Millbrow Care Home

We found the following examples of good practice.

The service followed safe visiting procedures. Visits were restricted to essential visitors only. However, there were safe measures in place to facilitate visits for people receiving end of life care and where it had been assessed as being in the persons best interest due to their wellbeing. Family entered the service through the nearest external door to where their relatives bedroom was located. All visits were conducted in the persons own room and visitors were required to wear full PPE.

Signage with instructions about shielding and social distancing rules were on walls around the building. We observed shielding and social distancing rules were complied with. The environment had been adapted to support social distancing.

There was a dedicated procedure that accommodated people should they develop COVID-19 or show symptoms. Safe procedures were followed for admitting people to the service. Virtual assessments were completed, and people were only admitted following evidence of a negative COVID-19 test. On moving into the service people were required to self-isolate for 14 days.

Stocks of the right standard of personal protective equipment (PPE) were well maintained and staff used and disposed of it correctly. Guidance on the use of PPE and current IPC procedures were clearly visible across the service.

People and staff had access to regular testing.

Staff reassured people throughout the pandemic and provided them with the support they needed to maintain regular contact with their family and friends through the use technology.

Further information is in the detailed findings below.

Millbrow is a residential care home providing personal and nursing care for up to 44 older people. At the time of the inspection, the service was supporting 42 people across two floors. The upper floor was dedicated to accommodation and care for people living with dementia, while the ground floor provided nursing care.

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

Medicines were not always safely managed in accordance with best practice. Risk associated with the building were not always managed safely. Quality assurances processes were more robust and effective. However, they had not been effective in identifying concerns found during this inspection. The service remained in breach of regulations regarding Safe Care and Treatment and Good Governance.

Improvements had been made and sustained since the last inspection. Staff received regular supervision and support. The service was no longer in breach of regulation regarding Staffing.

Systems and processes were in place to safeguard people from the risk of abuse. Individual risks to people were assessed. It was unclear if there were always enough staff to meet people's assessed needs. Arrangements were in place for making sure that premises were kept clean and hygienic so that people were protected from the risk of infections.

People were given a good choice of nutritious food and drinks in accordance with their needs and preferences. Their healthcare needs were met through effective working with a range of healthcare professionals. The service operated in accordance with the principles of the Mental Capacity Act 2005 (MCA). 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.

Staff treated people with kindness, compassion and respect. People’s faith and cultural needs were recorded and understood by staff. People were encouraged to be as independent as possible. Staff understood the need to protect people’s privacy and dignity when providing care.

Care records were personalised for each individual. Care plans were reviewed regularly to ensure they remained accurate and reflected people’s needs. Staff adapted the way in which they communicated with people to engage them and to ensure important information was shared. People were supported to engage in a range of activities and to maintain important relationships. People’s end of life wishes were considered as part of the assessment and care planning process.

Notifications to the Care Quality Commission (CQC) had been submitted as required. The service had a positive learning culture where people were supported to reflect on performance and improve practice. The provider regularly engaged people using the service, their relatives and staff through, surveys, meetings and informal discussions. People said communication with the registered manager was good.

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

The provider has acted to reduce the risk posed by the issues we identified during this inspection.

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 16 March 2019) and there were three breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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 the service:

People who used the service were happy about the service being delivered to them. We received mixed comments about the food and people were unsure of the choices of food available.

Staff had followed the Code of Practice in relation to the Mental Capacity Act 2005 (MCA). However, Statutory notifications regarding authorisations of DoLs were not always submitted to the Care Quality Commission (CQC) as required by law. The registered manager has submitted all required notifications following the inspection.

We identified a breach of regulation relating to staff supervision and appraisals. Staff noted improvements to the service since the registered manager commenced in post. They felt supported and listened to.

Health and safety needed regular oversight and support to consistently manage safe systems at the service. We noted some areas of repair were needed within the building and a lack of evidence of environmental risk assessments and quality assurance checks in the management of health and safety within the building.

Improvements were needed so that medication administration records (MARs) were appropriately completed. We identified a breach of Regulation regarding safe care and treatment and management of medications and health and safety.

Staffing was supported by agency staff at a rate of 75%. Agency staff were regularly used for vacancies and sickness. This created a risk to the stability of the workforce and inconsistency of care delivery. We identified a breach of Regulation relating to the safe management of staffing within the service.

Quality assurance processes had not identified issues highlighted during this inspection. We identified a breach of regulation relating to good governance as we did not see sufficiently established and effective quality assurance systems in place.

Staff were knowledgeable of local safeguarding procedures. The service had learnt from recent safeguarding incidents that had serious outcomes to the care people had received at the service.

Updated care plans described the support people needed. People were referred to appropriate health and social care professionals when necessary to ensure they received treatment and support for their specific needs.

Information and arrangements were in place for the staff team to respond to concerns and complaints.

We noted some personal records openly on display in the nurse’s office. This highlighted potential concerns about people being able to access personal information.

We have made a recommendation that the service review storage of confidential information.

We recommend the service review the dining experience and look at trialling various initiatives to help improve this aspect of support for people.

We recommend the service review and make improvements to the environment to meet the needs of people who were living with cognitive impairments and dementia

Rating at last inspection: This was the first comprehensive inspection since the service registered with CQC in February 2018. This comprehensive inspection took place on the 4 and 13 February 2019 and was unannounced.

Why we inspected: This inspection was a planned comprehensive inspection. We had received information of concern prior to the inspection from two safeguarding incidents that had been reviewed by Halton local authority and were substantiated.

Enforcement: We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Follow up: You can see what action we told the provider to take at the back of the full version of the report. We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner