Archived: Millhouse

The inspection was carried out on 12 November 2014.

Our inspection was unannounced. Millhouse is located on the outskirts of Faversham and provides care and support for up to 24 older people who are living with dementia. Some people had sensory impairments, limited mobility and one person received care in bed. Accommodation is set out over two floors with lift access to the first floor. On the day of our inspection there were 18 people living at the home.

Millhouse had a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the home. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the home is run.

People gave us complimentary comments about the service they received. People felt happy and well looked after and safe. However, our own observations and the records we looked at did not always match the positive descriptions people and relatives had given us.

Risks to people’s safety had not been properly managed. There were no risk assessments in people’s care records to determine the steps that needed to be taken to reduce or control risks of a health care related infection. The home was not clean, areas of the home were visibly dirty; and systems for managing waste did not ensure that people were protected from the risk of infection. We informed the local environmental health office about the risks to people’s safety.

There were risks to people due to the environment. The fire escape was dangerous because of plant growth. We informed the Fire and Rescue Service about the risks to people’s safety. Maintenance of the premises and servicing of equipment had not been carried out effectively to ensure people were comfortable and safe.

There were not always enough staff to ensure that people were safe when they spent time in communal areas. People’s needs had not been assessed to ensure sufficient staff were employed at all times. Safe recruitment procedures were not always followed to ensure the staff employed were suitable to work with people.

The medicine cupboard was not clean and some medicines were stored inappropriately in a damp cellar. We have made a recommendation about the storage of medicines.

People living with dementia were not supported to access different areas of the home independently or to orientate themselves as to time and place. The environment had not been adapted or signs provided to help people find important places, such as toilets and bedrooms. The home’s clock was broken and showed the wrong date and time.

The home did not have an activities schedule, and the only planned activities were the ones arranged through ‘Friends of Millhouse’, a group of relatives. One person told us that they do “Nothing much” in the day, and one relative was not aware of any activities that took place in the home.

There were no formal processes to make sure people and their relatives views were taken into account in how the home was run. People and their relatives’ views had been sought informally and usually these had been acted on.

Staff all said that the owners were slow to sort things out if there was a financial cost involved. Repeated requests for repairs, staff training and activities had been made but not responded to or acted on. The management team failed to monitor or assess the safety or quality of the home and services and failed to identify shortfalls or take action to make improvements. This meant that the home was not well led because any quality assurance systems were not effective.

Records relating to people’s care and the management of the home were not well organised or adequately maintained. Records were not securely kept.

Staff had not been supported to undertake training relevant to their job roles to enable them to understand and meet people’s needs and protect them from harm. Staff had received appropriate induction and support when they were new in post.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Staff had limited understanding of the Mental Capacity Act 2005 (MCA) and had no MCA or DoLS training. The registered manager had taken action to ensure that where needed referrals had been made to the local authority. The registered manager recognised that other people in the home required a DoLS application as people were restricted from leaving the home and were provided constant supervision and care for their own safety. These applications were being submitted in line with guidance from the local authority.

People told us that they felt safe living in the home. One person told us, “I feel very safe here”. Relatives told us, “I never have any fears about abuse here”.

Staff understood the various types of abuse to look out for to make sure people were protected. They knew who to report any concerns to and had access to the whistleblowing policy. Staff told us that they had completed safeguarding adults training.

Individual risks to people were assessed and managed effectively to make sure risks to their safety were minimised.

People had enough to eat and drink and were offered their choice of drinks throughout the day. They told us that they had a good choice of quality food. The atmosphere was relaxed and calm during meal times.

People told us “It’s lovely here, they look after me’; “They [the staff] are happy and friendly here”. All the relatives we spoke with said they found the staff “Very kind and caring”. Staff communicated well with people. Staff were respectful and kind and used people’s preferred names.

One person told us “I can go to bed when I like”. People were enabled to follow their preferred routines. Relatives told us that they had been involved with developing care and support plans. They told us that they had been consulted about their family member’s likes and dislikes when they moved in. Staff were caring and patient in their approach and had a good rapport with people. They gave people plenty of time to communicate their needs. Care plans detailed people’s preferences and staff made sure people’s choices were respected.

Staff supported people to do as much for themselves as possible to help them maintain their independence.

People were treated with dignity and cared for in the privacy of their own rooms.

Visitors were welcomed at the home at any reasonable time and people were able to spend time with family or friends in their own rooms or in the communal areas of the home.

One staff member told us that us that feedback was sought from people in an informal way rather than during formal meetings. We saw staff asking people for their views and offering choices.

Staff understood how to help people to make complaints and how to direct these to the right person. People had access to the complaints procedure and one relative who had complained told us that the issue “Had been dealt with straight away, the source identified and things changed”.

Staff understood their roles and responsibilities. The staffing and management structure ensured that staff knew who they were accountable to. Staff told us that they were able to make suggestions and where possible their ideas would be implemented, however if there was a cost involved it would not always be implemented.

Staff were encouraged to come forward with any concerns and they felt able to do so.

Staff told us that the home had an open culture and communication was good. Staff told us the home provided a flexible, caring and safe environment where people could have independence choice and dignity respected. Our findings were not consistent with those of the staff regarding the safety of the environment.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.