CQC report explained · a residential care home
What the CQC found at Mill House
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Good
- People were protected from abuse and avoidable harm. There were enough suitably skilled staff, risks were managed well and incidents were investigated so lessons could be learned. Medicines were generally managed safely, although records were not always updated promptly when medicines were discontinued.
- Effective?
- Good
- This question was not inspected during this focused inspection. Its previous rating was carried forward when calculating the overall rating.
- Caring?
- Good
- This question was not inspected during this focused inspection. Its previous rating was carried forward when calculating the overall rating.
- Responsive?
- Good
- Staff understood people's communication needs and supported their interests, relationships and activities. However, goals were not always broken down into achievable, measurable targets or monitored regularly. This rating fell from Outstanding at the last inspection.
- Well-led?
- Good
- Management was visible and approachable, staff felt valued and the provider sought feedback and worked with other organisations. The rating remained Good.
What inspectors found, June 2023
Rated Good; inspectors found safe, kind and person-centred care, but goals were not always planned or monitored properly.
This was an unannounced focused inspection. The inspection activity took place between 23 May and 9 June 2023, with visits on 23 and 30 May. Inspectors spoke with four people using the home, five relatives and seven staff. They also reviewed care, medicines, staff and management records.
The home was rated Good overall. Safe, responsive and well-led were rated Good. Inspectors found enough trained staff, good safeguarding arrangements, safe medicines systems and support that respected people's choices, communication needs and interests.
There were two weaknesses. People's goals and aspirations were not always broken into achievable, measurable steps or checked regularly. Medicines records were not always updated promptly when medicines were stopped, although the manager acted immediately after inspectors raised this.
This inspection did not assess Effective or Caring. The previous ratings for areas not inspected were used when calculating the overall rating. The previous overall rating was Good, published in January 2018, while Responsive had previously been Outstanding and is now Good.
Enough skilled staff
Inspectors found staffing levels and staff skills matched people's needs, including support for activities and visits.
“The provider ensured the service had enough staff, including for one-to-one support for people to take part in activities and visits how and when they wanted.” from the report
Communication support
People had individual communication plans, visual prompts and staff who understood how they communicated.
“Staff had good awareness, skills and understanding of individual communication needs, they knew how to facilitate communication and when people were trying to tell them something.” from the report
Activities and interests
People were supported to take part in regular social and leisure activities, including activities in the local community.
“People were supported to participate in their chosen social and leisure interests on a regular basis.” from the report
Open management
The manager was approachable and involved people, relatives, staff and other professionals in decisions and improvements.
“Management were visible in the service, approachable and took a genuine interest in what people, staff, family, advocates and other professionals had to say.” from the report
Goals were not consistently monitored
needs fixingGoals and aspirations were not always adapted to each person. They were not consistently broken into achievable, measurable steps or reviewed regularly. Inspectors made a recommendation, and this issue had also been identified by external professionals in September 2022.
“The provider did not ensure people's goals and aspirations were always appropriately adapted to the person.” from the report
Medicine records
minorRecords were not always updated promptly when medicines were discontinued. The manager took immediate action after inspectors raised this.
“Records were not always updated promptly when medicines were discontinued but the registered manager took immediate action following our feedback.” from the report
- 01How are each person's goals broken down into achievable and measurable steps?
- 02How often are people's goals reviewed, and how is progress recorded?
- 03What checks now make sure records are updated promptly when medicines are discontinued?
- 04Which ratings were carried forward from the previous inspection because Effective and Caring were not assessed?
- 05How do people and their relatives help shape care plans, activities and improvements?
This was an unannounced focused inspection of Safe, Responsive and Well-led; Effective and Caring were not inspected and their previous ratings were used to calculate the overall rating. This explanation was written from the published report of 23 June 2023 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, January 2018
Mill House was rated Good overall, with Outstanding responsive care and highly personalised support for people with autism.
This was an unannounced comprehensive inspection. Inspectors visited on 15 August and 5 September 2017, and spoke with relatives and professionals by phone on 21 August. They observed care, spoke with staff and reviewed care documents, medicines records and other records.
The home supported five people with autism. Inspectors found people were safe, treated with dignity and supported to make choices. Care plans were detailed and staff understood people's individual needs, risks and communication methods.
The home was rated Good for safe, effective and caring care, and for being well-led. It was rated Outstanding for responsive care because staff supported individual goals, activities, communication and life experiences in a particularly detailed and flexible way. The overall rating remained Good, the same as at the May 2015 inspection.
Detailed care planning
Care documents described people's histories, needs, behaviour, communication and preferred support in considerable detail. Staff used this information to provide consistent, individual care.
“Care documents were significantly detailed and accurately reflected to a high degree each person's history and needs.” from the report
Meaningful lives
People were supported to choose activities, develop skills and work towards personal goals. This included gardening, cultural events, community involvement and achievement awards.
“People were enabled to live extremely fulfilling lives in which they were given choice about their activities.” from the report
Strong response to individual needs
The home used pictorial plans, social stories, communication aids and regular discussions to help people express themselves and make choices.
“We found staff were exceptionally responsive to people's individual needs.” from the report
Careful holiday planning
Staff researched the needs of people with autism when planning a group holiday abroad. They prepared individual autism passports and risk assessments to reduce distress and support a safe journey.
“The staff had extensively researched holidays abroad when the people using the service wanted to go on a group holiday.” from the report
Safe medicines and staffing
Medicines were locked away, administration records were complete and guidance was available for medicines given when needed. Staffing arrangements included dedicated support for people who required it.
“We looked at the Medicines Administration Records (MAR); all of the MAR charts were up to date and there were no gaps in recording” from the report
Positive management and oversight
The manager used audits, external reviews and an improvement plan to monitor the home. Staff and relatives said they felt supported and able to raise concerns.
“Regular audits to monitor the quality of the service were carried out and overseen by the manager.” from the report
Inspectors raised no specific concerns in this report.
- 01How are my relative's care plan, communication tools and personal goals reviewed and updated?
- 02How would you support my relative through a major change, such as moving in, changing routine or returning from hospital?
- 03How do you make sure there are enough staff, including dedicated support where needed, for my relative's daily activities?
- 04How do you support people to choose activities, develop independence and take part in the local community?
- 05What autism-specific support and planning would be available for travel, hospital visits or other situations that might cause distress?
This was an unannounced comprehensive inspection covering all five questions and the overall rating, with visits on 15 August and 5 September 2017 and telephone discussions on 21 August 2017. This explanation was written from the published report of 16 January 2018 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of Mill House
3 rated inspections over 8 years: the service has held its Good rating throughout.
- June 2023Goodcurrent ratingstayed GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- January 2018Goodstayed GoodSafe: GoodResponsive: OutstandingWell-led: Good
- August 2015GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- August 2014
Registered with the Care Quality Commission on 6 August 2014.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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47 live-in carers within about an hour of County Durham
These are self-employed carers on PrimeCarers, the introductory agency that runs this directory. Each has a profile with their own rates and reviews from families, and you choose who to talk to.
Most charge £960 to £1,210 a week. 42 can care for a couple. 10 years' experience on average.
“Petty introduced herself to Mum every time she was caring for her and responded very quickly to Mum if she was distressed in the night.”
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