This inspection took place on 28 February 2017 and was unannounced. Mill View is a purpose built home providing residential and nursing care for up to 70 people including people who live with dementia, mental health conditions and have general nursing needs. The service provides both long term and respite placements and at the time of the inspection there were 61 people living at the home. Some people were independent but others were living with dementia and had a mixture of dependency levels and needs. Many of the people had difficulties in communicating their needs. This meant that they were vulnerable as they were unable to raise concerns or make basic decisions about their care and welfare needs.
The service had a new manager in post who was about to apply to become the registered manager. 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.
At the last inspection in September 2016 we identified continued breaches of the regulations in two areas. We took enforcement action against the provider. We issued one warning notice in relation to good governance and asked the provider to make further improvements to arrangements for supporting people with food and hydration. We undertook a comprehensive inspection on 28 February 2017 to check whether the required actions had been taken to address the breaches we previously identified. This report covers our findings in relation to these requirements.
Improvements to the governance of the service had been sustained and embedded and this meant that the breach of regulations had been addressed.
Systems for monitoring care provision had become embedded in practice. This meant that risks to people were being effectively managed in a sustained in a consistent way across the service. Clear management and consistent monitoring had led to improvements in the quality of record keeping. This meant that staff had accurate information to support them in providing personalised care to people. People and relatives told us that they had noticed improvements since the last inspection in September 2016. One person said, “I think they have improved quite a bit in the running of this place. All in all, I would say it’s a good place to be.” A relative told us, “It hasn’t been good here but I’d say it is getting better.”
People were being supported to have enough to eat and drink. “Hydration stations” had been introduced around the home to encourage people to help themselves to drinks and snacks. Staff were focussed on ensuring that people were offered regular fluids and snacks. People’s records were being completed accurately and confirmed that they were consistently meeting fluid targets. People told us that they had plenty to eat and drink and our observations confirmed that people were receiving the support they needed. One person told us, “We have lots to drink, if we want, we ask them and they make it straight away.” A relative said, “Staffing levels at meal times are much better and people get the help they need.” The provider had followed their action plan and was now meeting the requirements of the regulations.
People told us they felt safe at Mill View, one person said, “It’s nice here there are lot of people around if you need something, you just need to call out.” A relative told us, “Staffing levels have really improved over the last six months or so, I complained about staffing levels previously but it is much better now.” Our observations confirmed that people were not having to wait for their care needs to be met. Staff were consistently responding to call bells within two minutes and there were enough staff to support people at meal times. Risks to people were identified and care plans detailed how to support them to reduce the risks. People’s medicines were stored administered and managed safely and people told us they received their medicines when they needed them.
Staff had the training and support they needed to carry out their roles and responsibilities. People told us they had confidence in the staff. One person said, “I am confident that they (staff), are well equipped to care for everyone.” Staff understood their responsibilities with regard to the Mental Capacity Act 2005 and were consistently working in line with the legislation and guidance. People were supported to access health care services and told us that staff were proactive in seeking advice. A relative said, “Staff are very quick to contact the doctor if they are concerned.”
People and their relatives told us they had developed positive relationships with the staff. Their comments included, “They are extremely kind, very, very kind,” and, “The staff are wonderful. I can’t fault the staff they are very caring.” Staff knew people well and spoke about them with warmth and affection. One staff member said, “We have such lovely residents, they are our main focus.” People were able to express their views about their care. Staff were proactive in offering people choices and supporting them to remain as independent as possible. People were treated with respect and their dignity and privacy was protected. One person said, “The staff are very respectful.”
People received care that was responsive to their needs. Care plans were personalised and updated regularly. This provided staff with the information they needed to deliver care that was appropriate for people’s specific needs. A relative told us, “They (staff) have been fantastic in responding to the changes in (person’s name)’s health.” Care records included details of people’s life history, interests and hobbies. Staff used this information to encourage people to follow their interest. One person told us, “They have a choir here and they sometimes arrange to go out, it’s nice to get out. I have recently taken up painting lessons; there is a lady who comes in on a Wednesday morning.”
People and relatives knew how to make a complaint and told us that they were confident that any concerns they raised would be acted upon. There was management oversight of complaints and incidents and accidents. Analysis of these events was undertaken to identify any patterns and to improve the quality of the service.
People, their relatives and staff spoke highly of the management of the home. Most people we spoke with were aware that there was a new manager. One person said, “The manager is very good, very approachable and very accessible.” A relative said, “They seem very effective, things are dealt with quickly.” A staff member told us, “It feels different here now, calmer, more organised. The new manager has made the difference. Staff are a lot happier, the staff meetings are more positive. It’s nice to come to work again.”
There was an open culture where issues could be discussed freely. People and their relatives told us they were able to discuss any concerns at regular meetings and records confirmed this. People and staff told us that staff morale had improved. One staff member said, “Staff work well together now, there is good communication, we have regular meetings and the manager listens to our issues.”