Mill View Care Home

Mill View Care Home is a large purpose built residential care home which is registered to provide both personal and nursing care to up to 180 people. The home consists of 6 separate 30 bedded units which provide a mix of residential, dementia and/or nursing care, although only 5 units are currently in use. At the time of inspection, 117 people were living at the home.

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

We found improvements were required with medicines management, governance processes and record keeping. We also identified staff did not always have time to complete all of the responsibilities asked of them.

We have made recommendations about how staffing levels are determined and the providers quality assurance process.

People felt safe living at Mill View Care Home and overall spoke positively about the care and support they received. Staff were reported to be very busy and as a result were unable to regularly facilitate activities, which was one of their newer responsibilities. Staff had received training in safeguarding and knew how to identify and report concerns. Accidents, incidents and falls were documented and reviewed to identify patterns and trends and consider lessons learned. Risk assessments provided guidance for staff on how to keep people safe and meet their needs. The home was clean, with effective cleaning and infection control processes in place.

Audits and monitoring were used to assess the quality of the care provided. However, these had not consistently identified shortfalls, such as the issues we found with medicines management. The majority of people and relatives we spoke with said they would recommend the home. They spoke positively of the care and the staff who provided this. People, relative and staff’s views were sought through regular meetings. Views were also gathered though surveys and questionnaires. Although any actions from these were added to the home’s improvement plan, feedback was not currently being provided to people or relatives.

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 the service was good (published 1 January 2022).

Why we inspected

This inspection was prompted by a review of the information we held about this service, along with concerns reported by the local authority during meetings held with them. Concerns included an increase in safeguarding referrals and other reporting.

We undertook this focused inspection to assess whether the current rating of good was still accurate. This report only covers our findings in relation to the key questions safe and well-led, as these were the only key questions inspected.

For those key questions not inspected, we used the ratings awarded at the last comprehensive inspection to calculate the overall rating. The overall rating for the service has changed from good to requires improvement based on the findings at this inspection.

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

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.

Enforcement and Recommendations

We have identified a breach in relation to medicines management at this inspection. We have also made a recommendation relating to staffing.

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

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Mill View is a residential care home providing personal and nursing care for up to 180 people aged 65 and over. At the time of the inspection, the service was supporting 153 people across six single storey units on the same site. Each unit specialised in; residential, nursing or dementia care.

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

We had been made aware that some incidents which should have been submitted to CQC had not been sent. This had been rectified immediately and will be dealt with outside the inspection process. We made a recommendation that the provider ensure notifications are submitted in a timely way in future.

Medicines were managed safely within the service, but the medicine round we observed took a long time to complete. We made a recommendation to ensure medicines rounds are planned effectively.

The service was in the process of changing their recording system. This meant there were some gaps on the new system. However, the information was available when asked for and staff were working towards ensuring all documents on the new system were complete and up to date.

People felt safe at the home. There were systems in place to help safeguard people from the risk of abuse and staff understood how to recognise and report any concerns. Risks to people’s safety were assessed, monitored and reviewed. All required health and safety certificates and risk assessments were in place and up to date. All required Infection prevention and control measures were followed.

Assessments had been completed prior to people moving into the home. People’s needs were reviewed and updated regularly and the information held was person-centred. People’s nutritional and hydration needs were supported. People felt there was plenty food on offer and they were offered choices. The staff referred to other agencies and professionals as required.

There were systems to ensure staff were suitable to work with vulnerable people. There were some staff shortages, but staff were meeting people’s needs with the help of regular agency staff. The service was actively recruiting more staff to fill the vacancies. New staff had a thorough induction and training was on-going throughout people’s employment.

The premises were clean, odour free and well maintained, with lots of space for people to move around. There was clear signage in place to assist people living with dementia.

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 told us they were well treated and supported and we saw their individuality was respected. Different methods of communication used by individuals were recorded and staff were aware of these. The home provided activities each day and a schedule was displayed.

The service responded promptly and appropriately to complaints. Lessons were learned from any concerns raised. The service engaged well with people using the service, their relatives and staff. People were encouraged to speak up about what they wanted from their placement, via reviews and surveys and informally when chatting with staff.

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 14 December 2019).

Why we inspected

The inspection was prompted in part due to concerns received about an increase in falls and a number of outbreaks of infections A decision was made for us to inspect and examine those risks.

We found no evidence during this inspection that people were at risk of harm from these concerns.

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.

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

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.

We found the following examples of good practice.

Visitors to the service were screened for symptoms of respiratory infections and were supported with prominent signage, guidance and the supply of hand sanitizer and PPE to wear on their visit.

Good, alternative methods of maintaining contact between people who used the service and their relatives had been implemented throughout the pandemic.

The service ensured people were admitted to the home safely. People were isolated for 14 days, as per guidance, following admission.

Risk assessments were in place for all, with particular risk assessments for people in higher risk groups.

