The Mill House

Updated 4 September 2019

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.

Inspection team

The inspection was carried out by an inspector, a medicines inspector, a registered nurse specialist advisor and and Expert by Exerpience. 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

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. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The manager of the service had applied to be registered with the Care Quality Commission.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. 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 ten people who used the service and five relatives about their experience of the care provided. We spoke with ten members of staff including the regional director, manager, wellbeing and dementia services manager, a nurse, two care team laders, three care workers and an administrator. We also spoke with a visiting health care professional.

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

After the inspection

We spoke with one relative and a local GP and we continued to seek clarification from the manager to validate evidence found.

Updated 4 September 2019

About the service

The Mill House is a residential and nursing home providing personal and nursing care to 45 people aged 65 and over at the time of the inspection. At the time of our inspection, there were 36 people using the service.

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

Medicines were administered safely by competent staff but records and storage of medicines did not always support safe administration. Some poor infection control practice was observed. Most of the time people received care in a timely way by staff who had been recruited safely however some concerns were raised about staffing numbers. People were kept safe from abuse and from risk of harm. People’s needs were assessed and staff took the necessary steps to promote their safety and wellbeing. Lessons were learnt from accidents and near misses, which were routinely reported, recorded and monitored.

Staff were well trained and regularly supervised. People were supported to eat and drink and their dietary needs were met. People were given choices with their meals. Emerging and existing health care needs were identified and managed well and people were supported to access external health professionals. Some improvements to the communication with the local GP surgery was needed. 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.

People were supported by very caring and kind staff, who treated people as individuals and showed a genuine interest in them. People were supported to communicate their wishes and preferences about their care and to be involved in health and care decisions. People were treated with dignity and respect and staff sought to ensure people stayed as independent as possible.

People’s care planning was personalised and effective. There were examples of positive outcomes and people and relatives were happy with the care provided. The service supported people to avoid isolation and undertake activities of interest to them. People’s communication needs were met and end of life care planning was good. The manager dealt appropriately with and ensured the service learnt lessons from complaints.

The manager led and managed the service with enthusiasm and professionalism. They had instilled a caring and positive culture since their appointment and staff had responded well to this. People and relatives praised the staff and the manager and spoke of their contentment with the service. There was a clear drive for improvement and a willingness to ensure views from people, staff and reletiaves were reflected in plans to develop the service. Governance of the service was generally strong. Some improvements to the auditing of the recently introduced electronic care record system is required. Staff will benefit from further training on the new electronic care record system so that its functionality can be maximised.

Rating at last inspection and update

The last rating for this service was requires improvement (published 15 February 2019) and there were multiple 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 we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

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.

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