The Mill House Care Home

The Mill House is registered to provide accommodation and personal care for up to 31 older people, including people with dementia. At the time of our inspection visit there were 29 people living at the home. Care is provided across two floors. A communal lounge and dining area are located on the ground floor. Not all bedrooms were ensuite but there were further communal bathroom facilities located on each floor. The provider was considering further improvements at the home which included the addition of an ensuite to existing rooms.

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

At our last inspection, we found some improvements were required with the risk management of people’s health and welfare, medicine management and better oversight of the service. In response to our last inspection, the provider completed their own action plan to ensure improvements were made and sustained.

Since the last inspection there had been changes in registered manager. There was a new registered manager in post who was continuing to make changes to improve outcomes for people. The registered manager was supported by the previous registered manager who was part of the provider’s management structure, as well as the owner who is the provider.

At this inspection, we found some improvements to medicines management, care planning and risk assessments. The provider had improved and increased their quality assurance systems and checks which were mostly effective. However, further improvements to some quality assurance systems were needed because some of the issues we found related to medicines, care planning and risk assessments at this visit had not always been identified from completed checks.

Electronic care planning and risk assessments were completed for people however in some cases, where a person had fallen or if people had risks related to certain activity, these were not always completed. However, we were assured people were safe and staff knew people’s risks and how to safely manage those identified risks.

Additional checks made sure medicines were administered and stored safely. Better recording of some medicines, such as topical creams and pain patch medicines would help to demonstrate medicines were administered safely. The registered manager took immediate action during our visit to improve medicines administration practices to ensure people continued to receive medicines safely. Positive links with a local GP practice ensured people were reviewed and seen promptly.

Infection control systems ensured the home was clean. Housekeeping staff supported the home in addition to care staff. Maintenance staff completed regular checks on health and safety to ensure the home remained safe for people.

People’s overall feedback to us was positive of a service they received that they felt met their needs. People knew how to raise an issue and when they did, they were confident they were listened too. People and relatives could attend meetings to share any feedback about the service. Post pandemic, plans were in place to increase the frequency of these meetings.

People felt the service was responsive to their needs. Staff knew people well and we saw during our visit, staff quickly responded to situations to help maintain an environment that promoted good care.

Staff interacted with people at their pace, unrushed and joked and laughed with each other. Staff in all roles were empowered to involve, engage and to sit and chat to people which helped develop relaxed and genuine relationships. People were involved in pursing their hobbies and interests. Social activities and engagement was a key feature that recognised the importance of promoting people’s emotional and physical wellbeing. Day trips, gardening, book clubs, quizzes were just some of the activities people were involved in. Further opportunities were planned with people’s involvement to continue to support people’s interests.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. Visitors were welcomed and there were no restrictions on visiting arrangements. Relatives were able to visit, and they were encouraged to book a visit in advance to help manage any potential risk.

Staff understood their responsibility to report any concerns to protect people from the risk of abuse.

Staff were positive about the management of the home and staff said people received a good quality of care. Staff enjoyed working at the home and staff said it felt like one big family. The provider had their own staff team and did not rely on agency staff so staff who supported people knew them very well. Staff had received training in key areas and staff said they felt supported to pursue additional training and opportunities to increase their knowledge and confidence.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 17 January 2020).

At our last inspection we recommended that the provider improved their processes in the management of medicines, risk management and quality assurance. At this inspection we found the provider had acted on those recommendations and they had made improvements, although their quality assurance systems still required some improvements.

Why we inspected

This inspection was prompted by a review of the information we held about this service and to check the provider had improved certain areas identified at our last visit.

This report only covers our findings in relation to the Key Questions Safe, Responsive and Well-led which contain those requirements. 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 good. This is based on the findings at this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

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

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The Mill House is a residential care home registered to provide personal care for up to 31 people over the age of 65 years. This is a purpose-built home providing care and support for people living with a dementia. The service consists of two floors. The facilities consist of communal areas including a cinema. At the time of the start of the inspection 29 people were living at the home.

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

People and most relatives were positive about the care and support provided by the staff team at the home.

However, there were areas of practice within the home which we brought to the attention of the registered manager as needing attention.

There were risks to people’s safety in their bedroom. We saw trailing wires which could present a trip hazard for people already identified as at risk of falling. The fire alarm was not always tested in line with the provider’s own procedures.

The storage of some items of medicines needed to be improved as well as some areas of recording medicines. People in their bedrooms did not always have their meal served suitably for them to access it appropriately.

Systems in place to monitor the quality of the service provided were in place however, they had not identified all the areas of concerns identified as part of this inspection such as shortfalls in the testing of the fire alarm and storage of certain medicines. Risks to people were not identified within assessments such as the trailing wires in bedrooms.

People liked the choice of food available to them and were offered regular drinks although records did not always show how much people should have to drink and whether this was achieved.

The registered manager took immediate action in all the areas we identified as needing improvement and gave an undertaking these improvements would be sustained.

Risk assessments were in place and safety checks were carried out on window restrictors, wheelchairs and water temperatures.

