Background to this inspection
Updated
27 September 2022
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 carried out by one inspector who visited The Mill House on 1 September 2022, and we were supported by an expert by experience. An expert by experience is someone who has experience of using this type of service. One inspector returned on 2 September 2022.
Service and service type
The Mill House is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.
Registered Manager
This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. 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.
At the time of our inspection there was a registered manager in post.
Notice of inspection
This inspection visit was unannounced on 1 September 2022. We announced our visit on 2 September 2022.
What we did before inspection
We reviewed the information we held, such as people and relatives’ feedback and statutory notifications, as well as any information shared with us by the local authority and Healthwatch. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England. The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make. We used all this information to plan our inspection.
During the inspection
We spoke with eight people who received a service to get their experiences about the quality of care received. We spoke with two visiting relatives and asked them for their feedback about the service provided. We spoke with four members of care staff including senior staff and an activity staff member and a maintenance person. We also spoke with the recently appointed registered manager as well as the previous registered manager who was part of the management team and the provider who was the owner.
We reviewed a range of records. This included four people’s care records and samples of medicine records and associated records of their care. We looked at records that related to the management and quality assurance of the service, fire safety and environmental risks and records for infection control and risk management. We also reviewed two staff recruitment files.
Updated
27 September 2022
About the service
The Mill House is registered to provide accommodation and personal care for up to 31 older people, including people with dementia. At the time of our inspection visit there were 29 people living at the home. Care is provided across two floors. A communal lounge and dining area are located on the ground floor. Not all bedrooms were ensuite but there were further communal bathroom facilities located on each floor. The provider was considering further improvements at the home which included the addition of an ensuite to existing rooms.
People's experience of using this service and what we found
At our last inspection, we found some improvements were required with the risk management of people’s health and welfare, medicine management and better oversight of the service. In response to our last inspection, the provider completed their own action plan to ensure improvements were made and sustained.
Since the last inspection there had been changes in registered manager. There was a new registered manager in post who was continuing to make changes to improve outcomes for people. The registered manager was supported by the previous registered manager who was part of the provider’s management structure, as well as the owner who is the provider.
At this inspection, we found some improvements to medicines management, care planning and risk assessments. The provider had improved and increased their quality assurance systems and checks which were mostly effective. However, further improvements to some quality assurance systems were needed because some of the issues we found related to medicines, care planning and risk assessments at this visit had not always been identified from completed checks.
Electronic care planning and risk assessments were completed for people however in some cases, where a person had fallen or if people had risks related to certain activity, these were not always completed. However, we were assured people were safe and staff knew people’s risks and how to safely manage those identified risks.
Additional checks made sure medicines were administered and stored safely. Better recording of some medicines, such as topical creams and pain patch medicines would help to demonstrate medicines were administered safely. The registered manager took immediate action during our visit to improve medicines administration practices to ensure people continued to receive medicines safely. Positive links with a local GP practice ensured people were reviewed and seen promptly.
Infection control systems ensured the home was clean. Housekeeping staff supported the home in addition to care staff. Maintenance staff completed regular checks on health and safety to ensure the home remained safe for people.
People’s overall feedback to us was positive of a service they received that they felt met their needs. People knew how to raise an issue and when they did, they were confident they were listened too. People and relatives could attend meetings to share any feedback about the service. Post pandemic, plans were in place to increase the frequency of these meetings.
People felt the service was responsive to their needs. Staff knew people well and we saw during our visit, staff quickly responded to situations to help maintain an environment that promoted good care.
Staff interacted with people at their pace, unrushed and joked and laughed with each other. Staff in all roles were empowered to involve, engage and to sit and chat to people which helped develop relaxed and genuine relationships. People were involved in pursing their hobbies and interests. Social activities and engagement was a key feature that recognised the importance of promoting people’s emotional and physical wellbeing. Day trips, gardening, book clubs, quizzes were just some of the activities people were involved in. Further opportunities were planned with people’s involvement to continue to support people’s interests.
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. Visitors were welcomed and there were no restrictions on visiting arrangements. Relatives were able to visit, and they were encouraged to book a visit in advance to help manage any potential risk.
Staff understood their responsibility to report any concerns to protect people from the risk of abuse.
Staff were positive about the management of the home and staff said people received a good quality of care. Staff enjoyed working at the home and staff said it felt like one big family. The provider had their own staff team and did not rely on agency staff so staff who supported people knew them very well. Staff had received training in key areas and staff said they felt supported to pursue additional training and opportunities to increase their knowledge and confidence.
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 17 January 2020).
At our last inspection we recommended that the provider improved their processes in the management of medicines, risk management and quality assurance. At this inspection we found the provider had acted on those recommendations and they had made improvements, although their quality assurance systems still required some improvements.
Why we inspected
This inspection was prompted by a review of the information we held about this service and to check the provider had improved certain areas identified at our last visit.
This report only covers our findings in relation to the Key Questions Safe, Responsive and Well-led which contain those requirements. 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 good. This is based on the findings 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.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Mill House on our website at www.cqc.org.uk.
Follow up
We will continue to monitor information we receive about the service, which will help inform when we next inspect.