CQC report explained · a residential care home
What the CQC found at Millfields Residential Care Home
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Good
- People told inspectors they felt safe. Risks, accidents and incidents were monitored, although inspectors found problems with medicines storage and some personal emergency evacuation plans.
- Effective?
- Good
- Staff had training, supervision and support, and people's food and healthcare needs were met. Best-interest procedures were usually followed but not consistently.
- Caring?
- Good
- People and relatives described staff as caring. Inspectors observed respectful support, including attention to privacy, dignity and personal relationships.
- Responsive?
- Good
- Care was planned around people's needs, preferences and end-of-life wishes. People enjoyed activities, and complaints systems were effective, although some assessment and care records varied in quality.
- Well-led?
- Good
- A new registered manager had been appointed and inspectors found effective audits, an inclusive culture and evidence that people's suggestions were acted on.
What inspectors found, October 2018
Rated Good; inspectors found kind, safe care and clear improvements since the previous inspection, with some records and decision-making still needing attention.
This was an unannounced inspection on 21 June 2018. Inspectors observed care, spoke with people, relatives and staff, checked records and medicines, and looked around the building.
The home was rated Good in all five areas: Safe, Effective, Caring, Responsive and Well-led. People said they felt safe and were positive about the care, food, activities and staff.
The previous inspection in August 2017 found breaches involving staffing, dignity, consent, nutrition and management. Inspectors found the actions taken since then had led to improvements, including better staffing arrangements, training, care and quality checks.
Some issues remained. Best-interest decisions were not always recorded consistently, some care records lacked detail, and medicines storage and emergency evacuation plans needed improvement. The medicines storage issues were corrected during the visit.
Improvement since the last inspection
The home had acted on the previous inspection findings. Inspectors found that changes to staffing, training, care and management had been effective.
“On this inspection, we found these actions had been effective.” from the report
Kind and respectful care
People and relatives spoke positively about staff. Inspectors saw staff communicating gently and protecting people's privacy and dignity.
“On this inspection we observed staff to be caring and respectful.” from the report
Good safety monitoring
The home reviewed accidents and incidents, looked for patterns and changed staffing and training when needed. Individual risks were assessed and reviewed.
“This meant the service was learning lessons from incidents and using the information to promote safety.” from the report
Personalised support and activities
Care records included people's histories, preferences and communication needs. People were offered activities and one-to-one support based on their interests.
“Care was planned and delivered with a person-centred approach.” from the report
Open management
Inspectors found the home was managed openly, with regular audits and meetings for people, relatives and staff. Suggestions were followed up.
“It was evident from the actions taken since the last inspection that the service learned from experiences and valued input from people involved.” from the report
Best-interest decisions
needs fixingAlthough the home usually followed the right process, inspectors found an example where a person's move within the home happened before the best-interest meeting process was complete.
“However, we found the person had moved to the area requested without the best interest meeting procedure being concluded.” from the report
Care records need more detail
needs fixingSome assessments were brief, and one nutritional care plan did not clearly include professional advice or enough information about diabetes. Inspectors also found little evidence that people were involved in developing or reviewing some care plans.
“We also found the care plan lacked detail in relation to the person's diabetes.” from the report
Busy periods
minorSome people and staff said there were busy times when more staff would help. One person said they had heard call bells ringing for a long time, although the home had changed staffing arrangements.
“I've heard buzzers ringing for a long time before being answered, however other times its ok.” from the report
Medicines storage
needs fixingAn insulin pen was not stored according to the manufacturer's guidance, and some medicines were in an unlocked cupboard. Both problems were fixed during the inspection.
“Both issues were addressed during our visit.” from the report
- 01How do you make sure every best-interest decision is completed and recorded before changes are made to a person's care or living arrangements?
- 02Have all personal emergency evacuation plans been checked to make sure the equipment and instructions are suitable for an emergency?
- 03How do you check that care plans contain current information about diabetes, nutrition and advice from health professionals?
- 04How do you decide when extra staff are needed at busy times, and how do you monitor delays in answering call bells?
- 05How do you make sure medicines, including in-use insulin pens, are stored safely and according to the manufacturer's instructions?
