Mill Lodge Care Home

 This inspection took place on 16, 17 and 18 June 2015 and was unannounced.  At our last inspection on 1 August 2014 the provider was meeting all of the regulations required by law.  

Mill Lodge Care Home is a residential home that provides accommodation for up to 20 older people who require personal care.  At the time of our inspection there were 17 people living at the service with three people waiting to move in.    

There is currently no registered manager at the service.  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.  

People did not always receive their medicines safely and as prescribed.  We found that medicines were not stored safely and medical intervention had not been sought when people had missed doses of their medicines.    

People and their relatives told us that they felt safe.  We found people were not always protected  from potential abuse and harm.  Staff did not always understand the severity of concerns about people’s safety and well-being and which concerns required escalating to the local authority.  They were not able to tell us how they would refer these concerns.  Recruitment practices were not rigorous enough to ensure that all staff members were suitable to work in the roles they were recruited for.  

People were receiving care and support without having provided their consent.  We saw an incident where one person was very distressed by staff providing care without their consent.  We found that there were no systems in place to assess people’s capacity, obtain consent or to make decisions where people were lacking capacity within the boundaries of the required legislation.    

We saw that most people enjoyed the food they ate.  Food was prepared freshly on site and hygiene standards were good.  People were not supported to eat at times of their choosing due the provider offering meals at set times during the day.  Nutritional risks were not always identified and managed in order to protect people’s health.  

Staff were not always given access to effective training and they were not given the skills needed to support people effectively.  Not all staff had completed training in important areas such as dementia and nutrition.  

People were supported by a staff team that were caring in their interactions.  We saw staff using warm, supportive tones of voice and taking their time when supporting people.    

People’s care was not always personalised to their individual choices.  We saw that choices were not offered in certain areas such as personal care.  People’s privacy was mostly respected although their dignity was sometimes compromised.   People were not supported to access a range of leisure opportunities and we found that people’s needs and preferences were not always reflected in the care they received.    

People told us that they felt comfortable raising issues with staff and managers and we saw certain changes had arisen in the environment as a result of people’s feedback.  

People living at the service and staff were not supported by a robust leadership and management structure.  Quality assurance systems were not in place and the provider had failed to identify the areas of improvement required within the service.  Staff were not working in an open and supportive environment.  They did not always feel that they were able to escalate concerns to the provider and felt their position may be at risk if they did so.  

We found areas in which the provider was not meeting the requirements of the law.  You can see what action we told the provider to take at the back of the full version of the report.  

The overall rating for this provider is ‘inadequate’.  This means that is has been placed into ‘special measures’ by CQC.  The purpose of special measures is to:

·         Ensure that providers found to be providing inadequate care significantly improve

·         Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made

·         Provide a clear timeframe within which the providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration

Services placed in special measure will be inspected again within six months.  If insufficient improvements have been made such that there remains 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 the service.  This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.  The service will 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 we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.

This inspection took place on 18 June 2015 and was announced. At our last inspection on 1 August 2014 the provider was meeting all of the regulations reguired by law.

Mill Lodge Care Home operates as a residential home and as a domiciliary care agency. This inspection was of the domiciliary care agency known as First for Care at Home. As the service is registered with us under the name of Mill Lodge Care Home this is the name we shall use throughout this report. We have published a separate report for the residential home that was inspected on 16 and 17 June 2015.

Mill Lodge Care Home provides personal care for people in their own homes. At the time of our inspection there were 16 people using the service.

There was no registered manager in post at the time of our inspection. 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.

People were not always protected from harm due to inadequate management of risk by the provider. Accidents and incidents were not recorded formally or reviewed by a manager. People’s health and well-being was not protected through the effective use of care planning and the assessment of risk. We found that areas such as ensuring people’s skin remained healthy and intact and safe moving and handling of people were not managed effectively.

People were being exposed to risk of harm as their medicines were not managed safely. Staff were administering medicines without their training or competency in this area having been checked by the provider. Staff were not keeping records of the medicines people needed and their administration to ensure that people received their medicines as prescribed and were kept safe.

The provider was not using safe recruitment practices. We were unable to find evidence that all of the required pre-employment checks to ensure that only suitable people were employed had been completed as required. Background checks such as ID checks and referencing were insufficient.

Relatives told us that there were insufficient numbers of care staff to effectively meet people’s needs. Staff told us that they needed more staff within the care team in order to provide the support people needed.

We found that people’s human rights were not being upheld as they were not being supported to consent to their care, if they were able to, in line with current legislation and guidance. Decisions that were made on people’s behalf were not recorded and there was no evidence that decisions were made in people’s ‘best interests’.

People were not supported by a staff team who were trained and whose competency in their role had been fully checked. Training records showed that staff had not received all of the training the provider deemed as essential to keep people safe from harm. Staff had not received regular one-to-one meetings with a manager to ensure that they were competent and fully supported in their roles.

We found no evidence that people were involved in decisions about their care or that their choices were taken into account in their plans of care. Insufficient records were kept within the service to allow us to review how people’s preferences were reflected in the care they received. The care records that we reviewed did not reflect the care that was given to people. The provider had not reviewed the care people received to ensure it met their needs and preferences.

Relatives told us that the staff team were caring in their approach. We were told that staff took time to talk to people and developed effective relationships with them. There was insufficient documentation kept to provide evidence to show that people’s dignity and independence was supported.

There was no system developed by the provider to record or monitor complaints to the service. Relatives told us that they felt frustrated when they tried to raise a complaint. They told us that they did not feel listened to nor did they feel their complaint had been addressed.

The provider had failed to ensure that there was a robust management structure in place. Staff and relatives were unsure as to who the current manager of the service was. During the inspection the staff running the service were unable to produce evidence to show that the service was meeting all areas of the regulations. People were not supported by staff who were motivated and working within an open and transparent culture where they were supported to question and improve their practice.

People were not supported by a service with robust quality assurance procedures in place. No systems were in place to identify, analyse and monitor issues and areas of improvement within the service. Management meetings and reviews had not taken place. There was no action plan to show that the provider had identified issues and areas of improvement with any aspect of the service.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

The overall rating for this provider is ‘inadequate’. This means that is has been placed into ‘special measures’ by CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve
• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made
• Provide a clear timeframe within which the providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration

Services placed in special measure will be inspected again within six months. If insufficient improvements have been made such that there remains 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 the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will 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 we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.

Following our inspection, we were informed by the provider that they have decided to remove rhe regulated activity of personal care. This means they intended not to continue a domiciliary care service from 5 July 2015. We have received an application from the provider to cancel their registration and this was being processed at the time this report was published. The provider has informed us that they have submitted this cancellation in order to focus on driving improvements within their residential home in order to ensure they are meeting the regulations.