Archived: Millbrook House

Millbrook House is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The service is registered to provide care for a maximum of 60 people. At the time of this inspection 48 people were receiving care at the service.

People’s experience of using this service:

Medicines were not always managed safely in accordance with the relevant guidance. We made a recommendation regarding this.

Risk assessments were completed in relation to a range of health conditions and the environment. However, a small number of records relating to the management of risk had not been completed correctly or consistently. We made a recommendation regarding this.

The registered manager and provider completed regular safety and quality audits to measure performance and generate improvements. The issues identified during this inspection had not been identified by these audits. However, the response to address any issues and improve future practice was extensive and immediate.

Concerns identified at the previous inspection had been addressed and the service was no longer in breach of regulation.

Staff had been trained in adult safeguarding and understood their role in relation to keeping people safe. Staff had been safely recruited and deployed in sufficient numbers to meet people’s needs.

Staff were trained in relevant subjects and given support to do their job. Staff were aware of the relevant standards and guidance and used this effectively to assess people’s needs and plan their care.

Comments from relatives regarding the quality of food were mostly positive. People were given plenty to eat and drink and supported by staff where required.

Staff and managers worked effectively with healthcare professionals to ensure that people received the care they needed.

The design and flow of the building have been improved to make it more appropriate for people living with dementia.

Staff obtained consent for people's care and support. Staff understood the principles, of the MCA and people were supported wherever possible to make their own decisions.

Relatives told us that their family members were always treated well by staff and were involved in decisions about their care. We saw a number of examples where staff spoke to people with kindness and respect throughout the inspection.

Staff knew people’s personal histories and their likes and dislikes. They used this information to hold conversations and to engage people in activities.

Important information was made available in a range of accessible formats to help people understand and to promote their involvement.

Complaints were addressed in accordance with the provider’s policy and best-practice guidance. None of the people that we spoke with said that they had made a complaint recently. They each said that they would feel comfortable raising any issues with any member of staff.

Each of the people that we spoke with had a clearly defined role within the service and understood their role and responsibilities.

The provider placed continuous learning and improvement at the heart of their practice. Lessons learnt from incidents and accidents in other services were shared with managers and staff to improve practice.

Rating at last inspection:

Millbrook House was rated Requires Improvement at our last inspection. The report of the last inspection was published on 6 July 2018.

Why we inspected:

This inspection was scheduled and conducted in accordance with our methodology for Requires Improvement services to ensure that concerns identified at our last inspection had been addressed.

Follow up:

We will continue to monitor information and intelligence we receive about the service to ensure good quality care is provided to people. We will return to re inspect in line with our inspection timescales for Good services.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Millbrook House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

At the time of the inspection 47 people were living at Millbrook House.

At the time of the inspection there was no registered manager in post. The current manager has applied to us, the Care Quality Commission, (CQC), for the position of registered manager and their application is being processed. 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 the provider was in breach of Regulation 10 of the Health and Social Care Act (Regulated Activities) Regulations 2014. The breach related to people’s dignity being compromised as there were insufficient staff on duty at the time of our observations to provide care and support to people. In light of our findings we have also made a recommendation regarding reviewing the staffing arrangements in the home to ensure consistent staffing numbers at all times.

Relatives were complementary regarding the attitude of staff and the way in which they cared for their family member.

Systems were in place and followed to recruit staff and check they were suitable to work with vulnerable people.

We found the environment to be clean and free from any odour. Staff had access to protective clothing such as, gloves and aprons to support the control of infection.

The premises and equipment were subject to safety checks to ensure they were safe and well maintained. The premises was kept in good decorative order and had been adapted to support people with dementia; this included the provision of appropriate signage, colour schemes and communal areas.

People’s medication was safely managed and they received it on time and as prescribed.

Staff had a good understanding of people's individual care needs and appropriate referrals to external healthcare professionals took place. Guidance and advice that was provided was being followed; this meant that people’s overall health and well-being was being safely and effectively supported. Relatives spoke positively regarding the care and support given by the staff.

Assessments of people’s care needs had been carried out and people had a plan of care which provided guidance for staff on how to meet their needs safely and effectively. In the main these had been subject to review to check they were up to date and accurate. We found a few care records needed further information and these were updated during the inspection.

Relatives were involved in the planning of their care to support their family member and they were kept up to date with matters relating to their health and welfare.

Staff received training and support to help them support people in accordance with their individual need. Staff confirmed they received a good standard of training to support their learning and development.

Risks to people’s safety and wellbeing were recorded to enable staff to support people safely whilst promoting their independence. Accidents and incidents were recorded and an analysis undertaken to look for trends or patterns to minimise the risk of re-occurrence.

