Archived: Mill View Care Home

The registered manager at the home had recently left their employment and a new manager had been employed by the service. They were in the process of registering with the Care Quality Commission. On the day of the inspection the new manager had been in post only a few days. 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 unannounced inspection took place on 28 and 29 November 2016. At the previous inspection on 15 and 16 June 2015 the service was given a rating of good overall. This inspection was brought forward due to concerns received from HM Coroner around an incident that had happened at the home. The concerns were around the lack of appropriate training in relation to assisting people with swallowing difficulties to eat. Information received from the provider and evidence gathered at the inspection demonstrated that the service had responded to the concerns appropriately. They had produced an action plan, updated staff guidance around assisting people to eat and included more specific instruction and guidance within the nutritional training for all staff.

There was a house manager for each of the six houses as well as two clinical service managers who oversaw the running of three houses each.

People told us they felt safe at the home. Appropriate individual and general risk assessments were in place and these were reviewed and updated on a regular basis.

Staffing levels were appropriate to meet the needs of the people who used the service. Staffing was based on the dependency levels of the people who used the service. Recruitment procedures were robust and the induction of new staff was thorough.

The premises were clean, tidy and warm with no malodours. The premises and equipment were maintained and serviced regularly to help ensure they remained fit for purpose.

There was an up to date safeguarding policy in place and staff were aware of how to recognise and report any safeguarding issues. Safeguarding issues were followed up appropriately by the home. We saw the home’s medication systems which helped ensure medicines were safely ordered, administered, stored and disposed of.

Staff had appropriate skills and training to ensure they were able to administer care effectively. Supervisions were undertaken regularly but recording needed to be more consistent.

The service was working within the legal requirements of the Mental Capacity Act (2005) (MCA) and authorisation for Deprivation of Liberty Safeguards (DoLS) was sought appropriately.

People’s nutritional and hydration requirements needs were assessed and documented appropriately. Special diets were adhered to by the chef and people were given choice with regard to meals. Food and drink were plentiful throughout the day.

People told us they were treated with respect and kindness and we observed good interactions between staff and people who used the service. Visiting times were unrestricted and visitors told us they were made to feel welcome at all times.

People who used the service and their families were involved in care planning where appropriate. People’s wishes for when they were nearing the end of their lives were documented and their preferences adhered to if possible.

Care plans were person centred and included a range of health and personal information. This included people’s likes, dislikes and care needs. There was a varied programme of activities at the home and people’s preferences for how they liked to spend the day were supported.

Complaints were dealt with appropriately by the service and there were a number of forums for people to put forward suggestions and raise concerns.

The new manager at the home had not yet had time to become established. We were therefore unable to assess her leadership skills. People who used the service, visitors and staff reported that the management team were approachable. Staff meetings took place regularly.

A number of audits and checks were carried out by the home. Some were followed up appropriately but others lacked analysis and follow up actions.

During the inspection we looked at care and welfare, safeguarding, management of medicines, staffing and quality assurance.

This is a summary of what we found, using evidence obtained via speaking with stakeholders, speaking with staff, speaking with people who used the service and their relatives, observing care delivery and looking at records:

Is the service caring?

We undertook a short observational framework for inspection (SOFI) on one of the dementia units. SOFI is a tool used by inspectors to allow them to observe moods, interactions and activities for a sustained length of time. The atmosphere was calm, people were offered a choice of food and there was good staff interaction and encouragement offered. Staff did not rush people with their food and staff sat on people's level and chatted with them.

We saw personal preferences were recorded within the care records. Where people were unable to express their wishes these had been obtained from family members.

We spoke with staff members who demonstrated a good understanding of the needs of the people within their unit. Staff were complimentary about the new manager, who they described as very supportive and 'a breath of fresh air'.

We spoke with several visitors and most comments were positive.

One visitor felt their relative had put on some weight, 'X enjoys the food and is a good eater'. The person who used the service added, 'They are good at giving you choice.'

