Mill River Lodge

Updated 26 October 2021

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was undertaken by three inspectors and an Expert by Experience who contacted people’s relative’s remotely by phone. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

Mill River Lodge is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

We gave a short notice period of the inspection because we wanted to ensure we had up to date information regarding the COVID-19 status of the home. This would enable us to plan our visit safely.

What we did before the inspection

We reviewed information we had received about the service since the last inspection and the monthly reports submitted under the conditions of registration. We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We used all of this information to plan our inspection.

During the inspection

We spoke with 14 people who used the service and seven relatives about their experience of the care provided. We spoke with 20 members of staff including the managers, deputy manager, registered nurse, team leaders, care workers, housekeeping staff, maintenance staff, activities champions and the chefs.

We reviewed a range of records. This included nine people’s care records and multiple medication records. We looked at three staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.

We are currently improving how we gather people's experience and views on services when they have limited verbal communication. We have trained some CQC team members to use a symbol-based communication tool. We checked that this was a suitable communication method and that people were happy to use it with us. We did this by reading their care and communication plans, speaking to staff and the person themselves. In this report, we used this communication tool with one person to tell us their experience.

After the inspection

We continued to seek clarification from the provider to validate evidence found. We looked at staff competencies, minutes from meetings and audit and quality assurance records. We requested feedback from three professionals who regularly visit the service.

Updated 26 October 2021

About the service

Mill River Lodge is situated in Horsham, West Sussex. It is a residential ‘care home’ providing care for up to 70 people in one adapted building. People residing at the home may be living with dementia, physical disabilities, older age or frailty as well as up to 20 people who may require nursing care. At the time of inspection there were 63 people living at the service.

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

Since our last inspection it was evident that the managers of the service and staff had continued their work to improve the standard of care people received and the overall governance of the service. Quality assurance and monitoring systems had been revised and embedded. Support from external organisations and health professionals had been utilised effectively and recommendations implemented to address the concerns raised about Infection Prevention and Control (IPC) and managerial oversight of people’s care.

IPC practice had significantly improved and was in line with current government guidance. People and their relatives told us they felt safe and were cared for by staff who knew them well. People told us staff wore Personal Protective Equipment (PPE) when providing care and ensured that visitors to the home completed a lateral flow test for COVID-19 before they entered the building.

Risks to people’s health and safety were assessed and people were supported to stay safe. Care plans were person-centred and provided staff with clear guidance on how to support people. Staff were aware of their safeguarding responsibilities and knew how to report and escalate concerns. Accidents, incidents and safeguarding concerns were appropriately investigated with actions taken to reduce the risk of reoccurrence.

Medicines were managed safely. People received their medicines in line with the prescribers requirements from staff who were trained and competent in the task. People who were prescribed medicines to be administered ‘as and when required’ (PRN) had detailed care plans to guide staff when PRN medicine should be administered.

People and their relatives told us staffing levels had improved and there were enough staff to meet their needs. Staff were recruited safely and had the skills, training and competence to provide safe and effective care. Staff had regular supervision where they received feedback about their practice and opportunities for development.

People received care in accordance to their needs and had access to healthcare services and support. One relative told us, “They [staff] always take time to help any resident who needs it. They don’t get impatient and they help in a gentle way.” 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 supported this practice.

The culture within the home was positive, person-centred and promoted good outcomes for people. People and their relatives felt involved in their care and were complimentary about how the home was managed. A relative told us, “I think the home is very good and I have recommended it to people. I feel very confident with my [person] being there.”

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

Rating at last inspection (and update)

The last rating for this service was Requires Improvement (published 07 April 2020). There was one breach of regulation relating to the leadership and governance of the home. The provider completed an action plan to show what they would do and by when to improve. A targeted inspection was held on 10 November 2020 (published 08 April 2021) to follow up on this breach and look at concerns raised at the time about people’s care. The provider had not met all of their action plan and there was a further breach of regulation relating to infection prevention and control and people’s care. The home had failed to make enough improvements and remained Requires Improvement. The provider was served a notice to impose conditions on their registration. The provider was required to submit monthly reports to CQC to demonstrate their quality assurance and monitoring systems were effective and utilised to improve people’s care.

At this inspection enough improvements had been made and the provider was no longer in breach of regulation 12 (safe care and treatment), and regulation 17 (good governance).

Why we inspected

We undertook this focused inspection to check the provider had complied with the conditions imposed on their registration. We also needed to ensure that actions submitted in their monthly reports were embedded and confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective, Responsive and Well-led which contain those requirements. The rating from the previous comprehensive inspection for the key question not looked at on this occasion was 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 COVID-19 and other infection outbreaks effectively.

The overall rating for the service has changed from Requires Improvement to Good. This is based on the findings at this inspection.

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

Follow up

We will continue to work alongside the provider and local authority to monitor progress. 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.