Archived: Millbrow Care Home

Millbrow provides accommodation and personal care for up to 44 people. At the time of our inspection the service was accommodating 42 people.

There was a registered manager in place at Millbrow. 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.

During the inspection we found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 related to: person centred care; dignity and respect; safe care and treatment; safeguarding service users from abuse and improper treatment; meeting nutritional and hydration needs, staffing and good governance. We also found a breach of the Care Quality Commission (Registration) Regulations 2009 as the registered person had not always notified the Commission of incidents or allegations of abuse.

Risk assessments and care plan did not always adequately identify and address people’s health and personal care needs. Staff did not always follow actions stated as being required on people’s care plans. People did not always receive safe and effective care.

Allegations of abuse were not always reported or acted on in accordance with local procedures. Medicine management systems were not effective. Medicines were not always stored safely and records were not complete.

Medicine management systems were not effective. Medicines were not always stored safely and records were not complete.

Standards of food hygiene and safety were poor and systems were not robust to prevent the spread of infection.

Agency staff were employed on a regular basis. The process for ensuring that these staff were adequately inducted when they first started working at the home needed improvement.

We saw that people were left without access to drinks for long periods of time and there was as long as a 17 hour gap between the evening meal and breakfast the following day for some people. People’s dietary requirements were not always met and staff had not always supported people effectively with weight loss or gain which presented a risk to their health and wellbeing.

The environment on the first floor, for people living with dementia was poor. There was a lack of visual and tactile stimuli and a lack of signage made it difficult for people to orientate themselves around the home.

People’s personal hygiene was not always attended to in a timely manner. Monitoring charts were inaccurate, as they were not completed contemporaneously. We observed instances where staff recorded that they had attended to people when we could evidence that they had not.

The leadership and governance in the home was inadequate. Quality assurance systems were complicated but failed to identify serious failings in the care people were receiving.

People did tell us that they enjoyed the activities that were arranged at the home. The home employed an activities coordinator who was passionate and enthusiastic about her job.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still 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 this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to 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 so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

This responsive inspection was carried out to look at concerns raised by Halton Council with regard to infection control and leadership of the service.

This report only covers our findings in relation to the Safe and Well-Led domain.

You can read the report from our last comprehensive inspection by selecting the 'all reports' link for Millbrow Care Home on our website at www.cqc.org.uk.

Millbrow is a purpose built two-storey care home situated in the Mill Brow area of Widnes. The home is accessible by public transport and convenient for the town centre. The home is part of the Four Seasons Healthcare group of care services. It is registered to provide nursing and personal care for up to 44 people. There were 41 people living there at the time of the inspection.

There was a registered manager at Millbrow. 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.

During this inspection we found breaches of the Regulations in respect of safeguarding service users from abuse and improper treatment and good governance. You can see what action we told the provider to take at the back of the full version of the report

We found that since our last inspection the premises had been redecorated and some furnishings had been replaced. We were aware that concerns had been raised by Infection Prevention and Control regarding the standard of cleanliness of serving trolleys and during a walk round of the home it was noted that some rooms were malodorous of urine and toilet areas were soiled. Domestic staff only worked until 2.15pm each day which provided insufficient time to ensure all areas of the home were kept hygienic.

Risk assessments were in need of update to include details of any action taken to minimise avoidable harm.in respect of the management of the home and premises.

Notifications and records of accidents and incidents were not always managed appropriately.

People living in the home and their relatives said staff were attentive and caring. They said that if they had any concerns they were addressed promptly. People told us that they felt safe, the food was good.

Medicines were well managed and a new clinical room has been created by utilising a decommissioned bathroom on the upstairs unit.

We met with the newly appointed interim manager, the peripatetic manager, the regional manager and two agency nurses and they assisted us throughout the inspection.

We watched medicine administration on both floors of the premises and spoke with two sets of relatives of the people who lived at Millbrow.

We considered all the evidence we gathered under the outcomes we inspected. We used the information to answer one of the five questions we always ask;

• Is the service safe?

We looked at medicine administration records. There were ‘gaps’ in administration records. We found that people had a medicine no longer prescribed entered on their medicine chart. This can result in the wrong medicine being given. Another person was prescribed a medicine they were allergic to; there were no records to show that nurses had checked if this was intentional before administering the medicine.

Examination of records, discussions with staff and observations of practice identified that the medication was not well managed and improvements were needed to protect people from receiving inappropriate or unsafe medication. These shortfalls constituted a breach of Regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

Prior to our visit we had received information which indicated that care records were not always available for people's relatives or friends to read, care and support was not always provided as appropriate to need and staffing levels were low.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask.

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well led?

Is the service safe?

