CQC report explained · a nursing home
What the CQC found at Mill River Lodge
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Good
- Inspectors found that risks were assessed, medicines were managed safely and infection control had improved significantly. Staff understood safeguarding procedures and incidents were investigated.
- Effective?
- Good
- People received care suited to their needs and had access to health professionals. Improvements had been made to oral care, nutrition, staff training and support with consent.
- Caring?
- Good
- Caring was not covered by this focused inspection. The rating from the previous comprehensive inspection was carried forward.
- Responsive?
- Good
- Care plans were personalised and staff were given accessible information about people's needs, preferences and histories. People and relatives said they were involved in care planning and complaints were dealt with.
- Well-led?
- Good
- Management and quality monitoring systems had improved. Managers used audits, feedback and outside advice to identify concerns and make changes.
What inspectors found, October 2021
Rated Good; inspectors found safe, kind and personalised care after major improvements, although staffing and mealtime support still need attention.
This was a focused inspection on 7 and 8 September 2021. Inspectors spoke with 14 people, seven relatives and 20 staff. They reviewed care records, medicines records, recruitment files and management records. They also checked infection control arrangements.
The home was rated Good overall. Safe, Effective, Responsive and Well-led were all rated Good. Inspectors found improvements in infection control, care planning, medicines, staffing oversight and quality monitoring. People and relatives generally said they felt safe and well cared for.
The home had previously been rated Requires Improvement. Earlier inspections found breaches relating to safe care and treatment and good governance. At this inspection, the provider had made enough improvement and was no longer in breach of those regulations. Caring was not assessed during this focused inspection, so its previous rating was carried forward.
Improved infection control
Inspectors found that infection prevention practices had improved and were in line with current guidance. Staff were observed using protective equipment correctly.
“IPC practice had significantly improved and was in line with current government guidance.” from the report
Safe medicines support
Medicines were given by trained and assessed staff. Records, storage and reviews were checked and found to be safe.
“Medicines were managed consistently and safely.” from the report
Personalised care
Care plans included people's preferences, histories and ways they wanted to be supported. Staff used daily meetings and short care summaries to stay informed.
“People received personalised care that was responsive to their needs.” from the report
Good communication and activities
Information was adapted for people with different communication needs. People were supported to take part in activities and maintain contact with relatives.
“Information had been adapted to meet people's communication needs.” from the report
Stronger management oversight
The home had revised its audits and monitoring systems. Inspectors found that these were being used to identify concerns and make improvements.
“Quality assurance and monitoring systems had been revised and embedded.” from the report
Mealtime staffing
needs fixingInspectors saw one staff member supporting seven people in a dining area while another person took 50 minutes to eat and needed prompts. The mealtime process was changed the following day, but the home should explain how this is now monitored.
“It took the person 50 minutes to eat their meal.” from the report
Staff vacancies
needs fixingThe home had vacancies and sometimes used agency staff when there were shortages. People and relatives mostly felt staffing had improved, but feedback was mixed and one relative wanted more staff on each floor.
“Although the service had vacancies, there was an ongoing recruitment program which aimed to ensure the vacancies were filled.” from the report
- 01How many staff are planned for each shift, and what happens when there are vacancies, sickness or agency staff?
- 02What changes were made to mealtime staffing after the inspection, and how do you check that people receive enough one-to-one support?
- 03What is the current rating for the Caring question, which was not assessed in this focused inspection?
- 04How are medicines given to people who need them only when required, and how are these decisions recorded?
- 05How will you make sure the improvements in infection control and quality monitoring continue?
This was a focused inspection of Safe, Effective, Responsive and Well-led; Caring was not assessed and its previous rating was carried forward. This explanation was written from the published report of 26 October 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, April 2021
Mill River Lodge was inspected but not rated; inspectors found serious infection-control and management failings, despite improvements in some areas.
This was an unannounced, targeted inspection on 10 November 2020. Inspectors checked whether earlier required improvements had been made, looked at concerns raised since the last inspection and reviewed infection-control arrangements during the COVID-19 pandemic.
