9 December 2021
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.
As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.
The inspection team consisted of two inspectors and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.
Service and service type
Mill View is a ‘care home’. 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.
The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection
This inspection was unannounced.
What we did before the inspection
We reviewed information we had received about the service since the last inspection. We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We used all of this information to plan our inspection.
During the inspection
We spoke with six people who used the service and nine relatives (by telephone) about their experience of the care provided. We spoke with seven members of staff including the registered manager, two nurses, two team leaders and two care workers. 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.
We reviewed a range of records. This included six people’s care records and multiple medication records. We looked at three staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.
After the inspection
We continued to seek clarification from the provider to validate evidence found. We looked at training records, quality assurance records and team meeting notes.
9 December 2021
About the service
Mill View is a residential care home providing personal and nursing care. The home accommodates up to 70 people in a purpose built two storey building. On the day of this inspection there were 35 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.
People’s experience of using this service and what we found
Leadership was not consistent and people, their relatives and staff were not fully engaged and supported by the registered manager. Some people told us they felt isolated in the home and relatives described a lack of effective communication with the registered manager. Staff did not always feel well supported because the registered manager was not always visible and accessible to staff.
There were enough staff to provide care safely, but the deployment of staff did not always support person centred care. Staff described having little time to spend with people. The registered manager said they were developing plans to address these issues.
People and their relatives spoke positively about the care they were receiving at Mill View. One person said, “I feel very safe here, all the staff are kind and caring and I am always treated with the upmost respect.” Relatives said people were well cared for by kind staff who were knowledgeable about their needs. One relative told us, “The staff really care about the residents here.”
There were safe systems in place to assess, monitor and manage risks to people. Lessons were learned when things went wrong, and comprehensive risk assessments and care plans supported staff to care for people safely. Some people needed support with eating and drinking. Staff were knowledgeable about their needs and there were safe systems in place to ensure people were supported in the way that met their individual needs.
Staff had received training relevant to their roles, including in how to safeguard people from abuse. People were supported to access health care services when they needed to.
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.
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 good (published 19 March 2020).
Why we inspected
We undertook this focussed inspection to check that the provider continued to manage risks associated with eating and drinking. We undertook a focused inspection to review the key questions of safe, effective and well-led only. We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe and effective section of this focussed report.
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.
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 remained good. This is based on the findings at this inspection.
We have found evidence that the provider needs to make improvements. Please see the well led section of this full report.
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.
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.