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Inspection Summary


Overall summary & rating

Requires improvement

Updated 6 February 2019

We undertook an unannounced focused inspection of Mill View on 30 October 2018, due to information of concern that we had received regarding an incident at the home. This incident is subject to an investigation and as a result this inspection did not examine the circumstances of the incident. However, the information shared with CQC about the incident indicated potential concerns about the management of risks of choking. This inspection examined those risks.

The team inspected the service against three of the five questions we ask about services: is the service safe, effective and well-led? This report only covers our findings in relation to those key questions. No risks, concerns or significant improvement were identified in the remaining key questions through our ongoing monitoring or during our inspection activity so we did not inspect them.

The ratings from the previous comprehensive inspection for these key questions were included in calculating the overall rating in this inspection. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Mill View on our website at www.cqc.org.uk At the previous inspection on 28 February 2017 we rated Mill View as Good. At this inspection we identified areas in need of improvement and this meant that the overall rating of the home has changed to Requires Improvement.

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

Mill View accommodates up to 70 people in one purpose built two storey building. On the day of this focussed inspection there were 62 people living at the home. People living at the home had a range of needs including nursing needs, mental health needs and some people were living with dementia.

The home had a registered manager who was present during the focussed inspection. 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.

Some people were not receiving the support they needed to eat their food. Staff were not deployed effectively to support people in a timely way at lunch time and staff were not always aware of people’s needs. This was identified as a breach of the regulations.

Risks to people had been assessed. However, care plans did not always give staff clear guidance in how to manage some risks and some staff were not all accessing care plans. This meant that people were at risk of not receiving the care they needed. This was an area of practice that needed to improve.

Quality assurance systems were not always effective in identifying shortfalls. Analysis of incidents had led to positive changes in supporting people at meal times. However, these changes were not yet fully embedded and sustained in all areas of the home. This was an area of practice that needed to improve.

People told us they felt safe at the home. People were receiving their medicines safely and staff were knowledgeable about infection control. There were enough staff on duty and recruitment procedures were robust. However the deployment of staff was not always effective, for example at meal times.

People had confidence in the staff skills. One person said, “They are very good here. The staff know how to care for people well.” Staff had received the training and support they needed. One staff member told us, “We have training all the time. The dementia training was very powerful.” Staff described effective team work and there were systems in place to support communication between staff. People’s needs and preferences were assessed in a holistic way. Staff u

Inspection areas

Safe

Requires improvement

Updated 6 February 2019

The service was not consistently safe.

Risks assessments and care plans did not always provide clear details to guide staff. Staff were not all accessing risk assessments and care plans. This meant that people were at risk of not receiving safe care consistently.

People were receiving their medicines safely and medicines were stored and disposed of safely. Incidents and accidents were monitored and improvements were made when things went wrong.

There were enough staff on duty. Staff had been recruited through a safe recruitment system. Staff understood their role in safeguarding people from abuse. Lessons were learned when things went wrong.

Effective

Requires improvement

Updated 6 February 2019

The service was not consistently effective.

Some people were not receiving the help they needed to have enough to eat.

Staff received the training and support they needed. Staff demonstrated a clear understanding of their responsibilities to seek consent.

People were supported to access the health care services they needed. Their needs and choices had been assessed.

Caring

Good

Updated 21 April 2017

The staff were caring .

People were treated with dignity and their privacy was respected.

People were supported to express their views.

Staff knew people well and had developed positive relationships with people.

Responsive

Good

Updated 21 April 2017

The service was responsive.

People received personalised care that was responsive to their needs.

People were supported to follow their interests.

People felt able to raise complaints and were confident that their concerns would be acted upon.

Well-led

Requires improvement

Updated 6 February 2019

The service was not consistently well-led.

Quality assurance systems were not consistently effective in identifying shortfalls in the quality of the service.

There was a clear management structure and staff understood their roles and responsibilities.

Staff had made positive connections with local organisations.