There were sufficient care staff on duty to meet people’s needs as well as other staff to ensure the needs of people were able to be meet. Staff were supported by the management team and received regular training via a training consultant to enable them to meet people’s needs. Safe recruitment procedures were in place.

People felt save living at the home. The registered manager and staff team were aware of their responsibility to report any safeguarding concerns. People’s needs were assessed prior to them moving into the home so they could be assured their needs were able to be met.

People were cared and supported by staff whom people liked and found to be kind and considerate. People had their privacy and dignity respected. Complaints and concerns were investigated and well managed.

People were able to access healthcare professionals to ensure their well-being was maintained. People at the end of their life were well cared for and their family members were supported by staff members.

The home was seen to be clean and staff were aware of how to reduce the risk of cross infection. The garden was assessable to people who could also spend time outside. Signage was in place to assist people find their way around.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; systems in the service supported this practice. People were supported by staff who were kind and compassionate.

The registered manager and staff were motivated to provide the best service they could for people and their relatives. Systems were in place to audit the levels of service provided to people. They were keen to continually learn and take steps to make improvements.

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

Rating at last inspection

The last rating for this service was Outstanding (published 19 April 2017).

Why we inspected

This was a planned inspection based on the previous rating.

We have found evidence that the provider needs to make improvements. Please see the safe, responsive and well led sections of this full report.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

We had the opportunity to talk with four people who lived at the home on the day of the inspection. We spoke with 7 relatives and a friend of a person who lived at the home. Not everyone was able to communicate directly with us, so we used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

A manager was in post at the time of our inspection. They were in the process of applying to become a registered manager. 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.

The registered manager and senior staff team supported care staff to provide safe and compassionate care. Risks to people’s safety were recognised and staff took action so people were able to do things they enjoyed in a safe way. There were enough staff available to support people in the ways they wanted. Staff knew what actions to take, if they had any concerns for people’s safety or well-being and were able to obtain advice from the manager, provider or external organisations if required. People were supported to take their medicines so they would remain well.

Staff had the skills required to support people so they would enjoy a good quality of life. People’s right to make decisions and their freedom was protected and staff worked with other organisations to make this happen. Staff supported people to enjoy a range of food and drinks safely, so they would remain well. People were supported to see their preferred health professionals and staff promptly sought emergency health assistance when required.

People had developed strong relationships and bonds with staff, who supported people with compassion and respect. People enjoyed being with the staff who cared for them and were given reassurance by staff when wanted this. Staff knew how to support people so they were able to make choices about what daily care they wanted. People’s need for independence and to maintain their preferred lifestyles were taken into account by staff when they cared for them.

People benefited from living in a home where staff understood their individual preferences and unique needs. The whole staff team were committed to making sure people received the right care for them as individuals. Staff recognised when people’s needs changed and took action so people continued to enjoy life and receive care in the best way for them. Where people were not able to decide on all aspects of their care themselves, staff worked with their relatives, so people wishes and preferences were embedded into the way their care was planned and reviewed. People and their relatives knew how to raise any complaints they had and were confident staff would take action if this happened.

There was clear and open communication between the provider, manager and staff, so staff knew what was expected of them. The provider, manager and senior staff based their approach to care on nationally recognised best practice. The manager and senior staff reflected on the care they provided, so they could be assured people received the care they needed and improvements were driven through. The manager and senior staff worked with the local community to promote people's understanding of the needs of people with dementia. Checks were undertaken on the quality of the care by the manager and senior staff and actions were taken where developments had been highlighted. The manager and senior staff made sure there was a focus on continuous development of the home.

We saw that people and their relatives were involved in decisions about the care provided and details of their needs and interests were included in their care records.

Care plans and risk assessments were in place and were updated regularly to ensure people received the care they needed. There were a variety of activities designed to meet people's needs and maintain their independence. People told us they liked living at The Mill House. One person told us, “I’m alright here.”

People’s safety was protected because there were systems in place to report safeguarding concerns and staff received relevant training. People told us they were satisfied with the care provided and said they felt safe. A relative we spoke with told us, “I can’t fault it. I’m happy they are here.”

Relatives we spoke with said the staff were excellent. Staff we spoke with said they loved working at The Mill House. Staff said they were supported with relevant training to care for the people who used the service.

People experienced good quality care and effective systems for monitoring were in place. There was evidence that people and their relatives knew how to complain if things were not right.

The three care files that we reviewed indicated that arrangements had been made to support people in receiving their health and care needs. We saw recordings that confirmed that staff had actively promoted people's health and well-being. From the discussions held with staff we found that people were well supported in leading a varied lifestyle that suited their individual preferences. People were encouraged and supported to do things for themselves and were given choices. One person told us, "It's very nice here and food's good, I like it."

We found that systems were in place to keep people safe. Staff had received training in safeguarding people and knew how to respond to concerns.

We found that there were enough staff allocated to work for each shift so that people's care needs were met. There were systems in place for staff to attend appropriate training courses. We spoke with the registered manager, the care manager and two senior care workers. We received positive feedback about the day to day running of the home.

People told us they knew how to make a complaint but that they had not needed to.