Mill View Care Home

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

Well-led – this means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture. At our last assessment we rated this key question requires improvement. At this assessment the rating has remained requires improvement. This meant the management and leadership was inconsistent. Leaders and the culture they created did not always support the delivery of high-quality, person-centred care.

This service scored 61 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Shared direction and culture during this assessment. The score for this quality statement is based on the previous rating for Well-led.

The provider had inclusive leaders at all levels who understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation. Leaders had the skills, knowledge, experience and credibility to lead effectively. They did so with integrity, openness and honesty.

Changes to the management team had taken place over the last 3 months, with a new home manager in post and a clinical unit coordinator appointed. The management team now consisted of the home manager, deputy manager, unit coordinator and clinical unit coordinator. Feedback from some relatives and the majority of staff was these changes had been positive, with the new home manager being described as, “visible, approachable and down to earth”. A relative told us, “There is a new manager, only been here a few weeks but seems good. It’s what they need here, a manager going actively round and sorting things out.” A staff member stated, “The service has improved significantly. The management are much more helpful and the culture is much better.” Another staff member told us “[The manager] is competent and has the appropriate experience to do the role.”

The provider fostered a positive culture where people felt they could speak up and their voice would be heard.Staff told us they felt more confident in speaking up and raising concerns, since changes to management had occurred. One staff stated, “Yes, I could raise concerns with the manager, she is approachable. We could go to her with anything.” The provider had up to date ‘Whistleblowing and ‘Speaking Up’ policies, which staff had access to. Information on speaking up and raising concerns was also displayed within the home.

We did not look at Workforce equality, diversity and inclusion during this assessment. The score for this quality statement is based on the previous rating for Well-led.

The provider did not always have clear responsibilities, roles, systems of accountability or good governance. They did not always act on the best information about risk, performance and outcomes, or share this securely with others when appropriate.

The provider had a quality assurance framework in place, which each home, including Mill View, was to follow. This detailed what audits were to be completed weekly, monthly, quarterly, 6 monthly and annually. Alongside this, a range of separate ‘as needed’ audits could also be completed. Audits provided during the assessment showed the framework was currently being followed. However, it was apparent provider level auditing was more robust, than those which had been completed by the previous management team. Provider level auditing had identified numerous concerns, which should have been picked up by management, but had not been. This included the majority of issues we noted during our assessment. We noted provider audits had commented on the internal audit process not being effective, with scores awarded for certain areas not being reflective of the ‘evidence in front of you’.

The new home manager had taken on board this feedback and was working with the management team to ensure auditing under their stewardship was more effective. During the assessment we identified issues with contemporaneous record keeping, including gaps in monitoring charts. Some of these issues had been identified though provider level auditing, including improvements being required with hygiene, oral care and repositioning charts, though it was taking time for required improvements to be sustained.

The provider understood their duty to collaborate and work in partnership, so services worked seamlessly for people. They shared information and learning with partners and worked together for improvement.

The provider was working collaboratively with the local authority and other system partners to help drive improvements within the home. Regular multidisciplinary meetings had taken place, where progress with planned actions had been reviewed. We spoke with representatives from Bolton Council who told us they were happy with the level of engagement from the provider, who were committed to making the necessary improvements.

The provider did not always focus on continuous learning, innovation and improvement across the organisation and local system. They did not always encourage creative ways of delivering equality of experience, outcome and quality of life for people. They did not always actively contribute to safe, effective practice and research.

A monitoring visit by the local authority in October 2024 had identified issues in a number of areas including, poor personalised care, people’s involvement and the provision of information, safeguarding, suitability of staffing and the quality of management. The provider’s governance processes had not been effective in identifying a number of these shortfalls, albeit they now formed part of the provider’s service improvement plan.

During our assessment we noted a number of action plans had been generated to address issues noted though audits and governance processes. Some of these were very lengthy, which indicated how much work was required to ensure the home was meeting required standards. For example, a quality review completed by the provider in February 2025 contained 61 actions, including care plans requiring more evidence of resident / relative involvement, staff needing to complete activities and repositioning, oral care, hygiene charts to be reviewed daily and any gaps addressed. From reviewing a selection of the action and improvement plans in place, we noted actions were not being completed in a timely way, with no clear rationale being documented for this. Of the 61 actions mentioned above, 24 were overdue, with another 4 listed a pending. A diabetes audit completed in December 2024 had highlighted the need for foot checks to be completed for all people with diabetes. The same audit in February 2025 showed this action had yet to be completed. We also found some actions had been listed as completed, despite these still being issues noted during our assessment. For example, the action relating to monitoring charts being reviewed daily and any gaps addressed, was listed as completed. However, the fact we found gaps within a number of people charts, indicates this is still an area of concern.

One of the purposes for assessing service delivery, identifying shortfalls and creating action plans is to drive improvements. Changes to practice and introduction of new processes should ensure improvements are sustained over time. However, we found this was not always the case. For example, diabetes audits on one unit in December 2024 had rated the compliance level as 91%. In January 2025 this had dropped to 83% and in February 2025 it had dropped again to 65%. Similarly, the compliance scores for mealtime audits completed across the home were worse in February 2025, than they had been in December 2024. It was not clear whether this deterioration was due to how the audits had been completed, or whether practice had deteriorated.