The Millfield

People’s experience of using this service:

There were sufficient numbers of suitably qualified staff to meet people’s needs in a timely manner. People and their relatives told us there were always enough staff available to assist them. One person told us, “There always seems enough staff.” Staff had completed training that enabled them to deliver good care and support to people effectively.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice. Medications were stored and managed safely and people received their medicines as they had been prescribed.

People’s individual preferences for food and drink were catered for and this also included people’s specific health and dietary requirements. Staff gave the right level of support to those who required extra help in eating and drinking. One person told us, “The food is good, very good and you get a good choice.” We observed the dining experience it was pleasant, sociable and very personalised.

Care provided to people respected their privacy, dignity and promoted their independence. It was clear from our observations that staff knew people's needs well. Kind and friendly interactions were observed taking place. One person told us, “It’s excellent here it really is, the girls [staff] are very kind, they spoil me really.” Another person told us, “The staff are really kind. They look after me very well, they seem to know what I want before I do.”

The service remained at the heart of the local community with strong links including the local school whose pupils visited the home regularly. The activities coordinator told us, “People from the town are very involved in the home, we get lots of input and help.” There was a varied and individualised activity programme in place that ensured people lived a fulfilled life of their choosing.

Staff were motivated and proud of the service. One staff member said, “We do work hard but this place is so much better to work in than some others, we are all family here.” There was a particularly strong emphasis on continuous development and improvement of the service with staff gaining additional qualifications and the implementation of electronic care records.

A variety of audits were in place that demonstrated the service was monitored and safe for people to live in. Feedback about the service was consistently good especially from health professionals we spoke with. One health professional said, “They [staff] work exceptionally hard with people they have referred to us. They follow our instructions and it shows in that those people no longer require our service.”

More information is in the full report.

Rating at last inspection:

GOOD (The date last report published was 19 July 2016)

Why we inspected:

This was a planned inspection based on the rating at the last inspection. The service remains Good.

Follow up:

Going forward we will continue to monitor this service and plan to inspect in line with our reinspection schedule for those services rated Good.

The Millfield Retirement Home (The Millfield) is situated in a residential area close to the centre of the Lakeland town of Keswick.

The Millfield is a former private house which has been converted to provide personal care and accommodation for up to 45, mainly older people, people living with dementia, mental health issues or physical disabilities.

Accommodation is spread over three floors and includes private bedrooms, some of which have en-suite facilities. There are communal lounges, a conservatory and dining areas as well as specially equipped communal bathrooms. Entrance ramps, stair lifts and a passenger lift help ensure people can access all areas of the home including the gardens.

At our last inspection of this service on 29 August 2013 the service was compliant in all of the areas we inspected.

There is a registered manager at the home. 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.

All of the people who used this service, who we spoke to during our inspection, told us that the staff were “very good” they also said that they were “very well looked after.” People who used this service did not raise any concerns with us during our inspection visit. Although one person did think that lunch and tea were quite close together.

A visitor to the home told us; “This is an excellent home. The girls (staff) are great and very patient.”

The day time care workers thought that the staffing levels during the day were sufficient and that they had time to care for people and meet their needs appropriately. However, the night time care workers had a different view. They were concerned about the amount of domestic tasks that they were expected to carry out in addition to providing care and support to people during the night. However, people using this service did not raise this as a concern.

We observed daytime staff supporting people who used this service in some of the communal areas. We saw that staff were respectful of people’s privacy and dignity and only intervened when necessary or when people requested their help. This meant that people who used this service were supported and encouraged to remain as independent as possible.

On the day of our inspection the home was clean, tidy and there were no unpleasant odours.

The registered provider had safeguarding procedures in place and staff at the home had received training and updates to help them identify and effectively report abuse allegations or concerns.

In the sample of care records we looked at we found that there were some aspects that needed to be reviewed and updated to reflect people’s current support needs and preferences. The registered manager had started to address these matters before we left the home on the day of our inspection visit.

We found that medicines were managed and handled safely. People were able to store their own medicines safely in their own rooms. There was some confusion around the use of covert medication and we have made a recommendation about this.