Staff sought consent from people before providing support. When people were unable to consent, the principles of the Mental Capacity Act 2005 were followed in that an assessment of the person's mental capacity was made to protect them. This included applying to the local authority for a Deprivation of Liberty Safeguard (DoLS) for people.

Staff understood the concept of safeguarding and knew how to report any concerns. Records evidenced safeguarding referrals to the local authority had been made appropriately.

People were supported to eat and drink enough to maintain a balanced diet and meet their dietary requirements. People were offered a good choice of meals and alternatives were offered if the menu choices were not to their liking.

The service had a complaints’ policy and procedure. Complaints received had been logged and responded to appropriately. Relatives told us they would speak up if they had a concern.

There were systems in place to consult with people who used the service, to assess and monitor the quality of their experiences. This included completion of feedback surveys and meetings.

Systems were in place for checking the quality of the service to maintain standards and drive forward improvements. We discussed with the manager the need for more robust oversight at management level regarding the staffing arrangements in the home.

The manager had notified the Care Quality Commission (CQC) of events and incidents that occurred in the home in accordance with our statutory notifications. The ratings from the previous inspection were on display in accordance with requirements.

You can see what action we took at the back of this report.

We asked the provider to take action to address these concerns. After the comprehensive inspection, the provider wrote to us to tell us what they would do to meet legal requirements in relation to the breach.

We undertook a focused inspection in October 2017 to check that they had they now met legal requirements. This report only covers our findings in relation to the specific area / breach of regulation. This report only covers two questions we normally asked of services; ‘Is the service safe?’ and ‘Is the service Well led?’

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Millbrook House’ on our website at www.cqc.org.uk.

Millbrook House is a purpose built nursing home which provides care for older people with mental health care needs. It can provide care for up to 50 people and it is located in Southport.

There was a registered manager in post. ‘A registered manager is a person who has registered with the CQC 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’.

We found the service had made improvements to the environment to promote good standards of hygiene. This included refurbishment of bathroom and toilet facilities as part of the upgrade for the service. This breach had been met.

We found the service had made improvements regarding the overall monitoring arrangements for infection control and further developments were evident in respect of providing a ‘dementia friendly’ environment. We also saw evidence of the current auditing system to help monitor standards. This breach had been met.

Millbrook House is a nursing home which provides care for older people with mental health care needs. It can provide care for up to 42 people and it is located in Southport.

A registered manager was in post. 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.

We found the environment was in need to attention which made it difficult to keep hygienic to maintain standards of infection control. This was particularly evident for the toilet facilities on the ground floor which were not clean.

This is a breach of Regulation 12 (2) (h) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: Safe care and treatment.

The provider had systems and process in place to monitor and drive forward improvements. This included a number of audits (checks) for various aspects of the service. We found on this inspection that the existing auditing system was not robust as this had not picked up on the deficits we identified around monitoring standards of infection control and other developmental issues we discussed on the inspection.

This is a breach of Regulation 17 (2) (a) (b) (c) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: Good Governance

With regards to promoting a dementia friendly environment there were some appropriate wall coverings, themed décor and pictures in corridors and doors were painted in different colours to aid orientation. Some toilets and bathrooms had signage but this was not consistent in the home. There was a need for some further development to enhance the environment, particularly on the ground floor to improve accessibility, safety and orientation. We found toilet doors were locked during the inspection which meant they were not accessible for people. This was rectified during the inspection.

We have made a recommendation around the provider considering current guidance and best practice around promoting a dementia friendly environment to support people living with dementia.

The home had a consistent staff team though the numbers of staff on duty during the first day of the inspection were not in accordance with the staffing rota due to staff sickness. Staff rotas we viewed showed that in general staffing levels were consistent and staff were deployed in sufficient numbers to support people.

People were offered a varied social programme, based on individual preference. We saw social activities were meaningful and well planned at different times of the day. People told us they enjoyed what was arranged, particularly the music and cookery sessions.

External contracts were in place and internal health and safety checks and audits were completed to help maintain the safety of the building and its equipment.

Care files held thorough risk assessments to mitigate hazards to people's safety and welfare.

People had a plan of care which set out their health and social care needs. Plans of care contained person centred information, which helped to provide a holistic approach to care.

We observed staff treated people appropriately, supportively and with an understanding of their needs. We saw people were relaxed in the presence of the staff.

Recruitment procedures were robust and the required checks had been completed. Thus ensuring staff were ‘fit’ to work with vulnerable people.

