CQC report explained · a residential care home
What the CQC found at Mill House & Cottages
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Good
- Medicines, risk assessments, infection control and staffing were found to be managed safely. Inspectors found that previous problems with medicines and infection control had been addressed.
- Effective?
- Good
- Staff had relevant training and competency checks. People received appropriate support with food, drink, healthcare and decisions about their care.
- Caring?
- Good
- Staff were kind and respectful and supported people's dignity, privacy, independence and choices. Relatives and people spoke positively about the care.
- Responsive?
- Good
- Care plans reflected people's needs and preferences and were regularly reviewed. People had activities, different ways to keep in touch with relatives and a complaints process that used feedback to make changes.
- Well-led?
- Good
- The manager and provider had introduced improvement plans, audits and stronger leadership. Inspectors found that governance systems were now effective and that people, relatives and staff felt the service had improved greatly.
What inspectors found, April 2021
Rated Good and no longer in special measures; inspectors found substantial improvements in safety, care and leadership.
Inspectors visited on 9 and 17 March 2021. They spoke with seven people, three relatives and four staff. They observed care, reviewed eight care records, medicines records, staff files and management documents.
The home was rated Good in all five areas: Safe, Effective, Caring, Responsive and Well-led. Inspectors found medicines were being managed safely, care plans were personalised, staff training had improved and people received kind and respectful care.
This was a major improvement from the previous Inadequate rating, published in March 2020. The home had been in special measures and had warning notices linked to medicines and governance. Inspectors found the warning notices had been met, and the home was no longer in special measures.
Medicines managed safely
Inspectors found that medicines were given at the intended times, records were accurate and plans for as-needed and covert medicines were clear and personalised.
“People's medicines were managed safely. We noted that medicine administration was completed in accordance with good practice.” from the report
Kind and respectful care
Staff promoted dignity, privacy and independence. People were involved in decisions about their care and staff supported them patiently.
“We saw caring interactions between staff and people in the service. Staff greeted people when they saw them, offering support and reassurance as necessary.” from the report
Improved meals and nutrition
Mealtimes were calm and people were offered choices, suitable support and drinks. Nutrition and fluid intake were monitored.
“Our observation of mealtimes showed the experience for people was pleasant and enjoyable.” from the report
Strong improvement work
The manager and provider had introduced audits, training and a service improvement plan. Inspectors found better leadership and clearer oversight of risks and care quality.
“The provider had a range of audits to monitor the quality and safety of the service provided.” from the report
Activities and family contact
People took part in activities and the home supported contact with relatives through visits, telephone calls, letters, cards and photographs.
“People and their relatives have kept in contact through different methods. Telephone, visits, letters, cards and photographs being sent between the people and their relatives.” from the report
Inspectors raised no specific concerns in this report.
- 01How do you check that the improvements to medicines management have continued since this inspection?
- 02How often are care plans, risk assessments and medicine records reviewed now?
- 03What staff training and competency checks are currently required, especially for medicines and moving and handling?
- 04How do you monitor staffing levels when people's needs change?
- 05What is the current position on the manager completing the process to become registered with CQC?
This announced inspection assessed all five CQC key questions and included infection prevention and control checks, observations, discussions with people and relatives, and reviews of care, medicines, staffing and governance records. This explanation was written from the published report of 22 April 2021 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, March 2020
Rated Inadequate and in special measures; inspectors found serious risks, unsafe medicines management and weak leadership.
This was an unannounced inspection on 2 March 2020. Inspectors spoke with people, a relative, staff and managers. They reviewed care plans, medicines records and staff files, and observed care and medicines being given.
The home was not consistently safe. Risks from damaged equipment, unsafe areas and inaccurate care records had not been properly assessed or managed. Medicines were sometimes late, records were incomplete and guidance for some medicines was missing.
Staff training and mealtimes needed improvement. People were not always offered choices, suitable drinks or well-prepared textured food. Staff were often kind, but care could be task-focused, with too little time for conversation, activities and independence.