Another person said, 'I've no complaints except at the beginning with getting X's own clothes', but that problem had been resolved as the system of laundering had been changed.

A third visitor said they visited three to four times weekly and had no concerns around care. They told us staff were very good, though they felt more staff should be on duty at mealtimes as they had observed a significant number of people required assistance with meals.

Other comments included, 'No complaints', 'Food good', 'Some staff I like some I don't', 'Not enough staff', and 'No stimulation whatever'. People who used the service agreed that when call assistance buzzers were pressed they didn't have to wait very long.

We spoke with the manager about the need for additional activities which they agreed they were aware of and had plans to address.

Is the service responsive?

Care plans we looked at demonstrated an individual approach to care, containing personal information, family background, likes and dislikes, preferences and culture in order to facilitate personalised care.

There were forums for people to make suggestions, discuss issues or raise concerns, such as the monthly relatives and residents meetings. The manager endeavoured to be available to speak with people if they had anything they wanted to discuss.

There was evidence within the care records that people's mental capacity was taken into consideration with regard to decision making and care was taken to ensure they were assisted to make their own decisions where possible.

There was evidence within the care records that the service responded to people's changing needs and updated the support plans appropriately.

Is the service safe?

Risk assessments were in place in the care records. These risk assessments were reviewed and updated regularly to ensure people's needs were met safely.

Medication Administration Records (MARs) were generally clear and accurate.

Medicines were only handled and administered by trained Registered Nurses on the nursing units and by Senior Carers on the residential units, who had been assessed as having the appropriate skills to manage medicines safely.

The manager carried out regular audits on medicines to make sure they were being handled properly. We saw evidence that where concerns had been found, action had been taken to address them and help prevent them from happening again.

Deprivation of Liberty Safeguards (DoLS) authorisations were sought appropriately from the supervising body (the Local Authority) and staff were aware of the individual nature of the authorisations and particular techniques to be used with each individual to keep them safe.

There were adequate numbers of staff in evidence to effectively care for the people who used the service.

Staff had undertaken appropriate training in areas such as Manual Handling, Health and Safety, Fire Safety and Safeguarding.

Safeguarding issues had been followed up appropriately by the home.

Is the service effective?

The home endeavoured to involve people who used the service with their care plan reviews. People's health and care needs were assessed and monitoring charts, such as weights and falls were complete and up to date.

Appropriate referrals were made to other professionals, such as the Dementia In Reach Team, when assistance, specialist help or advice was needed.

Special and cultural diets were supplied where required.

Signage, colours and layout demonstrated a commitment to good and effective care for people who were living with dementia.

Is the service well-led?

There was a registered manager in place who was appropriately registered with the Care Quality Commission (CQC).

A significant number of audits and checks were in place, including Infection Control, Medication, Care Files, Health and Safety, Fire Safety, Accidents and Incidents and Complaints. This helped the home to continually monitor, review and improve the service delivery.

The manager had been in post only a short time but a significant number of staff told us many areas had improved since their appointment, including staff morale, the environment, communication and staffing levels.

We looked at six care plans, which included information about health, care needs, background, likes and dislikes. There were appropriate risk assessments and monitoring charts which were reviewed and updated on a monthly basis.

We spoke with six people who used the service and five visitors. One person said 'I like to stay in my own room, this is the best home I have been in.' Another said 'Staff are wonderful, some of them."

A professional visitor said 'I can't fault the staff. I have seen improvements over the last few months."

The home had safeguarding procedures which were followed appropriately. Staff had an awareness of safeguarding issues and were able to recognise, report and record concerns.

We spoke with six staff members who felt they were supported in their employment, learning and development. They felt that if the staffing ratios were better they would be able to spend more quality time with people who used the service.

We saw the complaints procedure and complaints were followed up appropriately. There were a number of regular internal audits with any issues highlighted and addressed.