Mill View Care Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question requires improvement. At this assessment the rating has remained requires improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

The service was in breach of legal regulations in relation to the safe management of people’s medicines, assessing risks to people and doing everything practicable to mitigate any risks, and ensuring sufficient numbers of staff were deployed to complete all tasks required of them, and that all staff had received supervision as necessary.

This service scored 59 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had made a range of improvements to promote a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events.

The approach to managing duty of candour and lessons learned from accidents and incidents had been strengthened. For example, in recording, identifying and acting on themes and trends.

The provider had introduced formal systems to electronically record incidents and accidents which included actions taken, who had been informed, and any lessons learned. Following falls, checks were undertaken, including a 72-hour post fall follow up. Weekly clinical audits took place, which covered a range of areas including falls and wounds. Through this process, any potential causes could be identified and used to support the lessons learned process. The provider had added lessons learned to daily and quarterly staff meetings to ensure the sharing of relevant information and embed good practice.

The providers complaints policy was adhered to with written responses provided within timescales. A log was used to detail actions taken, outcomes and cross referenced to the providers electronic system where investigations and lessons learned were managed.

Staff told us that they felt safe and supported to raise concerns and that they would be listened to. They did not raise any serious concerns about safety at the home. A relative told us, “I feel that (relative) is safe on the unit.”

The provider worked with people, relatives and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.People were supported to safely access and transition between services as needed. The provider ensured people were assessed before admission to ensure their needs could be safely met.When people temporarily transitioned to another service, for example to hospital, information packs, often referred to as ‘hospital passports’ were sent with them, to support continuity of care.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. The provider, did not however, consistently document or clearly demonstrate what actions they had taken. Staff were mindful of the importance of protecting people rights to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect.

Safeguards to prevent those people being deprived of their liberty were lawful and in date. Staff understood what this meant for people in practice. However, where specific conditions had been included on Deprivation of Liberty authorisation forms, these had not always been transferred to people’s care plans, nor could we locate any evidence to show they were being met.

The provider had suitable safeguarding policies in place and staff received training around safeguarding. The provider worked with people and professionals to understand what being safe meant to them and how to best achieve this. The provider had listened to and acted on feedback on how to improve the recording and communication on risk with professionals.

Safeguarding referrals had been made in line with policies. Following a recent incident the provider had shared the concerns with relevant agencies in a timely manner. These safeguarding incidents were recorded on a central log that cross referenced with the providers electronic recording and monitoring system. Senior staff and management had oversight of this system and ensured that processes were completed, and any lessons learned were identified and addressed.

We spoke to 4 staff to check their learning in practice. They all understood their responsibilities and how to report concerns. They were confident managers would respond appropriately and said they were given feedback and updates about concerns they had raised.

The provider did not always work effectively with people to understand and manage risks. Records did not evidence how people or families had been involved in developing plans of care, support and risk assessments. Families told us they had not been involved in or seen their relatives care plans.

Some people’s risk assessments were detailed and person centred, others were lacking in detail or contained conflicting information and were not always robust enough to provide clear guidance on strategies to manage risk or to mitigate future risk. One person’s risk assessment did not provide sufficient emphasis on their risk to others. Another person’s information stated no sharp foods, which had not been adhered to consistently. The provider recognised risk management plans and behaviour charts needed to be improved to help minimise the impact on people living and working in the home. The provider advised they had been working with staff and other relevant professionals to improve their records.

Prior to the assessment, the provider had notified us of an incident involving a person who had suffered a minor burn after spilling soup on themselves. We checked whether guidance regarding safe temperatures to serve specific foods, including soup, was in place and found that it wasn’t. From reviewing food temperature logs on one unit, which record the temperature of food prior to being served, we noted soup had been served at a temperature of 88°C. Food safety guidance indicates food needs to reach 74°C when being cooked and kept above 60°C to prevent bacterial growth. As such, there was no reason for soup to be served at such a high temperature, which increased the risk of scalding. During our observations of lunch, we observed staff tell people to be careful as the soup was very hot. We raised our concerns with the provider, who agreed to put guidance in place and circulate this across all Advinia homes.

Staff were able to identify risk to people but did not always have the time to be able to support the person to do the things that mattered to them. For example, it was identified one person could become frustrated if unable to effectively communicate with staff. However, there was limited guidance and no aids in place to support communication, though this was rectified by the provider during our site visits. Those staff who did provide one to one support were able to verbalise personalised strategies to support people.

Risk assessments of the environment and equipment used within the home had been completed, to ensure these were fit for purpose and used correctly. Ongoing safety checks had also been completed in line with legislation, with certification in place to confirm compliance. This included checks of gas and electrical safety and equipment such as the passenger lift and hoists. An up-to-date fire risk assessment was in place and each person had a personal evacuation plan, in case of emergencies.

