CQC report explained · a residential care home
What the CQC found at Mill Lodge
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Good
- People's risks had been identified, assessed and managed, and there were enough staff to meet their needs. However, recruitment checks were not always fully completed when staff started, and some 'when-required' medicine guidance lacked enough personal detail.
- Effective?
- Good
- People received suitable food and drink, staff had relevant training, and people had access to health professionals. The report noted that mental capacity assessments linked to some applications for restrictions had not yet been completed.
- Caring?
- Good
- No separate Caring rating was given in the report. Inspectors described respectful, dignified and person-centred care, with people involved in decisions about their support.
- Responsive?
- Good
- Care plans reflected people's needs, communication methods, interests and choices. People were supported to maintain relationships, take part in activities and develop independence, but their end of life wishes had not been recorded.
- Well-led?
- Requires improvement
- The home had a positive culture and staff felt supported, but the provider's oversight was not strong enough. Its own monitoring checks had not been completed, some safety certificates were not readily available, and some recommendations remained outstanding.
What inspectors found, May 2022
Rated Good overall; inspectors found kind, person-centred care, but the home required improvement in its leadership and oversight.
Inspectors visited unannounced on 4 and 10 May 2022. They spoke with people using the service in different ways, reviewed care, medicine, staff and management records, and gathered views from relatives, staff and a healthcare professional.
People were supported safely and respectfully. Inspectors found enough staff, safe medicines practice, good health support, suitable food and drink, and care plans that reflected people's choices and needs. People were supported to be independent, take part in activities and use the local community.
The main weaknesses were in how the home was monitored and managed. Recruitment checks were not always completed fully at the start of employment. End of life wishes had not been recorded, the provider's own checks were not being completed, some safety certificates were held away from the home, and some recommendations had not been dealt with promptly.
The overall rating was Good. Safe, Effective and Responsive were Good. Well-led was Requires Improvement. The home had improved from Requires Improvement at the previous inspection in April 2019 and was no longer in breach of regulations.
Personalised support
People were involved in their care plans and were supported to make choices, build life skills and become more independent.
“Care plans showed people were fully involved in the support they received, and staffing arrangements meant people could be flexible in how they wished to spend their day.” from the report
Kind and respectful care
Inspectors observed discreet, dignified care. Relatives and staff said people were treated respectfully and supported well.
“Care plans showed discreet, respectful and dignified care was considered and our observations and discussions with people confirmed this was in place.” from the report
Good community life
People were supported to take part in activities, use local services, maintain relationships and pursue volunteering opportunities.
“People were encouraged to participate in activities, community events and to seek volunteering opportunities if they so wished.” from the report
Safe care
People's risks were assessed and managed. Medicines were administered safely, and people had access to healthcare and nutritious food.
“The risks to people had been identified, assessed and mitigated and the environment met people's needs.” from the report
Improvement since 2019
Safe, Effective and Responsive improved from Requires Improvement to Good. The previous regulatory breaches had been resolved by this inspection.
“At this inspection we found improvements had been made and the provider was no longer in breach of regulations.” from the report
Weak provider oversight
needs fixingThe provider had not completed its own monitoring assessments, so its formal oversight was still insufficient. The provider said it would introduce these checks.
“Whilst we found no major concerns at this inspection, the provider had not completed any of their own monitoring assessments and their formal oversight continued to be insufficient.” from the report
Recruitment checks
seriousFor two staff members, the provider had not fully confirmed their suitability before they started. Later assurances were received, but the process was not consistently robust.
“For two staff members, the provider had not fully assured themselves, at commencement of role, that they were entirely suitable for the roles.” from the report
End of life planning
needs fixingPeople's wishes for a sudden death or illness had not been recorded. The home said it had not felt the timing was suitable to discuss this with two recently bereaved people.
“However, should there be a sudden death or illness, the service did not have any information recorded to ensure people's wishes were met.” from the report
Safety records and outstanding actions
needs fixingSome maintenance certificates were held at head office rather than being easily available at the home. Some recommendations from other stakeholders and earlier findings had also not been dealt with.
“This meant the registered manager was not fully aware of what safety checks had been completed.” from the report
- 01What provider monitoring checks have been introduced since the inspection, and how are any problems followed up?
- 02How do you make sure all recruitment checks are completed before new staff begin work?
- 03How will you discuss and record each person's wishes about end of life care in a way that suits their communication needs?
- 04Are all current maintenance certificates and safety records now available at the home?