Medicines were administered safely to people and the registered manager completed medicine audits to ensure the safe management of medicines.

Staff were aware of what constituted abuse and told us the procedure they would follow should they need to report an untoward incident. Training records confirmed staff had undertaken safeguarding training.

We saw staff were responsive to each person's changing needs and care reviews took place. Staff supported people with external appointments with different health professionals at the appropriate time.

Staff received training and support and had a good understanding of how to support people with dementia.

Staff sought consent from people before providing support. When people were unable to consent, the principles of the Mental Capacity Act 2005 were followed and an assessment of the person’s mental capacity was made.

When necessary, referrals had been made to support people on a Deprivation of Liberty (DoLS) authorisation. 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. The applications were being monitored by the registered manager of the home.

The provision of meals at the home was via an external supplier. Snacks and foods such as, sandwiches, cakes and biscuits were prepared at the home; breakfasts were also prepared on site. People told us they enjoyed the meals.

Relatives told us they felt supported and encouraged to maintain relationships with those who lived at Millbrook House.

A complaints’ procedure was in place and people and their relatives felt confident in raising concerns with the registered manager.

Staff and people said the home was well managed and the registered manager was supportive, approachable and led a motivated staff team.

The registered manager had a good understanding of their role and responsibilities in relation to what was expected from them as a registered manager with us, the Care Quality Commission (CQC). The registered manager had notified us any notifiable incidents in the home.

After the comprehensive inspection, the provider wrote to us to tell us what they would do to meet legal requirements in relation to this breach. We undertook a focused inspection on 7 September 2016 to check that they had they now met legal requirements. This report only covers our findings in relation to Regulation 12 Safe Care and Treatment. This covered one area whether they are 'Safe’. The other four areas 'Effective’, 'Caring', 'Responsive' and ' Well led' were not assessed at this inspection.

You can read the report from our last comprehensive inspection on 29 February and 2 March 2016, by selecting the 'all reports' link for Millbrook House on our website at www.cqc.org.uk.

At the previous inspection we had concerns regarding a lack of care planning documentation around the use of fluid thickeners. Fluid thickeners are used to support people who have difficulty swallowing, eating and drinking. At this inspection our findings showed improvements had been made in relation to this. We found people’s plan of care recorded the use of fluid thickeners to support them with their dietary requirements which meant this breach had been met.

Millbrook House is a purpose built nursing home which provides care for older people with mental health care needs. It can provide care for up to 42 people and it is located in Southport.

A registered manager was in post. 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.

We found a breach of regulation related to the provision of safe care and treatment.

You can see what action we told the provider to take at the back of the full version of the report.

All of the people that we spoke with told us that they felt their relative was safe and we saw that staff were vigilant in monitoring people’s safety.

Staff understood the different types of abuse and what signs to look out for. They also understood what to do if they suspected that abuse had taken place.

Accidents and incidents were logged and analysed by the registered manager. The records that we saw showed a good level of detail and indicated where appropriate actions had been taken to reduce risk.

During the inspection we saw that there were sufficient staff to meet people’s needs throughout the day.

Staff had received training to provide them with the skills and knowledge to provide care and support. This training had been refreshed regularly. Staff had also been given access to additional, specialist training in dementia.

People were supported to eat and drink appropriately and were offered a choice of meals.

The home was in good decorative order, but there were marked differences in the decoration and signage on each floor. This meant that the first and second floors were not dementia-friendly.

Staff treated people with kindness and compassion. They demonstrated that they understood people’s right to privacy and the need to maintain dignity in the provision of care.

The home had an activities’ coordinator who engaged people in a range of events and activities.

All of the people that we spoke with told us that the home was well managed and that communications were open and honest.

The registered manager was aware of the day to day culture of the home and current issues and priorities.

Staff knew what was expected of them and were motivated to provide good quality, safe care.

The home can currently accommodate 42 people; they are in the process of having an extension built to enable this number to increase within the near future. The manager told us about the planned refurbishment of the home.

People were positive about the staff team and the care they received. Throughout the day we observed staff engaging with people in a kindly manner and involving them in decisions about activity related to their care needs. One person said, 'The staff are kind and will do anything for us.' Another person told us 'Visitors are always made welcome and we are treated with respect.'

The home had effective policies, procedures and systems in place to manage medicine and the administration process.

The home managed staffing levels appropriately and there were suitable arrangements in place to deal with foreseeable emergency cover.

Staff told us they felt well supported by their management and peers. They told us they were encouraged to attend training and said they worked well as a team.

As part of the inspection process we reviewed the complaints policy and procedure and found effective systems to be in place should a complaint need to be managed.