Background to this inspection
Updated
22 April 2021
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
This inspection was carried out by three inspectors, one of whom is a medicines inspector and an Expert by Experience.
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
Mill House and Cottages 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 was currently completing the process to become registered with the Care Quality Commission.
Notice of inspection
This inspection was announced.
We gave the service 24 hours’ notice of the inspection. This was to ensure space could be allocated to complete this inspection safely and the required documentation could be made available.
What we did before the inspection
The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.
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 and looked at any information in the public domain.
During the inspection-
We spoke to seven people living at the service and three relatives about their experience of the care provided. We spoke to four members of staff including, the manager and regional director.
We observed how people received their support in communal areas of the service.
We reviewed a range of records. This included eight people’s care records and multiple medication records. We looked at three staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.
After the inspection
We made contact with the manager to request additional documentation for review.
Updated
22 April 2021
About the service
Mill House and Cottages is a residential care home providing accommodation and personal care to 23 people aged 65 and over at the time of the inspection, some of whom are living with dementia. The service can accommodate up to 44 people in two areas within the main building and has nine bungalows adjoining this for people who wish to have an environment that better promotes their independence.
People’s experience of using this service and what we found
The last rating for this service was inadequate (published 30 March 2020) and there were multiple breaches of regulation. Following this previous inspection a warning notice was issued by CQC in relation to Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 regarding the safe management of people medicines and Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 regarding good governance. 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 imbedded by the service and the provider was no longer in breach of regulations and the warning notices had now been met.
The premises were maintained to a good standard. Extensive refurbishment had taken place to improve the internal and external surroundings, maintaining the safety of those who reside within the setting.
The management of medicines had improved since our last inspection. Care plans in relation to covert medicines and as and when required (PRN) medicines had been reviewed to ensure people received their medicines in a safe and personalised way.
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 supported people in a confident, competent manner. Training and development had improved since our last visit, enabling staff to develop skills to improve the support offered.
People were well supported at mealtimes. Staff engaged positively at these times and ensured people were given choice, appropriate equipment and support to enjoy their meal. People told us they enjoyed the food offered. One relative told us, “There is a fruit bowl and biscuits, if you need a snack and the cook is very good. Proper food”.
Staff were kind, caring and promoted people’s dignity. Staff understood the importance of treating people with respect and ensured they did this. People were observed to have good relationships with the staff team.
Care plans and risk assessments had been personalised and gave clear direction for staff to follow. These documents had been regularly reviewed and gave an accurate representation of individuals support needs and wishes. People were able to engage in activities and staff made time to engage and interact. Complaints were responded to quickly, and learning used to improve the quality of service.
The provider and manager had implemented a comprehensive service improvement plan, people and their relatives told us that the service had improved greatly. The manager provided staff with leadership and was visible and approachable, with a hands-on approach to modelling best practice working alongside staff supporting people. Staff were motivated and enjoyed strong team work, they commented to us positively on improvements made.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
This service has been in Special Measures since 30 March 2020. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.
Why we inspected
This was a planned inspection based on the previous rating.
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.
The overall rating for the service has changed from inadequate to good. This is based on the findings at this inspection.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Mill House and Cottages on our website at www.cqc.org.uk.
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.