CQC report explained · a nursing home
What the CQC found at Mill View
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Good
- Inspectors found that risks were assessed and managed, medicines were given safely, safeguarding systems were in place and there were enough staff to provide care safely. Infection prevention arrangements were mostly reassuring, although staff understanding of visiting arrangements was inconsistent.
- Effective?
- Good
- People were supported with eating, drinking and swallowing risks. Staff had relevant training, involved health professionals when needed and supported people in line with their care plans and preferences.
- Caring?
- Good
- This key question was not inspected during this focused visit. The report says ratings from the previous comprehensive inspection were used.
- Responsive?
- Good
- This key question was not inspected during this focused visit. The report says ratings from the previous comprehensive inspection were used.
- Well-led?
- Requires improvement
- Leadership and communication were not consistent. The registered manager was not always visible or accessible, staff deployment did not always support person-centred care, and governance systems did not always identify quality risks.
What inspectors found, December 2021
Mill View was rated Good overall, but inspectors found inconsistent leadership, limited staff time and some people feeling isolated.
This was an unannounced focused inspection on 30 September 2021. Inspectors checked safe, effective and well-led care, with particular attention to risks linked to eating and drinking. They spoke with people, relatives and staff, observed care, and reviewed care, medicine, staffing and management records.
The home was rated Good for safe and effective care. Inspectors found enough staff to provide care safely, good risk assessments, safe medicines systems, suitable support with food and drink, and staff with relevant training. People and relatives generally described staff as kind and caring.
The well-led rating fell from Good to Requires Improvement. Inspectors found that the registered manager was not always visible or accessible, communication about visiting arrangements was unclear, and staff did not always have enough time to provide person-centred support. Some people felt isolated.
The overall rating remained Good because this was a focused inspection. Ratings for the other key questions were carried over from the previous comprehensive inspection.
Risk management
Inspectors found personalised assessments and care plans for risks such as falls, malnutrition, dehydration and choking. These were reviewed and updated.
“Risk assessments were comprehensive and personalised according to people's needs and preferences.” from the report
Food and drink support
Staff understood people's dietary needs and followed specialist advice. People were offered choices, snacks and drinks, with extra support where needed.
“People were supported to have enough to eat and drink.” from the report
Skilled staff
Staff had relevant training, including dementia, swallowing problems, moving people safely and choking first aid. New staff received a thorough induction.
“Records showed that staff had received training that was relevant to their roles and the needs of people.” from the report
Kind care
People and relatives generally spoke positively about the care. Inspectors saw staff supporting people calmly and respectfully.
“People and their relatives spoke positively about the care they were receiving” from the report
Working with health professionals
Staff made timely referrals and shared information with health and social care professionals to support people's changing needs.
“Staff worked proactively with other agencies and had developed positive working relationships.” from the report
Inconsistent leadership
needs fixingStaff did not always feel supported because the registered manager was not consistently visible or available. Relatives also reported a lack of communication.
“Leadership was not consistent and people, their relatives and staff were not fully engaged and supported by the registered manager.” from the report
People feeling isolated
needs fixingStaff were busy and did not always have enough time to spend with people. The layout and long corridors could add to feelings of isolation.
“Some people told us they felt isolated in the home” from the report
Unclear visiting information
minorStaff and relatives received inconsistent information about visiting arrangements. The registered manager said clearer guidance would be provided.
“There are so many changes about visiting, we are not always quite sure on what to do.” from the report
Staff deployment
needs fixingAlthough staffing levels were enough for safety, the way staff were deployed did not always support person-centred care.
“The deployment of staff did not always support person centred care.” from the report
- 01What has changed to make the registered manager more visible and accessible to people, relatives and staff?
- 02How do you now deploy staff so people have enough time for company and person-centred support?
- 03How do you prevent people who spend time in their rooms from becoming isolated?
- 04How are visiting arrangements explained to staff and relatives so that information is consistent?
- 05What action has been taken since the inspection to improve governance and identify quality risks?
This was a focused inspection of Safe, Effective and Well-led; Caring and Responsive were not inspected and their previous ratings were carried forward. This explanation was written from the published report of 9 December 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 Good; inspectors found safe, kind and personalised care, with clear improvements since the previous inspection.
This was an unannounced, planned inspection because the previous rating was Requires Improvement. Inspectors spoke with people, relatives and staff, observed care, and reviewed care, medicine, recruitment and management records.
The home was rated Good in all five areas: Safe, Effective, Caring, Responsive and Well-led. Inspectors found enough suitable staff, safe medicines practice, effective infection control, kind care and personalised support.
There had been improvements since the previous inspection, especially in support with eating and drinking and the management of choking risks. The earlier breach of Regulation 14 had been resolved, and the home was no longer in breach of regulations.
Safer eating and drinking
The home had improved its systems for people at risk of choking. Staff understood modified diets and followed guidance about food, drinks and support at mealtimes.
“There were effective systems in place to ensure that people were receiving their food and drinks in the way they needed.” from the report
Kind and respectful care
Inspectors saw warm, patient interactions. Staff gave people choices, protected their privacy and helped them remain in control and as independent as possible.
“Throughout the inspection we observed positive interactions between people and staff.” from the report
Personalised support
Care plans included people's preferences, communication needs and routines. Staff knew what approaches worked for individuals, including people living with dementia.
“People continued to receive a personalised service.” from the report
Activities and relationships
People were supported to maintain important relationships and take part in activities, outings and interests suited to their needs and backgrounds.
“Staff planned activities that were relevant to people's needs, their backgrounds and wishes.” from the report
Active quality improvement
Managers used audits, incidents, complaints and feedback to find problems and make changes. Inspectors found that improvements from the previous inspection had been sustained.
“There had been improvements in the service since the last inspection.” from the report
Earlier care-plan inconsistencies
minorA quality audit had found inconsistent information in some care plans. The manager took action, and a later audit showed improvement, but families may want to check that records remain up to date.
“An audit of documentation had identified inconsistent information in some people's care plans.” from the report
- 01How do you currently identify and manage choking risks and make sure staff follow each person's modified diet plan?
- 02How many staff are usually available at mealtimes, and how do you respond if someone needs extra support with eating or drinking?
- 03How often will my relative's care plan and risk assessments be reviewed, and how will you involve our family?
- 04What activities and outings would be suitable for my relative's interests, communication needs and cultural or religious preferences?
- 05How do you make sure medicines that must be given at a specific time are administered promptly?
This was an unannounced planned inspection covering all five CQC questions, including the premises and the care provided; the previous rating was Requires Improvement, published on 6 February 2019. This explanation was written from the published report of 19 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 View
7 rated inspections over 7 years: the service has improved, from Requires improvement to Good.
- December 2021Goodcurrent ratingstayed GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- March 2020Goodup from Requires improvementSafe: GoodEffective: GoodWell-led: Good
- February 2019Requires improvementdown from GoodSafe: Requires improvementEffective: Requires improvementWell-led: Requires improvement
- April 2017Goodup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- November 2016Requires improvementstayed Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- May 2016Requires improvementstayed Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- March 2015Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- August 2014
Report published without a new overall rating.
- September 2013
Report published without a new overall rating.
- May 2012
Registered with the Care Quality Commission on 18 May 2012.
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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