Mitchell House Nursing Home

Mitchell House Nursing Home is a residential care home providing personal and nursing care to up to 45 people across four units. The service provides support to people with complex physical and mental health needs. At the time of our inspection there were seven people using the service.

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

There were improvements to the assessing and monitoring of people’s risks, but we found guidance for staff was not consistently in place and still required some improvement. The provider had made improvements to the management of people’s medicines, further oversight was required to ensure people received their medicines safely.

Some improvements were made to the detail in people’s care plans, but some information still required further updates. Improvements had also been made to the personalisation of people’s care plans; however, they did not always reflect people’s day to day life. There were improvements to the quality assurance process in place, but they were still not robust enough to always identify any required improvements.

The provider had made improvements to their infection, prevention and control systems. The manager had developed an effective system to review any accidents and incidents and to ensure actions were taken to reduce the risk of reoccurrence. The manager had also implemented an effective system to safeguard people from the risk of harm. People were now supported by permanent members of staff.

We found improvements were made and people were now 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 now had the right training to meet people’s needs. People were supported to eat and drink to maintain a healthy diet. People’s care and support was provided in a safe, clean, well equipped, well-furnished and well-maintained environment.

People were now involved in their care and supported to express their views. People’s right to confidentiality was respected, and their privacy, dignity and independence was respected and promoted. People were supported and treated well, with their equality and diversity respected.

People were supported to take part in activities which were of interest to them on a one to one basis. There was a system to record, monitor and respond to complaints. People’s care plans contained details of the care they required in an emergency situation.

Staff shared a positive culture which provided good outcomes for people. Staff were encouraged to be open and honest when things went wrong. People, their relatives and staff were provided with the opportunity to feedback on the service. The provider worked in partnership with others.

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 04 May 2022) and there were breaches of regulation. The provider completed a weekly action plan after the last inspection to show what they would do and by when to improve.

At this inspection whilst we found improvements had been made and the provider was no longer in breach of some regulations, we found the provider remained in breach of one regulation.

This service has been in Special Measures since 11 January 2022. 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 inspection was carried out to follow up on action we told the provider to take at the last inspection.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, responsive and well led sections of this full report.

Since our inspection the manager had reviewed their current systems to make changes, identify any areas for improvement and mitigate any risks.

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.

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

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 monitor the service and will take further action if needed.

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 request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Mitchell House Nursing Home is a nursing home providing personal and nursing care to seven people living with complex physical and mental health needs. The home had four units all with communal areas and a separate gym and café. The home can support up to 45 people.

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

People were not supported by sufficiently trained staff to meet all of their health needs. People were not always supported to receive their medicines as prescribed in a safe way. People's care needs and risks were not all explored within their care files and staff were not always aware of these or how to support people with them. People were not always supported in line with government COVID-19 guidance and best practice. Safeguarding concerns were not reported to the Local Authority as required for further investigation and to reduce future risk. People were not supported by regular staff who knew them well as the home relied upon agency staff.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. People's records were not stored safely to ensure confidentiality. People did not all feel able to raise concerns with the registered manager.

There was a lack of effective and robust quality assurance tools and oversight in place at the service. All concerns we identified were not highlighted by quality assurance tools in place. The registered manager had failed to notify CQC as required following potential safeguarding and police incidents.

People were supported by safely recruited staff. People were supported to eat and drink in line with their needs and preferences. People were supported to maintain their privacy and dignity. People gave positive feedback about the regular staff and told us staff knew them well. People and their relatives overall gave positive feedback about the registered manager. People were supported to have visitors and to access the local community. People had access to healthcare professionals when they required these.

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 05/07/2021 and this is the first inspection.

Why we inspected

The inspection was prompted in part due to concerns received about people’s risks being managed effectively. A decision was made for us to inspect and examine those risks. 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 have found evidence that the provider needs to make improvements. Please see the full report.

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 peoples’ safe care and treatment, capacity and the oversight and governance at the home.

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

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.