Archived: Millfield Lodge Care Home Limited

At the previous inspection on 12 and 20 April 2017 the service was rated as ‘Requires Improvement'. We found four breaches of legal requirements. These were in relation to the safeguarding of people, people’s care records, the governance of the service and incidents, such as serious injuries, not being reported to us.

As a result of our concerns we imposed additional conditions on the provider’s registration. We required the service to not admit any more people without our written permission. We also required information to be sent to us on a monthly basis to show us how the service was assessing and monitoring the safety and quality of the service being provided to people.

After this inspection we received further concerns about the service and we undertook this inspection. This report only covers our findings in relation to the concerns reported to us, to those requirements and the enforcement actions we took.

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

Millfield Lodge Care Home Limited is registered to provide accommodation and nursing care for up to 31 people. At the time of our inspection there were 16 people living at the service on the 4 July 2017 and 11 people on 1 and 9 August 2017. The service is a single storey premises located on the outskirts of Gamlingay with accessible garden areas. The service has communal lounges and dining areas. All bedrooms are single rooms with an en-suite toilet and washbasin facilities in 27 of these.

A registered manager was not currently in post. A registered manager is a person who has registered with the Care Quality Commission (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.

The management of the service was being overseen by a nursing management agency. They were assisting with the day to day running of this service. However, on 8 August 2017, they informed us that they were withdrawing their services due to the registered provider not being willing to support the actions needed to make the required improvements. People were not always safely supported with the management, administration and recording of their prescribed medicines. The premises were not safe and actions previously identified and made known to the registered provider had not been acted upon.

Where people had been identified as being at risk, assessments such as those for skin integrity had been completed. However, where these risks had been identified, the registered provider was not supporting people in a safe way or adhering to health care professionals’ advice and guidance. This put people at serious risk of harm.

There were no systems or processes to ensure that the service provided was safe, or well led. The registered provider was unable to demonstrate the skills, knowledge or ability to make the urgent changes that were required to make the service safe.

A sufficient number of staff with the right skills could not be assured to be in place to meet people’s assessed needs. There was not always a nurse on duty to carry out the health care tasks that people needed. This placed people’s health and welfare at serious risk.

Where accidents and incidents had occurred, these had not always been acted upon and reported to the appropriate authorities. Also, the registered provider had repeatedly not responded to the local authority’s request for investigations and information about previous incidents. This meant that the registered provider missed opportunities to identify or learn lessons and this put other people at risk of the same, or similar, risk of harm.

Although people’s care plans had been reviewed, full information about the needs of people were not available to staff. This was because the registered provider had removed information from the service.

Some improvements had been made to the governance arrangements in the service and this had been entirely due to the consultant nursing agency’s input. However, the registered provider’s lack of openness, honesty and candour put people at serious risk of harm.

At this inspection we found serious breaches of Regulations 5, 12, 13, 15, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

These breaches were assessed by CQC as extreme, as the seriousness of the concerns meant that unless we took the action we believed people would/potentially be at risk of harm.

The provider had 28 days to appeal against this decision to the First Tier Tribunal (Care Standards) under section 32 (1) (b) of the Health and Social Care Act 2008. This period has now passed and we can report on the decision that had been ratified by a judge and the action we took.

Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded. No representations were made.

At this inspection we found there had been further deterioration in the service provision. The overall rating for this provider is 'Inadequate'. On 10 August 2017 CQC used its urgent powers to keep people safe. This means that it can no longer provide any regulated activities and is closed.

Other stakeholders including the local authority supported people and relatives to find other homes or alternative care arrangements. On 10 August 2017, all 11 people using the service were safely moved from this service.

You can see the enforcement action we took at the end of this report.

This unannounced inspection was undertaken on 12 April and 20 April 2017. At the last inspection on 5 July 2016 the service was rated as ‘Good’.

There was not a registered manager in post at the time of this inspection. There had been four managers who had managed the service since the registered manager left in June 2014, however only one of these had applied to be registered prior to our previous inspection in July 2016. This meant that since January 2016 there had not been a registered manager. A registered manager is a person who has registered with the Care Quality Commission (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.