Training records highlighted that although some general training had not been updated, staff were up to date with all mandatory training needed to support people living at Millbrow. Staff said they felt they were appropriately supervised and appraised in accordance with their role and identified development needs. Staff told us that they understood their tasks and boundaries in relation to their work with people and felt competent and appropriately qualified to carry out their work.

Staff advised us that appropriate procedures, including reviews were in place should anyone need to be subject to a Deprivation of Liberty Safeguard (DoLS). DoLS is part of the Mental Capacity Act (2005) and aims to ensure people in care homes and hospitals are looked after in a way that does not inappropriately restrict their freedom unless it is in their best interests.

Is the service effective?

Feedback from the people who used the service was most positive. They told us that they were happy living in Millbrow. Comments included; 'I like it here, I feel at home', 'They do everything they can to make life good, I don't know how long I have been here but it's fine" and "If I had to score it out of ten it would get an eight. In general terms its not a bad home to live in".

We also used observational practices which identified that the people living in the home interacted well with each other and the staff and presented as being very comfortable within their surroundings.

We asked staff to tell us about the needs of some of the people using the service. Staff gave responses which indicated that they knew people well and were providing support based on the person's individual needs and choices. Care staff told us that they had read care plans and they had been regularly updated when people's needs changed. They also told us that the home manager and deputies were always available to provide advice and support when people's needs had changed. Staff told us that the records of the activities of daily life for each person who lived in the home were now stored in folders in the nurses office. This action had been necessary as some of the people who were living with dementia had ripped or damaged the records when they were stored within peoples own rooms. We noted that these records were fully accessible on request.

Is the service caring?

We observed that staff interacted well with the people who lived at Millbrow. They took time to ensure that they were fully engaged with the individual and checked that they had understood. Before carrying out interventions with the people using the service staff explained what they needed or intended to do and asked if that was alright rather than assume consent. Records showed that people who lived in Millbrow were actively involved and, wherever possible, engaged in the assessment and planning of care and support. They also showed that comprehensive risk assessments were in place and updated as and when required. This ensured that the people were in receipt of the care and support of their choice.

Is the service responsive?

Although we saw that each plan was personalised and reflected the needs of the individual we did find the documents hard to follow because there was no set format and we noted inconsistencies in the recording of information. We were told by senior managers of the organisation, who were visiting Millbrow as part of a quality assurance inspection that they had also noted that the care plans were in need of review. As a consequence the home had implemented an update of all care plans and we were able to evidence that this process had commenced.This means that the individualised care plans would now hold consistent records which focused on the person's individual assessed needs and on how they could be met. The care plans viewed focused on providing support to an individual in different aspects of their daily life, for example how the person was to be supported with promoting their independence.

Is the service well-led?

The staff members we spoke to said that the home was well managed and they enjoyed working there. We saw that the provider had a range of checks completed by the manager and staff on a regular basis. They also used senior managers to complete audits of the home as an on-going process.This showed that the provider ensured that there was an effective system to regularly assess and monitor the quality of service that people received. The staff members had regular staff meetings. These enabled managers and staff to share information and / or raise concerns.

Comments from staff were positive and included 'The manager and her deputies are very approachable and we can talk to them about anything", 'The manager is very approachable, they are always willing to listen.'

We also received wholly positive comments about the staff members from visiting relatives; they told us; 'Staff always speak and ask after me, they look after me as well. They encourage me to take part in whatever is going on in the home.'

There were no negative comments about staff from residents or visitors. Comments included; 'All the staff are absolutely brilliant. Most helpful in every way possible', 'A lot of them have been a long time and know your little ways, they still treat you with respect though and you can go to anyone and they will do their best for you.'

Information about the safety and quality of service provided was gathered on a continuous and on-going basis via feedback from the people who used the service and their representatives, including their relatives and friends, where appropriate.

Whilst there was no evidence to suggest that anyone's care needs were not being met the provider may wish to note that the care planning system could be improved.

There were also concerns about medicines administration and a pharmacist from the Medicines Management team within NHS Merseyside has visited the home on behalf of Halton Borough Council. They are producing a separate report for the council. A CQC pharmacist will visit the home if this is deemed to be necessary.

The people using the service who were able to tell us said that they were happy living in the home. Comments included; 'The staff do everything, I am very happy and wouldn't want to be anywhere else'.

We received wholly positive comments about the staff members from a visiting relative; they told us; 'Staff members go the extra mile, nothing is too much. Any problem they would always ring, they know everyone's habits and seem to know what is going to happen before it happens.'

We looked at one of the reviews attended by family members and found the following note; 'We are very happy with the care. Our relative always looks well looked after.'

We received positive comments about the staff members from the people using the service. Comments included; 'The staff are very good, they come straight away if I use the call bell' and 'The staff are lovely.'