Mill View Care Home

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

Responsive – this means we looked for evidence that the provider met people’s needs.

At our last assessment we rated this key question requires improvement. At this assessment the rating has remained requires improvement. This meant people’s needs were not always met.

The provider was in breach of the legal regulation relating to person-centred care.

This service scored 54 (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 did not always make sure people were at the centre of their care and treatment choices and they did not always work in partnership with people, to decide how to respond to any relevant changes in people’s needs.

Although some staff understood the importance of supporting people in a personalised way, this was not consistently embedded in practice across all houses. As a result, staff did not always deliver care in a way that respected people’s choices or aligned with what may have been important to them. This increased the risk of care becoming task focused rather than person-centred. For example, on Martin house although some interactions we witnessed were patient and kind, overall, we observed minimal interactions between staff and people, which were mainly task-led as staff were very busy.

The provider did not always work in partnership with people when planning or reviewing their care. People and relatives told us they were not routinely involved in discussions about changes to support arrangements. A person told us, “I don’t know if I have a care plan.” A relative said, “When [person] first came here, they [staff] talked to me about [their] care. They asked me to explain about [their] life, hobbies and so on, but since that meeting nothing else has been discussed. I haven’t seen the care plan.”

The provider did not consistently ensure care plans were adapted promptly and collaboratively. This meant staff did not always respond in a way that reflected people’s needs. For example, 1 person’s care plan stated they needed a mobility frame when walking and this was not in place; we were later told this was no longer needed. There were gaps in other people’s care records regarding personal care provision, so we could not be assured care had been provided as required.

On Atlas house people were left for 90 minutes at the breakfast table waiting for something to happen. There were limited choices on offer for breakfast. People’s care plans did not always reflect their needs, for example regarding personal care and communication. We observed numerous occasions when people were calling for staff assistance, but this was not provided quickly.

There were some shortfalls in how the provider understood the diverse health and care needs of people and their local communities, so care was not always joined-up, flexible or supportive of choice and continuity.

As care plans and risk assessments were not always in place or reflective of people’s current needs, we could not be assured people received consistent care. Care plans had conflicting information in them, for example, for 1 person who was hoisted, their mobility care plan also said they could stand. This meant people were at risk of not receiving consistent care.

On Atlas house it took 45 minutes to locate a spare key for the medicines trolley when the original had snapped, indicating a possible issue with storage of spares. As people and relatives felt they were not always involved with care planning or had not seen care plans, we could also not be assured they were fully accurate and reflective of people’s actual needs, hopes and aspirations.

The provider did not always supply appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

Information for people was not always presented in a way people could understand; this increased the chance of people not always being supported to make informed decisions about their care. Some relatives said they were not fully informed about incidents or changes in risk levels, and most people were not sure if they had a care plan in place.

Our review of people’s care records identified communication care plans were not always reflective of people’s communication needs, for example, people’s requirements to wear glasses. Some relatives told us they had not been given an information pack about the home. At breakfast time, people were not always advised of the options available to them for breakfast.

The providers’ accessible information policy stated in part, the ‘Company will provide accessible information, in a format that can be understood by the individual for whom it is intended, and communication support, where needed, to enable effective, accurate dialogue between a professional and a Resident or their main representative.’ However, feedback we received did not indicate this was happening in practice. For example, a relative told us, “I was involved in [person’s] care plan a long time ago, but I have heard nothing about it since.” A second relative said, "I haven’t seen a care plan since last December. The assessor said she was going to re-write the care plan, but I haven’t had a copy of it yet."

The provider did not always make it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. Staff did not always involve people in decisions about their care or tell them what had changed as a result.

Not all people and relatives were aware of how to make a complaint and did not know about the existence of a complaints policy; 4 relatives told us they were not aware of the complaints policy. The service user guide gave details of how to make complaints and suggestions, however, several relatives reported concerns they raised were not followed up or resolved, for example, regarding clothes regularly going missing and personal care not being provided. Not all relatives had been informed of an infectious outbreak on Albion house, which occurred shortly before our inspection.