The home had improved its management of nutrition, hydration, falls, moving and positioning, medicines and some healthcare needs. People said staff were kind and made them feel safe. However, inspectors found unsafe infection-control practices, including poor hand hygiene, incorrect use of protective equipment and equipment not always being cleaned between uses.
Two people did not always receive care that met their needs or preferences. This included missed oral hygiene support, personal hygiene support that did not follow preferences and failure to follow health professional guidance. The home's checks had not found these problems.
The inspection did not give new ratings. All four listed questions were recorded as inspected but not rated, and the previous overall rating of Requires Improvement remained in place. The report says the home breached Regulation 12 and Regulation 17, and CQC imposed conditions on its registration.
Staff support
Staff competence had been checked for important tasks such as giving medicines and helping people move. Staff were described as kind, attentive and reassuring.
“Staff took time to reassure people when assisting them to move and change position.” from the report
Communication
Staff adapted some information and used practical methods to help people understand choices. This included interpreting information and showing people food choices.
“People responded well to this approach and understood what was available so they could make an informed choice.” from the report
Some management improvements
The report found improvements in oversight of people's care, nutrition, hydration, falls, moving and positioning, and responses to some health concerns.
“Progress had been made since the last inspection to help improve aspects of people's care and provide improved oversight” from the report
Infection-control risks
seriousStaff did not always wash or sanitise their hands, use protective equipment correctly, keep people apart or clean shared equipment between uses. Inspectors said this increased the risk of infection spreading.
“Care and treatment was not provided in a safe way for all service users.” from the report
Personal and oral care
needs fixingTwo people did not always receive care in line with their assessed needs, preferences or professional guidance. One person received oral hygiene support only once in nine days during part of the inspection period.
“The person had not been supported according to their assessed needs.” from the report
Weak checks and records
seriousThe home's audits did not identify the problems inspectors found. Some records were inconsistent or inaccurate, including records about modified diets, snacks and people's weights.
“Quality assurance processes to help assess, monitor and improve the quality and safety of the service were not always effective.” from the report
- 01What changes have you made to ensure staff use gloves and aprons correctly and wash or sanitise their hands between supporting different people?
- 02How do you now clean hoists, wheelchairs and other shared equipment between uses?
- 03How do you check that oral hygiene, personal hygiene and advice from health professionals are provided and recorded for each person?
- 04How do you make sure people's preferences about the gender of staff and contact with relatives are respected?
- 05What evidence can you show that the registration conditions and your improvement action plan have been met?
This was a targeted inspection of specific concerns, including infection prevention and control, governance and care raised since the previous inspection; it did not assess all parts of the key questions, so the previous Requires Improvement ratings carried over. This explanation was written from the published report of 9 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.
Every inspection of Mill River Lodge
8 rated inspections over 6 years: the service has improved, from Requires improvement to Good.
- October 2021Goodcurrent ratingSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- April 2021Inspected but not ratedSafe: Inspected but not ratedEffective: Inspected but not ratedResponsive: Inspected but not ratedWell-led: Inspected but not rated
- April 2020Requires improvementstayed Requires improvementSafe: Requires improvementEffective: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- September 2019Requires improvementstayed Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- January 2019Requires improvementstayed Requires improvementResponsive: GoodWell-led: Requires improvement
- August 2018Requires improvementstayed Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- May 2017Requires improvementstayed Requires improvementSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- December 2015Requires improvementstayed Requires improvementSafe: Requires improvementEffective: Requires improvement
- June 2015Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- November 2013
Report published without a new overall rating.
- July 2013
Report published without a new overall rating.
- February 2013
Report published without a new overall rating.
- August 2012
Report published without a new overall rating.
- April 2011
Report published without a new overall rating.
- December 2010
Registered with the Care Quality Commission on 17 December 2010.
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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Most charge £1,020 to £1,170 a week. 23 can care for a couple. 11 years' experience on average.
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