Archived: Millington Springs Care Centre

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service, their relatives and the staff told us.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

People received care and treatment in an environment that was safe. The communal areas and bedrooms that we looked at within the home were clean and tidy. In the five care plans that we looked at we saw that each person had a personal emergency evacuation plan that was written appropriate to their needs. Each plan gave clear instructions to staff on how to safely evacuate each person from the home.

There were procedures in place to identify and prevent abuse to people occurring. Referral procedures to external agencies were in place and staff spoken with were aware of who to contact, both internally and externally, should they suspect someone had been the victim of abuse.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DOLS) which applies to care homes. We found the provider currently had a DOLS in place for one person, who was living with dementia and would be at risk if they left the home on their own. An application to prevent the person from leaving the home unattended had been made to the authorising authority and this had been granted. We reviewed the paperwork and saw that the DOLS was currently in force until July 2014. The deputy manager could explain the procedure for submitting this application. They were aware that should an extension be required, the application would need to be made in a timely manner in order to prevent the liberty of the person being unlawfully restricted.

A friend of a person who used the service told us, 'I would not leave my friend here, if I felt they weren't safe.'

Is the service effective?

In each of the five care plans we looked at we saw mental capacity assessments had been completed, and best interest decisions implemented, for people that did not have the capacity to make informed decisions for themselves. We saw these were regularly reviewed to ensure they were still appropriate for the needs of the each person.

We saw there were effective pressure care management procedures in place for staff to follow. Each person that used the service had risk assessments in place to determine their ability to their ability to reposition themselves risk assessed and plans implemented, such as two hourly turns, to reduce the risk of pressure sores from forming. We checked the repositioning charts for three people and each one reflected the recommendations as recorded in their care plans.

We reviewed four staff files and saw that mandatory training such moving and handling was, on the whole, up to date and completed by all members of staff. We saw training that assisted the professional development of staff was in the process of being completed. Some gaps were identified, but the training champion showed us a training programme that incorporated this training for the coming business year.

Staff performance was regularly assessed through formal supervisions, unannounced spot checks and annual appraisals.

Is the service caring?

We observed staff interact with people at different times in the day. We observed breakfast being served, medication being issued and activities taking place. Staff were friendly, calm and patient. People were encouraged to be as independent as they could, where they needed assistance this was provided in a way that was appropriate for their needs. One person who used the service told us, 'The staff do what I ask them to do, they are very gentle with me, they take their time.'

Is the service responsive?

People's individual needs were assessed and responded to appropriately. We saw staff respond to a variety of different situations throughout the day. For example, we viewed a member of staff assist people with eating their breakfast. They demonstrated a good knowledge of people's individual needs and adapted their approach accordingly. We saw the member staff provide encouragement where needed, but also left people who were more able, to eat their breakfast independently.

People's care and support was planned and delivered in a way that protected them from unlawful discrimination. People's rights were respected and their beliefs and values were incorporated into their care plan. A fortnightly church service was provided at the home which ensured people who were unable to leave the home were able to practice their religion at the home.

Is the service well-led?

Millington Springs does not currently have a registered manager, however a manager has now been appointed and they are currently in the process of becoming registered. The manager was not available during the inspection. We spoke with the deputy manager, area manager and operations manager. The deputy manager showed a good understanding of what was required to ensure that their staff were led by an effective management team.

Staff spoken with told us on the whole they respected the management team and felt their views on how the home could be improved were welcomed and acted on. A relative we spoke with told us they would like to see the owners, who visit occasionally, speak more often to people who used the service and their relatives.

During the previous inspection in January 2014 we identified areas of concern in relation to the effectiveness of the management review systems that were in place. We saw audits were not always completed and systems were not in place to assess whether recommendations made by the management team had been effective.

During this inspection we saw improvements had been made. The deputy manager had implemented new systems to monitor the quality of service provided for people. Care plan, environment and health and safety audits were some of the areas which were now regularly assessed.

Due to the complex needs of people who used the service we were unable to gain their views on the level of care and treatment they received. Therefore we used a variety of other methods to determine whether people were safe and well cared for.

During this inspection we reviewed documents, observed staff practice and spoke with the area manager, deputy manager, senior housekeeper, a care worker, a domestic assistant and a laundry assistant. We spoke with two relatives of people who used the service.

We found that there had been improvements in a number of areas and the quality of the service provided to people who used the service had greatly improved.

People at risk of obtaining pressure ulcers were regular assessed and repositioned. The cleanliness of the home had improved greatly. All areas were clean and tidy and the home was free from offensive odours. The provider had a process in place to safely store and dispose of medicines.

New staff had been recruited including full time nurses and more domestic assistants. Staff performance was regularly assessed.

Improvements were required to ensure that recommendations made by management had been implemented.

A relative we spoke with told us, "The care has improved so much since the new management took over."

We found that whilst the provider had made some improvements since our last inspection they had not fully complied with the actions we set.

Care and treatment was not planned and delivered in a way that was intended to ensure people's safety and welfare.

We looked at service information, records and carried out a tour of the building.

A relative told us, "They have not got the staff to deliver the care for my family member." A staff member told us, "We feel we are letting the residents down. We keep getting told to do things differently. We don't know where we are going. All the staff feel the same.'

We saw that infection control procedures were not satisfactory and there was no formal cleaning schedule in place that ensured the home was clean and tidy for people to live in.

We saw that medicines were not disposed or stored safely. We saw drug disposal bins were overflowing and some medicines stored in cupboards that were not locked.

Relatives of people using the service told us that there were not enough staff to meet people's needs. One person told us, 'They always seem to be rushed.'

Not all staff received a formal assessment of their ability to do their job. There was a lack annual appraisals and supervisions of their work.

People's views were not always taken into account when decisions were made that could impact the care provided. One relative told us, 'We are not consulted on changes.'

We spoke with five people who used the service, with three staff and to a Quality Assurance Manager. We also spoke with four relatives and to a Derbyshire PCT employee who was visiting.

People who used the service told us they were happy with the care they received. One person told us 'Staff are very caring.' Another said 'I enjoy being here. I can do what I like to do. I like my art and I like to paint.' People told us they felt safe and knew how to raise any concerns they might have. All said that staff treated them with respect.

Staff we spoke with said the provider was good in terms of ensuring that training was up-to-date and they enjoyed working there. One staff member told us, 'Things have been difficult lately but they are improving.'

Two relatives we spoke with who were visiting family members said they were happy with the care their family members received. One of these told us 'I think staff have a difficult job, but they go out their way to do their best. They always make me very welcome and I often stop and have a meal with [relative's name].' The other two relatives we spoke with expressed concerns about the care and support their family members received.