Mill House

Updated 28 October 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was carried out by two inspectors.

Service and service type

Mill House is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Mill House is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was not a registered manager in post. A new manager had been appointed and had submitted an application to register.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke with 3 people who used the service and 1 relative about their experience of the care provided. We spent time in the communal areas observing the support people received. We also spoke with the provider, acting manager, and 4 staff. We looked at the care records for 16 people and multiple medication. We looked at records relating to the management of the service, including policies and audits carried out within the home.

Updated 28 October 2023

About the service

Mill House is a residential care home providing personal and nursing care to up to 24 people in one adapted building. The service provides support to older people some of who are living with dementia. At the time of our inspection there were 24 people using the service.

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

Risks to people were not safely managed. Risks had not always been assessed or monitored and staff were not consistently provided with guidance to reduce those risks.

People were not receiving safe care. Staff did not have sufficient information to be able to ensure they understood how to manage risks to people from distress and anxiety, falls, pressure injuries and specific health conditions.

Incidents of potential abuse were not investigated and reported to the appropriate body for investigation. Where potential abuse had been identified by staff this had not been acted upon to ensure people were safeguarded from the risk of harm.

There was insufficient staff to ensure people had their needs met when they required support. We saw people were left unsupervised when they should have monitored continually by staff to keep them safe.

The service was not in good repair and there were concerns with infection control measures in place. People's medicines administration was not consistently documented.

When incidents and accidents occurred staff were recording these but there were no actions taken to review these and prevent reoccurrence.

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 did not support this practice.

People were supported to access health professional visits however where guidance was given to support people with their health needs this was not always clearly documented within people's care plans.

People did not consistently have their needs assessed and care plans put in place to meet their needs.

Staff training was not consistently up to date and there was inconsistent evidence of checks on staff competency.

There was limited management oversight in the service and quality and safety systems were not robust. Issues were not always identified in a timely manner which meant actions were not taken leaving people at risk of harm.

Governance systems in place to manage the service had not identified all the concerns we found during the inspection. CQC had not been notified of significant events as required.

People received enough to eat and drink and told us they enjoyed the food. Recruitment processes were safe to ensure only suitable people were employed.

Rating at last inspection and update

The last rating for this service was requires improvement (published 8 February 2022)

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found the provider remained in breach of regulations.

Why we inspected

We received concerns in relation to medicines, infection control and staffing. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

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 requires improvement to inadequate based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe, effective and well-led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We have identified breaches in relation to safe care and treatment, protecting people from abuse, consenting to care, staffing and governance at the home at this inspection.

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 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.

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.