- 05What has been done about the outstanding recommendations and actions identified by inspectors and other stakeholders?
This was an unannounced inspection that assessed the overall service and all five key questions, including infection prevention and control under Safe. This explanation was written from the published report of 19 May 2022 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, June 2019
Rated Requires Improvement; inspectors found kind and caring support, but concerns about safety, care records and management.
One inspector visited on 24 April 2019. They spoke with all three people living at the home, staff, managers, a social worker and a relative. They observed care and checked care records, medicines records, staff files and quality checks.
People said staff were kind, listened to them and supported them well. Staff understood safeguarding, there were enough staff, recruitment checks were completed, and people were supported with food, activities, healthcare and independence.
However, some care plans and risk assessments were out of date or did not give staff enough guidance. Fire safety recommendations had not been completed, hot pipes were exposed, and medicines taken out for social leave were not handled in the safest way. DoLS arrangements also needed prompt review.
The overall rating changed from Good at the previous inspection in 2016 to Requires Improvement. The home was not judged consistently safe, effective, responsive or well-led, although caring was rated Good.
Kind and respectful care
People said staff were kind, listened to them and supported them with dignity. Inspectors observed warm and comfortable relationships between people and staff.
“People were comfortable and happy in the company of staff and staff treated people with compassion and kindness.” from the report
Choice and independence
People were involved in daily choices, household tasks, their rooms and activities. The home supported people to build confidence and pursue work placements.
“People were encouraged to learn new skills and be as independent as they could.” from the report
Staffing and safeguarding
People and a relative said staff were available. Staff had safeguarding training and understood how to report concerns.
“The provider had safeguarding systems in place and all staff interviewed had a good understanding of what to do to make sure people were protected from harm or abuse.” from the report
Training and support
Staff received relevant training, induction, supervision and appraisal. Additional training was completed or planned where needed.
“There was an induction process for new staff, which included training, spot checks, and shadowing of experienced staff.” from the report
Environmental safety
seriousFire risk assessment recommendations had not been completed, and the main boiler cupboard was unsecured with exposed hot pipes. These created potential safety risks.
“We found the main boiler was housed in an unsecured cupboard with exposed hot pipes, which posed a potential risk of a person burning themselves if they came into contact with them.” from the report
Care plans and risk guidance
seriousCare plans and risk assessments were not always accurate or detailed enough, especially when people became distressed or their presentation changed. This could leave staff without clear instructions.
“Where people might be deemed as at risk at certain times due to changes in their presentation, there was not sufficient guidance for staff on what action they should take in these circumstances.” from the report
Medicines during social leave
seriousMedicines were sometimes removed from their original containers before people went out. Inspectors said this removed important checks, although the provider was changing the process.
“This is not considered good practice as this process removes the safety net of checking the medicine, strength and dose with the medicine administration record (MAR) and label on the medicine.” from the report
DoLS monitoring
needs fixingAn urgent DoLS authorisation had expired and there was no log to track applications and reviews. A new application was made after inspectors raised the issue.
“The service did not have a log in place of DoLS applications made so they could monitor when applications were made and ensure they were reviewed when needed.” from the report
Quality checks
seriousThe home's audits had not found the problems identified by inspectors. The provider was not carrying out its own quality assurance audits across all areas.
“There were auditing systems in place, but these had not identified the issues we found during this inspection.” from the report
End of life planning
needs fixingNo one needed end of life care during the visit, but there was no documentation template for people's wishes and staff had not received end of life training.
“However, there was no documentation available to use if this were needed, such as a template to record what people's wishes were in their final hours.” from the report
- 01Have all fire risk assessment recommendations been completed, and has the boiler cupboard been made safe?
- 02How are care plans and risk assessments now checked for accuracy when someone's needs or behaviour changes?
- 03How are medicines prepared and recorded when people go out for the day or take social leave?
- 04How are DoLS applications, expiry dates and reviews recorded and followed up?
- 05What quality audits are now completed, and how does management check that they identify safety and care record problems?
This was a planned inspection covering the premises, care and all five CQC questions, with the overall rating reassessed after the previous Good rating in 2016. This explanation was written from the published report of 11 June 2019 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 Lodge
3 rated inspections over 6 years: the service has held its Good rating throughout.
- May 2022Goodcurrent ratingup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- June 2019Requires improvementdown from GoodSafe: Requires improvementEffective: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- October 2016GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- March 2015
Registered with the Care Quality Commission on 23 March 2015.
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.