During the inspection, people and relatives consistently told us there were no meaningful activities and not enough staff on duty. A relative told us, “When [person] first came here, staff spoke to me about [their] needs. Staff told me they have everyone’s needs on their work phones and they refer to them; they sort of talked to me to find out about [person] before [they] came here and asked about [their] hobbies and likes. I told them [person] needs stimulating but that isn’t happening.”

As care plans were not always reflective of people’s current needs, we could not be assured people were regularly and actively involved in planning their care, for example, 1 person’s care plan on Martin House stated the person would like to remain independent and did not require any support from staff when mobilising, however, it also stated the person required the support of 2 staff and a Zimmer frame to mobilise; we saw the Zimmer frame was not next to the person’s chair in the lounge.

The provider did not always make sure that people could access the care, support and treatment they needed when they needed it.

The provider did not always ensure equity in access for all people using the service. People did not always have timely access to meaningful activities which reflected their preferences, backgrounds or interests; one person’s care plan referred to them in the wrong gender several times. Throughout the inspection we saw staff were not consistently providing regular, meaningful interactions, which meant people did not always receive the monitoring, reassurance or engagement they required. This placed people at increased risk of being neglected and contributed a reduced sense of wellbeing.

The completion of personal care and oral care records in some people’s care plans was poor, and we could not be certain people were not disadvantaged in how they accessed care, support and opportunities within the home. A relative told us, “I don’t feel [person] is getting the care [they] need as [they] are not being stimulated and are in the wrong unit.” On Albion house, one person’s call bell was not working so they could not easily summon staff assistance.

We found some discrepancies with care plans, for example, 1 person’s care plan stated they could use the staff call bell but later stated they could not. There were also discrepancies in the recording of screening tool scores used, for example, when people were at risk of malnutrition.

Staff and leaders did not always actively listen to information about people who are most likely to experience inequality in experience or outcomes. This meant people’s care was not always tailored in response to this.

People’s lived experiences were not always reflective of their expectations and needs. For example, people’s social and recreational needs were not being met due to a lack of activities and care needs were not met consistently, including bathing, oral care and being supported to change position. Communication among staff was also variable, which affected continuity of care.

There were some symbols and signage around the building to help people identify their own rooms, or communal areas. There were personalised memory boxes on Albion house with photos and memorabilia outside to help people identify their bedrooms. A relative told us, “The home is nothing special, it is very basic and a bit depressing; all the residents just sit around in various states of wakefulness. I am not sure what the policy is regarding taking people out to other community activities, but I’ve not heard of anything [person] could access.”

Many staff interactions with people were task led, for example, on Atlas house we saw staff were busy getting everyone up and people left for 90 minutes at the breakfast table waiting for something to happen. A relative said, “Management could be improved; they could improve staffing and catering as sometimes the food looks terrible.” A staff member told us, “It has changed from person-centred care to a task orientated, where it is completing one task, entering it on the care system by means of a tile and written account, before moving onto the next task.”

A person told us their wardrobe door was broken and would not shut; relatives had requested for it to be fixed, but several weeks later nothing had happened. A second person said, “Sometimes relatives are invited to meetings, but mine can’t attend; we asked for details of what happened at the meeting, but I don‘t think we got them.”

People were supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.

Where people had chosen to discuss this, care records contained some information about their end of life wishes, such as where they wished to be, who they wanted present and how their religious or spiritual needs should be met. A relative told us, “A ‘do not resuscitate’ (DNACPR) order is in place and we have discussed where we would like [person] to pass away.” A second relative said, “A DNACPR is in place, but I haven’t discussed anything else yet.”

Staff told us they had completed training in supporting people at the end of life. One staff member told us, “I completed a palliative care course approximately 3 years ago, ran by Bolton Hospice; the experience has given me suitable skills.” However, the staff training matrix sent to us by the provider did not identify this training. The provider confirmed this training had occurred and advised they would send us the proof; however, this was not received.