Mill Court Care Home

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• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

Responsive – this means we looked for evidence that the provider met people’s needs. This is the first assessment for this newly registered service. This key question has been rated requires improvement. This meant people’s needs were not always met through good organisation and delivery.

This service scored 57 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The registered manager and the staff did not always make sure people were at the centre of their care and treatment choices. They did not always work together to ensure people could receive the most appropriate care and treatment for them. People did not always remain in control of the care and support delivered to them. Some staff told us people’s wishes were not considered. People’s plans of care included information regarding their physical, mental, emotional and social needs and how to support them. However, we also noted details of certain areas for people’s support needed improvement to ensure staff continued providing person-centred care. For example, one person’s care plan did not always reflect their cultural or language needs as they spoke different languages. More information was needed about addressing a person’s skin condition and steps to take when they experienced symptoms. Although staff showed understanding of people’s needs, there was a risk that the staff may not have all individual information to be able to provide a co-ordinated care and support that would have positive effects for people.

There were some shortfalls in how the provider and the registered manager understood the diverse health and care needs of people and their local communities, so care was not always joined-up, flexible or supportive of choice and continuity. For example, one person was prescribed a specific anticoagulant medicine (Anticoagulants are medicines that prevent blood from clotting too quickly). There was no anticoagulation or bleeding risk management plan in place. The care plan for this medicine should include an International Normalised Ratio (INR) test that is a crucial blood test that measures how long the blood takes to clot. This was not in place, as well as a lack of clear documentation of doses and results, staff training on recognizing signs of both bleeding and clotting, and an emergency response protocol. This person was at risk of falls, but the plan of care needed more information on outlining specific prevention strategies and immediate actions if a fall occurred. This was reviewed and discussed with the clinical development nurse to make the necessary improvements. People were positive about the delivery of care from the same staff. One relative added, “The staff are all lovely as individuals, kind and really nice, but there are certainly not enough of them, particularly at weekends.” The staff team was mostly supported well by the external services which helped to deliver care and treatment to people and in a way that met their assessed needs.

People were able to get information and advice that was accurate, up-to-date and provided in a way that they could understand to ensure it met their communication needs. Staff were aware how to help people communicate their wishes and feelings. However, we noted some information such as an activities list and menus could be more accessible to all the people without relying on staff to read it or explain it. People’s communication needs were not always recorded in people’s care plans to support effective communication. For example, one person was deaf in both ears, but the communication needs and preferred methods of interaction were not clearly documented in their care plan. This meant the provider needed to make some improvements in this area to ensure responsibilities were followed in relation to the accessible information standard which applies to people who use a service and have information or communication needs because of a disability, impairment, or sensory loss. Some staff told us they did not always have access to all the information they needed to provide safe and effective care and support. They felt this affected the way they supported people and were worried they might miss important information. Staff said they had daily meetings to discuss people’s care needs.

The provider did not always make it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. There were 2 complaints recorded in the complaints log. It was unclear if people and families were satisfied with the outcomes and actions taken to rectify issues. It was not clear if any changes were made from this feedback, or if any learning had been identified, discussed with staff and applied. People said they felt able to ask for help or raise issues, and that staff usually responded positively. They also noted that some requests had not been actioned yet. Call bells were slow to be answered during busy periods, but staff were always described as polite. Requests for small changes, such as “gravy in a jug” or “different pudding choices,” were acted on, showing that feedback did make a difference.

The provider and the staff made sure that people could access the care, support and treatment they needed when they needed it. People’s needs were monitored to ensure their health needs were responded to promptly if any changes occurred. The staff team worked together to oversee their needs and respond effectively. Although staff did not feel supported fully by the registered manager, they knew when to take action promptly and make referrals to other health and well-being professionals to address any issues with their health or changing needs. This helped the care for people’s health and wellbeing be proactive and organised well.

The registered manager did not ensure they actively listened to information about people who are most likely to experience inequality in experience or outcomes and tailored their care, support and treatment in response to this. People’s care, treatment and support was not always organised and managed in a way that promoted equality and ensured people’s rights were protected. Staff told us people’s views or wishes were not always taken into account to ensure they had positive experiences. Most staff agreed the main issue was staffing. They said, “I think the main issues are about the staffing. The less staff means we are not giving adequate care. People wait for call bells to [use the toilet] – which means they have accidents, and some people get upset. In the morning, we have got some residents who want to get up early but you cannot do that.” However, staff’s feedback demonstrated they wanted to ensure people’s care, treatment and support promoted equality, removed barriers or delays, and protected people’s rights. People and relatives did not report they had experienced any discrimination or inequality. We heard and observed staff getting on well with each other, there was a certain amount of chat, and friendly cooperation when to complete a task or deal with a situation. The management team understood there were diverse groups of people in the service and the staff team supporting them. They also told us how they managed this to ensure people and staff were included and supported.

People were supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life. This was part of the assessment for the service to be aware of any specific wishes. The management team said any wishes for future treatment would be discussed with people. If people did not want to have this conversation, their wishes were respected. People’s care and support was also reviewed as part of the scheme in the service, called ‘Resident of the day’. People’s plans of care were routinely reviewed on monthly basis including if and when people became unwell. Information was stored on provider’s digital system regarding people’s wishes and how to carry those out.