Millington Springs

Millington Springs accommodates up to 42 people in one building over two floors. At the time of our inspection there were 14 people living at the service, some of whom were living with dementia.

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

Since the last inspection, the service had made significant improvements which reflected positively on people’s experience. The management acknowledged there were still further improvements to be made. People, their relatives and staff felt listened to and engaged with the service.

People felt safe when receiving support. People’s risks were assessed and managed well. Staff were trained to support people with specific needs. People were supported to take their medicines in a safe way.

People’s needs had been assessed and care was delivered in line with current guidance and law. People could choose what they preferred to eat, and staff were attentive to their hydration needs. People had been consulted when it came to how to decorate their own bedrooms and had access to outside space.

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.

People were cared for by kind and thoughtful staff who paid attention to little details to ensure people’s comfort. People felt their wishes were respected and were treated with dignity.

People’s plans of care were personalised and contained information that guided staff to provide individualised support that met people’s needs and preferences. People were supported to maintain relationships that were important to them and were encouraged to participate in activities. People knew how to raise concerns they might have, and these had been dealt with promptly.

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 inadequate (published 06 April 2021) and there were multiple breaches of regulation. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

This service has been in Special Measures since 06 April 2021. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This was a planned inspection based on the previous rating.

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.

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.

Millington Springs accommodates up to 42 people in one building. At the time of our inspection there were 21 people living at the service, some of whom were living with dementia.

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

People were not always supported in a safe way. We found concerns around medicines management and infection control. We also found risks were not always being managed adequately which placed people at increased risk of harm or injury.

The provider had not taken enough action following the last inspection report to ensure systems and processes in place to monitor the safety and quality of the service were being carried out effectively. This meant concerns and issues were not being identified or action was not being taken to rectify them.

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 inadequate (published 19 January 2021) and there were multiple breaches of regulation. The provider was asked to complete an action plan after the last inspection to show what they would do and by when to improve. The provider did not submit this action plan. At this inspection enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

We carried out an unannounced focussed inspection of this service on 12 October 2020. Breaches of legal requirements were found around safe care and treatment, staffing, safeguarding and good governance.

We undertook this focused inspection to check they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

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 coronavirus and other infection outbreaks effectively.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has not changed from inadequate. This is based on the findings at this inspection.

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

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safe care and treatment, safeguarding, staffing and good governance at this inspection.

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

Follow up

We will meet with the provider following this report being published. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

About the service

Millington Springs accommodates 42 people in one adapted building. At the time of the inspection there were 20 people living at the service. These were older adults and some people were living with dementia.

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

People were not always supported in a safe way. We found medication was not being managed safely. Medication was not always counted; storage temperatures were not monitored and some prescribed cream were out of date.

Health and safety issues were due to a lack of maintenance work being completed around the home, windows restrictors were not in use and radiators with broken thermostats were hot to touch.

Infection control practices were not always recorded to show that cleaning had been completed. Some equipment was not clean.

Care plans did not always contain the information staff needed to provide effective and safe care for people.

A dependency tool was used to decide staffing levels and an agency had provided cover to manage staffing shortages. However, agency staff were not always able to record the care they had provided due to the lack of inhouse training of the services care planning system.

Systems and processes to monitor and manage the quality and safety of the service had not been followed and audits were either not carried out or not identifying the issues found during this inspection.

Incidents and accidents were investigated to learn lessons but there was a delay in actions being taken which increased the risk of incidents reoccurring. Managers were often needed to provide care meaning some managerial tasks were being overlooked.

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 requires improvement (published 8 February 2019). This service has been rated requires improvement for the last two consecutive inspections. The provider was in breach of the regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

We received concerns in relation to infection control and management of falls. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them.

Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection. The overall rating for the service has changed to inadequate and is based on the findings at this inspection.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safe care and treatment and good governance

Please see the action we have told the provider to take at the end of this report.

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

Follow up

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions of their registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

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

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

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

Millington Springs accommodates up to 42 people in one building. At the time of our inspection there were 18 people living at the service; seven of those people had nursing needs and 11 people had residential needs.

Millington Springs was registered with the Care Quality Commission on 12 June 2017; this is the first comprehensive inspection of the service since it was registered.

There were two registered managers in post at the time of our inspection; One registered manager was working in another location owned by the provider and was not present during our inspection of this location. The other registered manager who was available at this location during our inspection was also the registered provider. 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 the legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Statutory notifications for allegations of abuse had not always been submitted as required.

Risks associated with people using bed rails had not always been assessed. Some areas of record keeping for cleaning and kitchen temperature records were not always complete. This required improvement to ensure the quality and safety of services in these areas were assured. In addition, we identified where infection prevention and control practices could improve to help protect people from the risks associated with infections.

People felt the care and treatment they received at Millington Springs was safe. Staff understood and had been trained in how to keep people safe. Recruitment checks helped the provider make decisions on the suitability of staff to work at the service. Sufficient numbers of staff were provided to help ensure people were cared for safely. Other risks to people’s health had been assessed and actions taken to reduce risks. Arrangements were in place for the safe management of medicines Accidents and incidents were reviewed to help identify improvements.

Care needs were assessed and focussed on achieving effective outcomes for people. Staff told us they felt supported by the management team; staff were trained in areas related to the needs of people using the service. People had access to other healthcare professionals such as GP’s and speech and language therapists. The premises were suitable for people.

People were supported to maintain a balanced and nutritious diet, however people would benefit from more choice over how their food was presented and some people may have benefitted from being able to see the food options available. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service support this practice. However not all staff were knowledgeable on which people had DoLS approved.

Processes were in place to assess any specific needs associated with the Equality Act 2010 to help prevent discrimination. Information was provided in ways to help them understand choices.

Staff were caring to people and knew them well. People’s independence was promoted. People were supported to maintain their relationships with their relatives and relatives felt welcome when visiting.

People contributed to their care plans and received personalised and responsive care. People had a range of activities provided at the service and were free to pursue their own interests. Processes were in place to manage and respond to complaints in an open and transparent manner.

The provider had taken steps to gather views from people, relatives and staff. Policies and procedures helped the governance of the service. Other checks were made on the quality and safety of services. Accidents and incidents were reported and action was taken to learn from events when things had gone wrong.

We found one breach of the Care Quality Commission (Registration) Regulations 2009 and one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014; you can see what action we told the provider to take at the back of the full version of this report.