the breaches of regulations identified at our last inspection.

People received their medicines when they needed them, and systems were in place to ensure that medicines were stored and administered safely and that adequate supplies were available. People were protected from the risk of abuse. Accidents and incidents were investigated to identify measure to prevent re-occurrences. Staff were recruited safely.

People received care in accordance with their needs and preferences. People were supported to maintain contact with their friends and families. There were opportunities for social stimulation. People felt their concerns and complaints would be listened to and responded to. People had plans relating to end of life care decisions where required.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection.

The last ratings for this service was requires improvement (report published 24 October 2019) and there were two breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection not enough improvement had been made and the provider was still in breach of regulations.

Why we inspected

We undertook this focussed inspection due to concerns we had received about the management of Mill House. As a result, we undertook a focused inspection to review the key questions of safe, responsive and well-led only. The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe and well led key sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

The overall rating for the service has remained the same. This is based on the findings at this inspection.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Mill House on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection.

We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so. We have identified breaches in relation to safe care and treatment, premises and equipment and good governance at this inspection. 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.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

People’s experience of using this service and what we found

Medicines were not always managed in a safe way, when needed guidance for as required medicines was not always in place. People did not always receive their medicines as prescribed. Risks to the environment including infection control concerns had not always been assessed or identified. The audits completed in the home were not always effective in identifying areas of improvement. The provider did not always seek feedback from people living at the home or use this information to make changes. People felt there could be more to do and there was a lack of activities taking place during our inspection.

Some individual risks to people were considered and these were reviewed and some lessons were learnt when things went wrong. Staff understood safeguarding and when people may be at risk of harm. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service support this practice.

People were supported by sufficient kind and caring staff who had the relevant skills. Peoples independence was encouraged and their privacy and dignity maintained. Staff knew people well, the support they needed and their preferences. People enjoyed the food and were offered a choice. People had access to health professionals when needed.

Staff felt supported and listened to. There was a registered manager in place who understood their responsibility around registration with us. Complaints were responded to in line with the providers procedure.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (16 January 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have found evidence that the provider needs to make improvements. Please see the safe, responsive and well led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

We have identified breaches in relation to the management of medicines and environmental risks. We also found concerns with the governance in the home as systems and audits were not always in place to identify areas of improvement.

Follow up

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

The home had 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.

People told us they felt safe in the home. Staff we spoke with were aware of their responsibilities to keep people safe and report any allegations of abuse. People’s individual risks were assessed. There were sufficient numbers of staff to meet people’s needs. People received their medicines as prescribed and systems were in place to store and dispose of medicines safely. The provider had processes in place to ensure staff were recruited safely and that they had the training and skills to meet people’s needs. Staff obtained consent before they provided care. Staff understood people’s decisions when supporting people and worked to ensure people’s best interests were met. People enjoyed their food and had choices regarding their meals. People were supported to access health care professionals to meet their health needs.

People said staff were kind and caring and treated them with dignity and respect. People felt involved in their day to day choices and were supported by staff to maintain their independence. People and their relatives were involved in developing their care plans and people received care that met their needs. People told us they were happy living at the home and took part in a number of different activities. People and relatives knew how to raise any concerns and were confident any issues would be addressed.

People and staff told us the registered manager was approachable and supportive. Staff understood their roles and responsibilities. People and their relatives were encouraged to share their opinions about the quality of the service received. Effective audit systems were in place to assess and monitor the quality of service provided.

We spoke with six people who lived at the home and two visiting relatives. We observed how care was provided to people and looked at five people's care records. We spoke with four staff, the acting manager and the provider. We also looked at other records relating to the management of the home.

People told us they were asked for their consent in respect of daily routines. We saw that staff gained consent from people who were not able to express their views through observation of their reactions. One person told us, 'Staff are very good, they do ask permission'.

People and a visitor we spoke with expressed satisfaction with the care and support that staff provided to people. We saw people were provided with care and support as set out in their care plans. One person told us that, 'Staff are okay, they are very helpful'.

People told us they had a choice of meals and were happy with the meals that they had. We saw that people who were more dependent were supported to ensure they had sufficient nutrition and hydration.

Staff told us that they were well supported by the provider and received sufficient training to ensure they were able to care for people safely and to an appropriate standard.

We saw the provider had effective systems to assess and monitor the quality of service.

We saw staff engaged positively with people and took steps to promote people's privacy and dignity. We saw that staff knocked bedroom doors before entering people's rooms, spoke to people respectfully and routinely offered them choices. People also told us how staff enabled them to retain their independence where possible.

People told us that they were happy with the care and support they received saying, 'It's alright' at the home and, 'Staff are very good really'. A visitor told us that they had,'Every confidence' with the service.

We saw that people's needs were assessed and their care was planned and delivered in line with their care plans. We found that people had regular access to health professionals for advice and treatment.

People felt able to share their views and raise any comments with the home. We saw that the manager responded appropriately to comments or concerns that people made to them. There were also systems in place to identify, assess and manage risks to the health, safety and welfare of people who use the service and others. This included making sure there was sufficient and safe equipment available that was needed to ensure people's needs were met safely.