The provider did not always make sure there were enough staff. They did not always make sure staff received effective support and supervision. They did not always work together well to provide safe care that met people’s individual needs.

The provider used a system for determining how many staff were needed each day. Although the new manager was reviewing this system to ensure it was effective, we were not assured staffing levels had always been sufficient to meet people’s individual needs and carry out all of the responsibilities asked of care staff, which included activity completion. Staff rotas evidenced some staff were working in excess of the provider’s own policy on recommended hours. The system in place to monitor this had not been effective. This was addressed by the provider during the inspection with the implementation of a more robust oversight and feedback process.

We observed staff moving hastily between tasks and this was especially apparent at lunch time. Interactions observed between staff and people were kind and compassionate but often functional in nature. This was due to the amount of task’s they were performing. Staff did not have time to support people to engage in meaningful activities and stimulation, and some people were left for extended periods of time with no staff interactions. One person told us “The staff are fine; they try their best but there are not enough of them. I am two to one [staff ratio] so if I need the toilet, I usually have to wait a while.”

Staff told us that there was not always enough staff on duty. One staff member told us, “We are probably short staffed once a week on average. Breakfast time is really hard, it can be 12 before everyone has eaten”.

Staff provided variable accounts of supervision. One staff member said, “I have regular supervision” and another stated “We used to have supervision every 6 months or so, but now we don’t have any”. The care home did not provide supervision in line with their own policy and there were several staff members without an up-to-date supervision. The provider’s quarterly audit of the home had identified improvements were required with supervision completion.

Staff told us they received sufficient training to support people, and there were opportunities to develop. Staff training was up to date with an effective audit system to capture and highlight training due to expire. Nurse registrations were checked by the provider, and we found these to be in date.

The provider assessed and managed the risk of infection and had processes in place, however measures were not consistently applied. . They detected the risk of infections spreading and shared concerns with appropriate agencies promptly.

At the time of assessment, there was an outbreak of diarrhoea and vomiting, affecting some residents within the home. Where possible, people with symptoms were being supported to isolate in their rooms. However, where this was not possible, for example people who could not understand the need to remain in their room, they were seated within specific areas of the lounges, to limit cross contamination. However, during observations on one unit, we noted staff used the same sling, stand aid and wheelchair to complete transfers of people with and without symptoms, without carrying out any cleaning or disinfecting of equipment in between. This increased the risk of cross contamination.

Some of the fixtures within the home were tired and damaged. This meant there were areas where chipboard was exposed around sinks. Exposed chipboard poses an infection risk due to its porous nature which can harbour bacteria.

Paper towels were missing from one unit as a person removed these and stored them in their room. This was raised during the inspection and management gave assurances they would explore options to address this.

We found the home to be generally clean, with infection prevention and control (IPC) processes and audits in place. We observed housekeeping staff on each unit, with colour coding for cleaning equipment; to stop cross contamination. There was a cleaning rota in place for each unit for the night staff to adhere to in addition to the housekeeper’s daytime regime. The laundrette facilities were clean, with separate entrances for soiled and clean laundry

Staff were seen to use personal protective equipment appropriately. There was evidence of up to date and ongoing infection, prevention and control training in place.

The service did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences.

For people who had their medicines crushed prior to administration this wasn’t always documented in their care plans, and there were not always written instructions available to staff to ensure these medicines were administered in an appropriate way. For one person out of three checked, who had their medication crushed to be hidden in food and drink to be administered covertly, it was not clear the appropriate people were involved in the decision-making process.

For medicines to be administered ‘when required’ (PRN), protocols were in place to explain how and when these medicines should be given. However, there was not always person-centred information included. PRN related information could sometimes be found in care plans, but this was inconsistent across the units.

For people prescribed medicines patches there was a record of where this was applied on the body, however, staff had not always followed the manufacturer’s instructions on rotating the location of the patch.

For two people we found that the prescribed time interval had not been observed for paracetamol containing products and they had received doses too close together. For one person on time sensitive medicines, this had not always been administered at the prescribed time.

Although there was a system in place for the recording of topical medicines such as creams, this was not always completed following the services policy.

We found care plans and medication records were not always up to date. Where medicines had been discontinued these were not always removed from the electronic medicine administration record system, and care plans sometimes contained out of date information.

People were supported to self-administer their own medicines if it was appropriate. However, there were not always risk assessments in place and care plans did not consistently identify when someone was able to look after their own medicines.

Audits were completed by the service and by external partners. The external audit had found issues similar to those found during this inspection.

Medicines were managed by staff who had been trained and had their competency assessed.Medicines were stored securely. We reviewed the record of a person prescribed powder to thicken drinks to prevent choking. We found that it was stored securely, and its use was recorded appropriately.