• Care Home
  • Care home

Archived: Milverton Gate Care Home

Overall: Inadequate read more about inspection ratings

Dawson Road (Off Aldermoor Lane), Stoke, Coventry, West Midlands, CV3 1FU (024) 7663 5799

Provided and run by:
Four Seasons (Bamford) Limited

Important: The provider of this service changed. See old profile

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Background to this inspection

Updated 20 March 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve across all key questions, Safe, Effective, Caring, Responsive and Well Led. This inspection took place on 21 November 2017 and was unannounced. We found actions proposed and taken had not been effective in making the necessary improvement.

The inspection was undertaken by two inspectors, a specialist nursing advisor, 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.

Before our inspection visit we reviewed the information we held about the service. We looked at information we received from relatives, the local authority and the statutory notifications the provider had sent to us. A statutory notification is information about important events which the provider is required to send to us by law.

We used information the provider sent us in the Provider Information Return (PIR). This is information we require providers to send us at least once annually to give some key information about the service, what the service does well and improvements they plan to make. We found some aspects of the service had changed since it had been submitted in March 2017 so did not consistently reflect our findings.

During our visit we spoke with four people who lived at the home, three relatives and one family friend, plus nine members of staff. This included day and night nurses/care staff. We spoke with a visiting healthcare professional, the new manager, the regional manager, a member of the resident experience team (RET) manager, and a manager from another of the provider’s homes.

We spoke with commissioners of the service who regularly monitored the home. They had identified some of the issues we found during our inspection visit. Commissioners are people who work to find appropriate care and support services which are paid for by the local authority.

We observed care and support provided in communal areas on both floors and we saw how people were supported to eat and drink. We looked at a range of records about people’s care including four care files, daily records for personal care, food and drink charts and medicine administration records (MARS).

We also looked at three staff files, staff training records, staff duty rotas and quality monitoring information. This included health and safety records, audit checks and staff meeting notes.

Overall inspection

Inadequate

Updated 20 March 2018

This inspection took place on 21 November 2017 and was unannounced. Milverton Gate 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. Milverton Gate Care Home provides both personal and nursing care across a two storey building and accommodates a maximum of 39 older people. On the day of our inspection 26 people lived at the home, several people lived with dementia and other people had high level nursing needs.

When we inspected the home in October 2015 we found there were four breaches in the legal requirements and regulations associated with the Health and Social Care Act 2008. (Regulated Activities) Regulations 2014. These breaches were in relation to: the safe care and treatment people received, ineffective medicine management, people’s nutritional needs not being met, and insufficient quality monitoring of the service. There were also not enough suitably qualified, experienced staff to meet people’s care and treatment needs.

At the following inspection on 1 March 2016, sufficient improvement had been taken in response to the breaches in regulations but there were still areas which needed further improvement.

At the last inspection on 4 April 2017 we found previous improvements had not been sustained. The provider was again in breach of the legal requirements and regulations associated with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We asked the provider to take the necessary action to improve. This included improvements to staffing arrangements, the notification of specific incidents (such as incidents that impacted on people’s safety) and improvements to the management of the home.

Although the provider had an action plan in place to address these areas, when we carried out this inspection on 21 November 2017, we found action taken had not been effective in making and sustaining the required improvements. The breaches in the regulations from the previous inspection in April 2017 continued. In addition there was a breach of the Care Quality Commission (Registration) Regulations 2009.

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. This 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 for any of the five key questions it will no longer be in special measures.

There has been no registered manager at the home for since February 2017. 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.

Milverton Gate care home has had different interim managers supporting the home in the last 12 months. There had been changes in the provider’s regional managers supporting the home. This had resulted in inconsistent managerial oversight of the home which staff told us they found challenging. When we carried out this inspection, a new manager was in post and had been working at the home for one week. People and staff were still getting to know the new manager and new regional manager but initial feedback from people was positive.

People and their relatives told us staff were not always available when people needed them and we found this to be the case. Throughout the day we saw some people received delayed care because staffing arrangements were not sufficient and effective. At mealtimes, there were not enough staff available to support people with their meals in a timely manner.

The provider had not ensured people received consistent safe care and treatment. We found serious risks associated with people’s care had not always been identified by the provider and staff. This placed people at risk of ill health. Records available did not always show how risks, such as those related to skin damage, were to be managed or stated how they had been managed.

Quality monitoring systems to assess, monitor and mitigate risks were either not in place or were not effective. Some serious incidents and accidents had not been investigated thoroughly, or reported to us and the local authority as required, to make sure health and safety risks to people were managed. There were some risks associated with the environment such as exposed hot pipes and a hot food trolley which had not been identified during audit checks of the home. This meant the risk of burns to people had not been assessed so they could be prevented.

Some people and their relatives were not aware of meetings they could attend to discuss the home. They were also not aware of questionnaires they could complete to offer their opinions of the home. There was a complaints procedure on display stating how people could raise a concern. There had not been any recent complaints received at the home.

Staff completed training to update their skills and knowledge but new staff had not consistently completed the induction training planned. Supervision meetings had not taken place since the last inspection to support staff in their role.

Staff lacked an understanding of the Mental Capacity Act despite having completed training on this. People were not always asked for their consent before care was provided. The requirements of the Deprivation of Liberty Safeguards (DoLS) were not met as people had not been referred to the appropriate authority for an assessment when they thought the person’s freedom was restricted. There was no effective process to determine people’s capacity where decisions needed to be made in people’s best interest.

Medicines were not always managed effectively to ensure people received them as prescribed. The new manager had recently implemented regular checks of medicines to make sure this was safe.

Arrangements were in place to ensure people could access healthcare professionals. Staff made contact with the GP when necessary to ensure referrals for dieticians, the speech and language team, and other healthcare professionals could be made.

People looked well presented with clean clothes to maintain their dignity. Staff knew about practices they should follow to respect people’s privacy and dignity. Most staff interactions were kind and caring but we saw they had limited time to engage with people and did not always have time to sit and talk with them. Some social activities were provided at the home but these were not always in accordance with people’s interests and hobbies.

The provider had taken immediate steps to ensure a new manager was recruited when the previous manager left. The provider had increased the number of quality checks at the home. We found some actions in response to improvements needed were still to be implemented. The provider’s management team were at the home on the day of our visit. They were open and honest regarding areas needing improvement and felt the actions they had planned would address these.

Shortly after this inspection visit, the provider sent us an action plan outlining the actions they were taking to address some of the issues we highlighted and they stated they would keep us updated about improvements made. The provider told us they had carried out a further review of staffing arrangements to ensure these were sufficient and stated they would not be accepting further people into the home until they had improved.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.