Staff were knowledgeable about how to recognise, and protect people from harm. However, we found that where incidents had occurred, these had not always been acted upon or reported to the appropriate authorities. This limited the organisations whose responsibility it was to investigate safeguarding concerns to act promptly, as required.

Staff did not always follow the guidelines on how the risks should be reduced. Reviews of individuals’ risk assessments following an incident did not always consider all events of a risk of harm to the person. This put people at an increased risk of harm.

People’s care plans did not always contain accurate or up-to-date information. This meant that staff were not always aware of the care needs of the people living at the home. We could not be confident that people always received the care and support that they needed.

Staff enabled people to access health care support when this was required.

People were supported to have choice and control of their lives. People's ability to make day-to-day and more complex decisions about their care and welfare were assessed by staff. Some restrictions on people’s liberty had however not always been determined as being in their best interests or in the least restrictive way possible. Some staff did not have a good understanding about the application of the Mental Capacity Act 2005. This put people at risk of being deprived of their liberty unlawfully.

Staff were provided with supervision and guidance to carry out their role. However, they were not always held to account when they hadn’t followed the correct procedures.

The manager and provider had not always notified the CQC about important events that, by law, they are required to do.

People, their relatives and staff were involved and enabled to make suggestions to improve how the service was run. A range of audits and quality assurance systems were in place to assess, monitor and improve the service. However, these had failed to bring about the expected improvements as identified by other agencies involved in the home.

Staff were trained and deemed competent to administer people their prescribed medicines. This meant that medicines were administered and managed safely.

There was a sufficient number of suitably qualified staff to help meet people’s needs. Following the successful completion of various checks, staff were recruited and once deemed suitable were employed. This helped ensure that staff were suitable to work with people who used the service.

People were looked after with respect for their dignity. Staff provided care that was compassionate and in consideration of each person that was cared for.

Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

The inspection took place on 5 July 2016 and was unannounced and carried out by an inspection manager, two inspectors and an expert by experience.

Since our last unannounced comprehensive inspection of 2 December 2014 improvements had been made in relation to the management of people’s medicines and the actions taken where people experienced a fall.

A registered manager was not currently in post when we inspected the home. The previous registered manager left in November 2014. A registered manager is a person who has registered with the Care Quality Commission (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. A new manager had been appointed and started work at the home the day before our inspection.

Staff were knowledgeable about reporting any harm to people that could occur and this helped people to be safe living at the home. There were a sufficient number of staff employed to meet people’s assessed needs. Recruitment procedures ensured that only suitably qualified and competent staff were employed. Arrangements were in place to ensure that people were protected with the safe administration and management of their medicines.

The CQC is required by law to monitor MCA and the Deprivation of Liberty Safeguards [DoLS] and to report on what we find. The provider was acting in accordance with the requirements of the MCA so that people had their rights protected by the law. Assessments were in place to determine if people had the capacity to make decisions in relation to their care. When people were assessed to lack capacity, their care was provided in their best interests. Where some of the people were subject to authorised DoLS applications, the conditions of these authorised DoLS were being adhered to.

Staff were supported with regular supervision and they were trained and assessed as being competent to do their job. Staff demonstrated how their training was applied according to the role that staff were employed for.

People were supported to access a range of health care professionals. Health risk assessments were in place to ensure that people were supported to maintain their health. People were provided with adequate amounts of food and drink to meet their individual likes and nutritional and hydration needs.

People’s privacy and dignity were respected. Staff provided people with compassionate care that that was attentive to people’s identified needs.

People were supported with hobbies and interests that had been identified and were based on those that people enjoyed. People’s care records and risk assessments were kept up-to-date. A complaints procedure was in place and this was accessible to people, relatives and was followed by staff. People knew who they would speak with if they needed to raise a complaint. Complaints were responded to the satisfaction of the complainant.

The provider had quality assurance processes and procedures in place to improve the quality and safety of people’s support and care.