Millvina House

Millvina House is a residential care home providing nursing and personal care to 42 people at the time of the inspection. The service is registered to support up to 60 people in one adapted building, located over 3 floors.

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

We have made a recommendation about the recording of medicines. This is because although the provider was no longer in breach of regulation, medicines administration records (MARs) were untidy and confusing, and it was not always clear if people had received their medications as prescribed.

We have made a recommendation in relation to records. This is because although care plans were personalised, we identified gaps in monitoring records, such as repositioning charts and food charts. We could not be certain people had received the care interventions reflected in their care plans.

Leadership, governance and oversight was much improved at this inspection. There were still some improvements required in relation to records. We identified concerns with areas of care provision that had not been picked up by the providers routine audits. The provider employed a new management team after the last inspection. People told us they liked the new manager. The new management team and governance processes needed further time to fully embed.

Systems to effectively manage risk assessments had improved. People’s care needs and associated risks had been assessed and there was more in-depth information in place to help keep people safe from harm.

Systems to determine safe staffing were in the process of being updated and we received some mixed feedback with regards to staffing levels. Relatives were mostly happy with the care their loved ones received. However, some still felt staffing levels needed to be improved. Our observations found there were generally enough staff to meet people’s needs. However, there were still some periods of time where the communal lounges were left unstaffed.

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.

Accidents and incidents were recorded and action was taken to mitigate risk following safety related events. Safeguarding referrals were made when needed.

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 inadequate (published 21 February 2023)

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

This service has been in Special Measures since 21 February 2023. 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.

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.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from inadequate to requires improvement based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Millvina on our website at www.cqc.org.uk.

Enforcement and recommendations

We have identified breaches in relation to good governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect. 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.

Millvina House is a residential care home providing nursing and personal care to 42 people at the time of the inspection. The service is registered to support up to 60 people in 1 building, located over 3 floors.

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

There were some significant concerns with the management of people’s health risks. Diabetes management had improved since the last inspection however, some people with diabetes did not always have enough information recorded in their care plans to ensure their condition was being managed safely. This put them at an increased risk of harm.

Medicines were not always managed safely. Some people were not being prescribed paracetamol safely, and some prescribed medicines were not always available to be administered.

Systems to determine safe staffing levels were in place, however the calculations for November were inaccurate. The provider responded to our concerns during the inspection and amended this system. However, staff told us, and our observations showed, there were not always enough staff on duty to meet people’s needs.

Accidents and incidents were recorded. However, not enough mitigation had been taken and we were concerned for people on 1 to 1 care who had sustained previous injuries due to being left alone for periods of time. Safeguarding referrals had been made when needed after incidents occurred.

Although care plans were personalised, there were gaps in monitoring records, such as repositioning charts, so we could not always be sure people were getting the correct care in accordance with their assessed needs.

Leadership, governance and oversight in the home required further improvement and systems were not yet imbedded to ensure effective auditing processes. Audits were being completed however, they did not always identify the issues we found at this inspection, such as with medicines and risks assessments and records. There was no registered manager in post at the time of our inspection. The provider employed a new manager after the inspection.

Relatives were mostly happy with the care their loved ones received. However, some felt staffing needed to be improved.

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.

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

Rating at last inspection

The last rating for this service was inadequate– (published 1 July 2022).

Why we inspected

We carried out an unannounced inspection of this service between 31 March and 25 April 2022. Breaches of legal requirements were found. We issued two Warning Notices in relation to Regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and the provider completed an action plan to show what they would do and by when to improve staffing levels and safeguarding procedures.

We undertook this inspection to check whether the Warning Notices we previously served had been met. We also needed to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Responsive and Well-led which contain those requirements.

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.

For the key question not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Millvina House on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to the assessment, management and mitigation of risk, staffing, and governance of the service.

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.

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.

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.

Millvina House is residential care home providing nursing and personal care to 52 people at the time of the inspection. The service is registered to support up to 60 people in one building, located over three floors.

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

There were significant concerns with the management of people’s health risks. People with diabetes did not always have their health condition well managed which put them at an increased risk of harm. The provider took action during the inspection to ensure there was appropriate clinical oversight of these concerns and reduced the risk to people.

Medicines were not always managed safely. People’s prescribed medicines were not always available to be administered and medicines records were not always completed accurately.

There were not always enough staff to meet people's needs. Systems to determine safe staffing levels were not completed consistently and not always accurate. The provider responded to our concerns during the inspection and employed extra day and night care staff to support safe staffing levels. However, on day three of the inspection we again raised concerns about staffing levels on one of the units.

People were not supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. One person had been subject to the use of restraint without the proper legal authority to deprive them of their liberty. Staff had been completing this practice without the knowledge of managers. This practice was not care planned to ensure it was in the persons best interests and safe to ensure the person was not subject to avoidable harm. The provider stopped this practice immediately once we raised the concern.

Accidents and incidents were recorded, although this was inconsistent and did not always show appropriate action had been taken. Safeguarding referrals had not always been made when needed after incidents occurred. Analysis of incidents was not robust enough to ensure learning could be implemented at the earliest opportunity to prevent reoccurrence.

People’s nutritional and hydration needs were not always recorded appropriately in their plans of care and food charts did not always evidence people had received an appropriate diet. However, staff were aware of people’s individual needs regarding this and we were assured people were receiving diets appropriate for them.

There was ineffective oversight of staff training. Not all staff had completed training deemed mandatory by the provider. There was a system in place to monitor training, but this was not effective.

There was a lack of leadership, oversight and governance in the home. Audits were not completed consistently, and when they had been completed, they did not always identify the issues we found at this inspection, such as with medicines and care plans. The manager made the decision to leave their role during the inspection. The provider employed a new manager after the inspection.

Relatives were mostly happy with the care their loved ones received. However, some felt there was a lack of communication with the manager at the home.

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

Rating at last inspection

This service was registered with us on 01/04/2021 and this is the first inspection.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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.

We undertook this inspection at the same time as CQC inspected a range of urgent and emergency care services across Merseyside. To understand the experience of social care Providers and people who use social care services, we asked a range of questions in relation to accessing urgent and emergency care. The responses we received have been used to inform and support system wide feedback.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to the assessment, management and mitigation of risk, staffing, safeguarding processes and governance and oversight of the service.

Please see the action we have told the provider to take at the end of this report.

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.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.