Communal areas, such as outdoor spaces, were used creatively to help with IPC.

There was a separate entrance for people to use to access the testing hub, ensuring they did not have to walk through the home.

The service demonstrated an understanding of how and when to access local IPC resources to gain advice and support.

Further information is in the detailed findings below.

Mill View is a residential care home providing personal and nursing care for up to 180 people aged 65 and over. At the time of the inspection, the service was supporting 169 people across six single story units on the same site. Each unit specialised in; residential, nursing or dementia care.

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

Medicines were received, stored, administered and disposed of safely. Systems and processes were in place to safeguard people from the risk of abuse. Individual risks to people were assessed. There were sufficient numbers of staff deployed to meet people's assessed needs. Arrangements were in place for making sure that premises were kept clean and hygienic so that people were protected from infections.

The service operated in accordance with the principles of the Mental Capacity Act 2005 (MCA). 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.

Staff had good relationships with health and social care professionals who had contact with the service. People's individual needs were assessed before they moved into Mill View. Staff received a good range of support including regular training. People were supported to eat a varied and nutritious diet based on their individual preferences. The premises were suitable for people's needs. Accessible bathing equipment was provided and signage throughout the building promoted people’s independence.

Staff treated people with kindness, compassion and respect. Staff were able to identify people with different religious and cultural needs and explained how these needs were met. Residents' and relatives’ meetings were held to enable people to raise issues and contribute to the running of the service. People were encouraged to be as independent as possible. Staff understood the need to protect people’s privacy and dignity when providing care.

Care records were personalised for each individual and recorded details about their specific needs and preferences. Care plans were reviewed regularly to ensure they remained accurate and reflected people’s needs. Staff adapted the way in which they communicated with people to engage them and to ensure important information was shared. People were supported to engage in a range of activities and to maintain important relationships. People’s end of life wishes were considered as part of the assessment and care planning process.

The registered manager and provider completed regular safety and quality audits to measure performance and generate improvements. The service had a positive learning culture where people were supported to reflect on performance and improve practice. The provider regularly engaged people using the service, their relatives and staff through, surveys, meetings and informal discussions. People said communication with the management team was good. The service worked effectively with internal and external partners to develop practice.

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 requires improvement (published 31 January 2019) and there were two breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

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.

Mill View is a care home providing nursing and personal care. It is situated about half a mile from Bolton town centre. The home is situated in its own grounds with garden areas and car parking available at the front of the home.

Mill View Care Home 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.

The care home accommodates up to 180 people within six separate houses. Each house caters for different needs including residential care, specialist dementia care and nursing. One the day of the inspection there were 164 people using the service.

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. There was a registered manager in place at the home.

Some of the documentation relating to medicines was not accurate and some medicines not given safely. Care files included relevant health and personal information. However, there were some inconsistencies and gaps with regard to care plans and risk assessments.

People told us they felt safe at the service. Safeguarding and whistle blowing policies were in place and staff had received training and were aware of how to raise a concern. Health and safety measures were in place.

Staffing levels were sufficient to meet the needs of people who used the service. The recruitment system was robust. General and individual risk assessments were in place.

The home was clean and tidy and infection control measures were in place. However, a number of infection outbreaks had been experienced by the home.

Staff regularly took mandatory training refresher courses and supplementary training was delivered as required. We saw evidence of staff supervisions and appraisals.

Nutrition and hydration needs were addressed by the service and there were choices of meals and drinks on offer throughout the day. People’s specific dietary needs were adhered to.

The service was working within the legal requirements of The Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).

Staff interactions with people who used the service were patient and kind. Privacy and dignity was respected. The home had appropriate policies around confidentiality and data protection and staff were aware of its importance.

There was an appropriate policy and procedure in place with regard to equality and diversity and staff had undertaken training. Communication needs were recorded within care plans and information could be produced in a number of different formats to suit people’s needs.

People were involved in their care and support planning and reviews. People who used the service were encouraged to be as independent as possible. All appropriate equipment was in place for people to aid people’s independence. The equipment was well maintained and in good working order.

People told us they felt the service was responsive. Care files included person-centred information and people’s choices were respected.

Activities had improved at the home and were offered seven days and two evenings per week. We saw evidence that the service was looking at more meaningful one to one activities for the future.

There was an appropriate complaints procedure and complaints were responded to appropriately. We saw a number of compliments received by the service.

People were supported to remain at the home when nearing the end of their lives if this was their wish.

There was a statement of purpose in place which set out the aims and objectives of the company. It also outlined dignity and privacy, safety and support.

People told us the management were accessible and approachable. Staff told us they were well supported by the management and had regular supervisions and staff meetings.

The company had a number of quality assurance processes in place. However, these processes had failed to identify the concerns we identified around medicine management and accurate maintenance of care records. There was evidence of good partnership working. The service had good links with the wider local community.