The overall rating fell from Requires Improvement to Inadequate. Safe and Well-led were rated Inadequate, while Effective, Caring and Responsive were rated Requires Improvement. The home was placed in special measures because improvements had not been sustained after earlier inspections.
Cleaner environment
The home was much cleaner than at the previous inspection, and staff were seen using protective equipment during care and laundry tasks.
“Since our last inspection the provider had deployed additional cleaning staff to ensure that the home was kept clean and free from the risk of infection.” from the report
Lawful decision-making
Where people could not make particular decisions, capacity assessments and best-interest decisions were recorded in line with the law.
“We found that assessments of people's capacity, and best interest decisions taken where done so in line with the law.” from the report
Support for independence
The adjoining cottages offered people with greater independence a choice about the level of support they received. Staff had also helped one person use community facilities independently.
“People were able to choose the level of support they wanted.” from the report
Open response during inspection
The manager acted promptly when inspectors identified some immediate safety issues. The report also records positive initial feedback about the newly appointed manager.
“The manager acted without delay and took action to make repairs and review records to make changes.” from the report
Unsafe medicines
seriousSome medicines were late or given at the wrong time. Records for patches, opened medicines and covert medicines were incomplete, so inspectors could not be assured they were managed safely.
“People did not always receive their medicines on time.” from the report
Environmental safety risks
seriousInspectors found damaged electrical equipment, unsafe railings, exposed hot water pipes and a damaged garden fence. Some rooms marked as unsafe were left unlocked.
“We found significant damage to electrical equipment, safety railings as well as exposed hot water pipes, all of which could have caused very serious injury.” from the report
Insufficient staff training
seriousThere were widespread gaps in training, including moving and handling, dementia care, safeguarding and nutrition. Inspectors also observed practice that did not follow safe guidance.
“We found widespread shortfalls in the monitoring and planning in compliance of staff training and checks of the competency.” from the report
Poor mealtime support
seriousPeople were not always offered a choice of drinks or where to eat. Food needing a changed texture was not prepared well, and kitchen staff lacked specialist training.
“The provision of meals for people who needed the texture of them to be adapted was poor.” from the report
Limited activities and choice
needs fixingPeople with limited mobility were often kept in one communal area for most of the day. Activities were limited and staff said they did not have time to organise more.
“People living at the home were offered minimal choice in how they wanted to spend their day.” from the report
- 01What action has been taken to ensure all medicines are given at the prescribed times and that patch, covert medicine and opened medicine records are complete?
- 02Which damaged equipment and environmental hazards identified in the report have been repaired, and how are daily safety checks now monitored?
- 03How many staff have now completed or refreshed training in moving and handling, dementia care, safeguarding, nutrition and end-of-life care?
- 04How are people with swallowing difficulties now being supported, and what specialist training have catering staff completed?
- 05How will the home provide more daily activities, involve families in care reviews and keep accurate records of complaints and concerns?
This was an unannounced planned inspection based on the previous rating and covered all five key questions, including the premises and care provided. This explanation was written from the published report of 31 March 2020 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 & Cottages
7 rated inspections over 6 years: the service has held its Good rating throughout.
- April 2021Goodcurrent ratingup from InadequateSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- March 2020Inadequatedown from Requires improvementSafe: InadequateEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Inadequate
- July 2019Requires improvementstayed Requires improvementSafe: Requires improvementWell-led: Requires improvement
- February 2019Requires improvementdown from GoodSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- February 2018Goodstayed GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- December 2015Goodstayed GoodSafe: GoodEffective: Good
- July 2015GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- May 2014
Report published without a new overall rating.
- February 2013
Report published without a new overall rating.
- September 2011
Report published without a new overall rating.
- January 2011
Registered with the Care Quality Commission on 20 January 2011.
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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13 live-in carers within about an hour of Norfolk
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 £990 to £1,120 a week. 9 can care for a couple. 14 years' experience on average.
Every carer has had an enhanced DBS check in the last 18 months, ID and right-to-work checks and an online interview. Their skills and training are for you to check with them. Carers set their own rates, and who is free changes week to week.