This was an unannounced inspection covering all five key questions and both the premises and care provided; the report also compares findings with the previous inspection in August 2017. This explanation was written from the published report of 11 October 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.
What inspectors found, November 2017
Requires Improvement overall; inspectors found serious weaknesses in leadership, staffing, nutrition, dignity and consent.
The unannounced inspection took place on 22 August 2017. Inspectors observed care, spoke with people, relatives and staff, checked care records, medicines, staff files and management records, and looked around the home.
The home was not always safe or effective. Staffing levels did not always meet people's needs, risk assessments were sometimes out of date, and nutritional and hydration needs were not always met. People were not always treated with dignity, and some decisions were made without the required evidence of consent.
There were also positive findings. Medicines were managed safely, staff received training and support, and people had access to activities and healthcare. However, leadership was rated Inadequate because quality checks had not identified or fixed important problems.
The overall rating of Requires Improvement means the home was not consistently meeting the expected standards. The provider was told to send an action plan, and CQC said it would check that the action was taken.
Medicines
Inspectors found effective systems for storing, administering and recording medicines. Stock checks, controlled-drug records and medicine audits were correct.
“We found there were safe systems in place to manage medicines.” from the report
Staff training
Staff had induction, ongoing training, supervision and appraisals. Recruitment checks included criminal record checks and references.
“Safe recruitment procedures were in place to ensure only staff suitable to work in the caring profession were employed.” from the report
Activities
People had access to a range of activities, including bingo, crafts, making cards and art sessions. People told inspectors they enjoyed these activities.
“People told us they enjoyed the activities provided, although some said they would like more opportunities to go out.” from the report
Healthcare access
Care records showed that people were seen by healthcare professionals, including GPs, district nurses, dieticians and opticians.
“People's care records showed they had been seen by a range of health care professionals including GPs, district nurses, dieticians and opticians.” from the report
Complaints handling
The home had a complaints procedure. Of three complaints since the previous inspection, two had been investigated and the outcomes shared with the complainants.
“The other two complaints had been investigated and the outcome had been relayed to the complainant.” from the report
Staffing and call bells
seriousThere were not always enough staff to meet people's needs. People in communal areas could not use the call bell system because the call points had no accessible leads.
“We concluded there were not always sufficient staff deployed to meet people's needs.” from the report
Consent and least restrictive care
seriousThere was no evidence of the required capacity assessments or best-interest decisions for covert medicines and a sensor used to alert staff when someone left their bedroom.
“This was a breach of Regulation 11 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.” from the report
Weak quality checks
seriousAudits had identified problems with food and fluid records, but the same problems remained. Weight-loss checks did not assess whether actions had worked.
“Quality assurance systems had not identified or addressed the issues we found at this inspection.” from the report
Out-of-date care information
needs fixingSome care plans and risk assessments were not accurate or up to date. This included records after falls and records for people who had lost weight.
“Yet in contrast other care plans were not up to date or accurate.” from the report
- 01How many care staff are now deployed during the day and at night, and how do you account for the home's layout?
- 02Can people in communal areas now summon help easily if staff are not present?
- 03How do you identify people at risk of weight loss or dehydration, and how do you check that food and fluid plans are followed?
- 04What evidence is now recorded for mental capacity assessments and best-interest decisions, including for covert medicines and sensors?
- 05What changes have been made to quality audits so that repeated problems are identified, acted on and checked again?
This was an unannounced comprehensive inspection covering all five questions and reviewing the overall quality and rating of the home. This explanation was written from the published report of 1 November 2017 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 Millfields Residential Care Home
4 rated inspections over 2 years: the service has improved, from Inadequate to Good.
- October 2018Goodcurrent ratingup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
Read what inspectors found at Millfields Residential Care Home →
- November 2017Requires improvementstayed Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Inadequate
Read what inspectors found at Millfields Residential Care Home →
- January 2017Requires improvementup from InadequateSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- August 2016InadequateSafe: InadequateEffective: InadequateCaring: InadequateResponsive: InadequateWell-led: Inadequate
- August 2013
Report published without a new overall rating.
- September 2012
Report published without a new overall rating.
- January 2011
Registered with the Care Quality Commission on 14 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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