Mill Court Care Home

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.
This is the first assessment for this newly registered service. This key question has been rated requires improvement. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.
 

This service scored 58 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People had care plans in place describing their needs and support required. Staff told us how they supported people with different needs and seeking further help. However, we found there was also some inaccurate or incomplete information regarding people’s support and care needs. For example, one person had several conditions affecting their health and wellbeing. Their plans of care needed more details around specific conditions and management of their skin integrity. This would support reduction of risk of skin deterioration and regular review of skin integrity. The care plan stated that personal care should be done twice a week, however there were no clear records this was happening regularly. A falls assessment has been completed, but there was no related falls care plan that addressed specific risks associated with the person’s conditions and mobility. This could put people at risk of injury or harm if staff did not have specific guidance to support this aspect of care. For another person, there was no comprehensive communication plan, despite the person having a hearing impairment and cognitive difficulties. They did not have a mental health care plan for anxiety, depression, or emotional wellbeing, despite being prescribed an anti-depressant medicine. The cognitive care plan did not include details of strategies for managing confusion, anxiety or distress. This meant people could be at potential risk of ineffective care due to inaccurate plans of care being in place.

The provider did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them. We reviewed people’s care plans and risk assessments containing some information related to peoples’ individual needs. For example, one person had diabetes noted as a medical condition in the general information section and identified as a risk. There was no specific diabetes care plan in place, nor evidence of regular monitoring or intervention strategies to mitigate associated risks. There was also a record made regarding a history of seizures, but no further details were provided regarding frequency, any triggers, or management. There was no epilepsy or seizure care plan in place. This meant the person may not receive timely and individual care and treatment. There was a risk that people may not receive care and treatment that was evidence-based and in line with good practice standards. The registered manager did not hold shared discussions and learning from reviews, and if any discussion of relevant legislation, evidence-based good practice and standards were shared with staff.

The people’s nutrition and hydration needs were met in line with current guidance, and it was managed with staff’s and professionals’ support. People told us the quality of food had improved recently, with a wider choice and well-presented meals, though opinions varied. Some people said, “The food is very good” and “They have had a bit of an issue with the food, there have been a number of chefs, but it seems much better now, and fish and chips on Friday is very much looked forward to.” While others felt there could be more meat options or variety. They told us, “I would describe the food as “yuck” pretty much, yes, there is a choice of main course, but I think it's a Barchester policy that there is an emphasis on vegetarian, there are not enough meat choices, for my taste” and “The food is alright I suppose.” There was a meeting held to discuss the food but this demonstrated there was some work to do still to ensure people were consistently happy with their food and meal experiences.

The provider worked across the teams and services to support people. The information was shared between teams and services to ensure continuity of care and when people were referred between services. Staff were sharing information and speaking with each other about planning tasks. People were able to access some health services without needing to leave the premises. The provider worked in collaboration across teams and services to support people as they moved between services so that people had positive outcomes. When people transferred from other services, there was a process to manage initial assessments and plans of care were compiled to ensure they considered people’s individual needs, circumstances, ongoing care arrangements and expected outcomes. Relevant staff, teams and services were involved in assessing, planning and delivering people's care and treatment and staff worked collaboratively to understand and meet people's needs. People told us they were supported with their needs and received care and support from the staff who knew them and their needs well.

The provider and staff supported people to manage their health and wellbeing to maximise their independence, choice and control. Staff supported people to live a healthier life and where possible, reduce their future needs for care and support. When people needed medical support, this was sought to prevent any deterioration of health and wellbeing. Families were kept informed of the changes and actions taken. After the site visit, we were informed by the management team that they had agreed a more structured working relationship with the local surgery so that people were seen every week. The plan also would include senior staff who would support the meetings and discussions.

The staff monitored people’s care and treatment to ensure the outcomes were positive and consistent. Plans of care and risk assessments were available, but some records lacked detail and did not always outline steps to mitigate identified risks. We discussed this with the senior staff. Supplementary charts, including repositioning charts, were checked and accurately completed. When required, external professionals such as speech and language therapists (SALT) and tissue viability nurses (TVN) were contacted promptly to provide specialist input and support.

The provider did not always tell people about their rights around consent or respect these when delivering care and treatment. People’s rights and wishes were not always respected in line with the Mental Capacity Act 2005 (MCA). For example, one person did not want to have bed rails fitted, however their decision was not respected. Therefore, they chose not to sleep in their bed. We raised this with the senior management, and the bed rails were stopped being used. Staff reported afterwards the person was much happier and was able to sleep in their bed as they wished. This was also discussed with staff to ensure people’s risks were considered to ensure their decisions were respected as much as possible. We reviewed care records that referenced “best interest” decisions. There was limited evidence of capacity assessments or detailed documentation to support these decisions. The care plans reviewed did not consistently demonstrate a clear understanding or proper application of the MCA framework. There were regular entries about people, but these did not always document people’s emotional wellbeing, meals, and participation in activities, which helped build a picture of daily life in the home.

Staff understood and were able to describe how they supported people with different decisions. They said, “Somebody who has dementia, you come to know the resident and know they would like breakfast first and they like music…just because they have dementia, they can still tell you what they want; you can offer and they can choose” and “I have so much patience for people with dementia…I make sure their wishes are my wishes…I support people with dementia the best way I can by trying to reassure them and make them feel safe.” People agreed that staff were respectful of their wishes and we observed staff sought consent as and when needed. They said, “The staff are always helpful, and I've never been made to feel awful or awkward in any way” and “All the staff are without exception very friendly and very helpful.”