Archived: Mill View

This inspection took place on 18 April 2018 and was unannounced. There were 46 people using the service.

Mill View is a care home. People in care homes receive accommodation and personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided and both were looked at during this inspection. Mill View can accommodate up to 50 older people/people living with dementia in a two storey, purpose built home.

At the last inspection in November 2016 we did not identify any breaches of Regulation, but the service was rated ‘Requires improvement,’ because we needed to see the improvements which had been made could be sustained and developed over time.

A registered manager was in place. 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.

The service was exceptionally well led. The service benefitted from strong leadership. The registered manager was passionate about providing person centred care and this was reflected in every aspect of the service. The registered manager, supported by the senior management team, was continuously looking at ways to improve the service for the benefit of the people who lived there. The registered manager had developed positive working relationships with staff and relevant stakeholders. The registered manager motivated the staff team with regular meetings, formal supervisions and training.

The registered manager understood their responsibilities and worked with people who used the service, relatives, staff and the provider to improve the quality and safety of care that was provided. Quality assurance procedures and a programme of audits were effective in driving continual improvements to the quality of service.

People received an outstanding responsive service. People who used the service received highly personalised care from staff who knew their background, interests and hobbies. The registered manager listened to people who used the service and about what they wanted. A shop, cinema, American style diner had all been created to provide people with interesting and stimulating facilities. Group and individual activities were on offer to keep people occupied. People were encouraged to pass on any concerns so action could be taken to improve the service they received. Excellent links had been made with local groups of young people who were regular and popular visitors.

People were safe because there were systems and processes in place to protect them. Staff, as a result of their training in safeguarding people, understood the different types of harm and to who they could report this to. Risk assessments were in place and these promoted people's safety such as when mobilising around the service. Incidents such as falls were used as an opportunity for learning and to help drive improvements. Medicines were administered, recorded and stored in a safe manner and all staff who administered medicines had received suitable training to do this.

Staff were subject to checks on their suitability before they were offered employment. Enough staff were employed to ensure that people’s needs could be met in a timely manner. Staff were aware of infection control measures and the service was clean and well maintained.

People received an effective service and were supported by staff who had received appropriate training. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible: the policies and systems in the service supported this practice. Staff knew when people needed support and also when to respect people's independence. Staff were supported in their role and they knew what standard of care was expected. People were enabled to access healthcare services. People's nutritional needs were met and meals at the home were excellent, offering choice and variety.

People received good care. We received very positive comments from a range of people about the caring nature of the service. People received high quality care from staff who had the time to spend with them. Staff showed kindness to people in everything they did by offering friendly support around their individual needs. People were at the heart of the service as staff put people first and foremost in everything.

People's care plans contained relevant personalised information and these gave staff the information they needed in order to meet people's needs. Staff used people's life histories to help them understand what was important to each and every person. Staff understood it was important for people to maintain their independence and they protected people’s privacy and dignity.

At the last inspection on 8 and 15 March 2016 we rated the service as ‘Inadequate’ and in ‘Special Measures.’ We identified three regulatory breaches which related to staffing, safe care and treatment including medicines and good governance. Following the inspection we took enforcement action. The provider suspended placements at the home and following the inspection sent us an action plan which showed how the breaches would be addressed. This inspection was to check improvements had been made and to review the ratings.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

There was no 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. A new manager was recruited following our last inspection and they had applied to become the registered manager. At the time of this inspection their application was being assessed.

Mill View is registered to provide accommodation and personal care and support to up to 50 older people and people living with dementia. The living accommodation is arranged over two floors and all of the bedrooms are single with en-suite toilet and shower facilities. It is located a short distance from Bradford city centre and is accessible by public transport.

The manager was providing strong leadership and direction and had brought about significant improvements in all areas of the service. We found staff up-beat, enthusiastic and confident, which had a positive effect on the people they cared for.

We found staff were being recruited safely and there were enough staff to take care of people and to keep the home clean. Staff were receiving appropriate training and they told us the training was good and relevant to their various roles. Staff told us they felt supported by the registered manager and area manager and were receiving formal supervision where their could discuss their on going development needs.

People who used the service and their relatives told us staff were helpful, attentive and caring. We saw people were treated with respect and compassion. They also told us they felt safe with the care they were provided with. We found there were appropriate systems in place to protect people from risk of harm.

Staff knew about people’s dietary needs and preferences. People told us there was a choice of meals and the food was good. We also saw there were plenty of drinks and snacks available for people in between meals.

Care plans were up to date and detailed exactly what care and support people wanted and needed. Risk assessments were in place and showed what action had been taken to mitigate any risks which had been identified. People who used the service and relatives told us they were happy with the care and support being provided. We saw people looked well groomed and well cared for.

People’s healthcare needs were being met and medicines were being managed safely. However, stack control needed to improve so people did not run out of prescribed medication.

Some activities were on offer to keep people occupied both on a group and individual basis. However, these needed further development.

We found the service was meeting the legal requirements relating to Deprivation of Liberty Safeguards (DoLS).

We saw some redecoration and refurbishment had taken place since our last inspection to improve the living and bedroom accommodation. We found the home clean, tidy and odour free.

We saw systems had been introduced to monitor the quality of the service. We saw these had identified areas for improvement and action had been taken to address any shortfalls. People using the service and relatives were being consulted about the way the service was being managed and their views were being acted upon. We saw that the new audit systems were helping to drive improvements in the service. However, these processes were still relatively new. Whilst it was clear the service was on a journey of improvement, it was too early for the provider to be able to demonstrate that the new processes were fully embedded and that these improvements could be sustained over time.

Since our last visit the overall management of the service has been taken over by Anchor Trust.

Mill View is registered to provide accommodation and personal care and support to up to 50 older people and people living with dementia. The living accommodation is arranged over two floors and all of the bedrooms are single with en-suite toilet and shower facilities. It is located a short distance from Bradford city centre and is accessible by public transport.

At the time of this inspection there were 46 people using the service.

There was no registered manager in place. 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.

There were not enough staff, with the right skills and experience, on duty to care for people safely or to make sure their needs were met in a timely way. There were not enough housekeeping staff to make sure the home was kept clean and odour free.

People told us they liked the staff and found them kind and caring. We witnessed some staff practices which demonstrated a lack of respect for people

People told us they felt safe in the home. However, we found staff did not have a good understanding of how to control risks to people’s health, safety and welfare.

People told us meals at the home were good and the cook understood people’s dietary needs. However, the mealtime experience for people varied depending on which floor they were on or which staff were assisting them.

We found people had access to healthcare services. Safe systems were not in place to manage medicines and people did not always receive their medicines at the correct times.

We found the service was meeting the legal requirements relating to the Deprivation of Liberty Safeguards (DoLS).

Visitors told us they were made to feel welcome and if they had any concerns they would speak to the manager or another member of staff.

People were not protected because the provider did not have effective systems in place to monitor, assess and improve the quality of the services provided. People using the service and their relatives were not being asked for their views and so were not able to influence the way the service was being managed.

Overall, we found significant shortfalls in the care and service provided to people. We identified three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The Care Quality Commission is considering the appropriate regulatory response to resolve the problems we found.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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 in any of the five key questions it will no longer be in special measures.