Most of the staff we spoke to at the home told us that they were well supported by the registered manager. We noted that they received regular supervision and staff meetings took place. Staff were supported in keeping their skills updated and there was a training plan in place. We looked at the way in which the service recruited new staff and found that this process was managed effectively. This meant that only suitable people were employed to work at The Millfield.

There was one person living at The Millfield who was subject to Deprivation of Liberty Safeguard. The registered manager had followed the correct processes, in line with the requirements of the Mental Capacity Act 2005. Care homes are required to notify us about any applications they make to deprive a person of their liberty under the Mental Capacity Act 2005 and about the outcome of those applications. The registered provider had done this.

“Do not actively resuscitate” orders did not consistently follow current guidance. There was confusing information regarding one person’s wishes and others had not had their “DNACPR” orders reviewed as required.

People who used this service were well supported with their nutritional needs. Healthcare professionals were consulted where people had been identified as being at risk of poor nutrition.

The accommodation at the home included various communal areas and an accessible garden. Adaptations and specialised equipment was available to help keep people safe or assist them in accessing the facilities at The Millfield.

We noted that the windows at the home had not been fitted with appropriate window restrictors to help prevent people accidentally falling out.

People who used this service told us that they could receive visitors at any time. People also told us that they went out with their families or out into the local community by themselves.

There was a complaints process in place at the service. We did not receive any complaints during our visit to the service. We checked the information we held about the service, we found that we had not received any complaints during the last 12 months. The format of the home’s complaint procedure may not meet the communication needs of everyone who used this service.

The registered manager had carried out various audits to monitor the quality of the service. Where shortfalls had been identified action plans had been developed to help drive improvements to the service. People who used the service were able to comment on their experiences and quality of the service they experienced. We saw that this had been done via questionnaires and meetings.

We have made a recommendation about the use of covert or disguised medicines.

We have made a recommendation about the use of “do not attempt cardio pulmonary resuscitation orders” (DNACPRs).

We have made a recommendation that the service considers current guidance from reputable sources to ensure the home is compliant with health and safety legislation.

We have made a recommendation that the service seek advice and guidance from a reputable source about providing information to people who use this service, in a format that meets their needs.

We saw that people were able to join in meaningful and sociable activities if they wished. Staff were pleasant, polite and we saw that people who used the service and their visitors, were treated with respect and dignity.

We found that people's care and support needs had been assessed and kept under regular review to help ensure people received the care they needed. We saw that people had access to health and social care professionals. The people we spoke with told us they received the help they needed when they needed it and that staff 'did not try to take over' the things they could manage to do for themselves.

There were some aspects of people's care plans that needed to include more information, particularly where end of life decisions had been made. We spoke to the manager about these matters so that she could ensure decisions and actions were taken and recorded, in the best interests of the people who used this service.

We found that the manager had carried out nutritional assessments to help identify people who may be at risk of poor nutrition. Where concerns had been identified, staff monitored their condition and sought help from medical professionals when necessary.

People told us, 'Meals are very good, the lunches are always excellent.' and 'We have different things for tea but always a choice.'

One of the people we spoke with told us they suffered from Diabetes. They told us that there were lots of sugary items on the menu and 'felt that the home was not good on diabetes'. They added that in their opinion, 'diabetics were not easy to cater for although generally though the home was not too bad.'

We did speak with the cook and visited the kitchen whilst we were in the home. We found that there were suitable options for diabetics available and we observed staff trying to encourage people to make healthy choices.

The people we spoke to during our visit to The Millfield were generally very positive about the home and the care they received. One person told us, 'I look after myself mostly staff help me get in the bath once a week, but I have a shower by myself at other times. I am looked after very well, I have no complaints. The staff are very, very nice and very patient.' Another person said, 'If I have a problem and need help, I can use the buzzer. The staff usually come straight away, I don't have to wait long.'

Some people told us about their social life. One person said, 'I go out to church every week by taxi and I go out with my family for lunch.' Another person said, 'I have lots of friends visit there is never a problem and they can get a cup of tea if they wish.'

The home regularly undergoes an internal audit and there are robust systems in place to monitor the quality and safety of the service.