CQC report explained · a residential care home
What the CQC found at Millstream House
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Good
- Inspectors found people were protected from abuse and avoidable harm. Medicines records had improved, staff recruitment checks were completed, and there were enough staff to support people.
- Effective?
- Good
- People received support with food, health care and hospital appointments. Staff had relevant training and worked with health and social care professionals.
- Caring?
- Good
- Inspectors found positive and respectful relationships between staff and people. People were involved in decisions, supported to stay independent and helped to keep in touch with family and friends.
- Responsive?
- Good
- Care plans reflected people's current needs and daily records supported communication between staff. People were offered individual and group activities, and complaints had been resolved satisfactorily.
- Well-led?
- Good
- The home had systems for checking quality, medicines, care plans, training and safety. Inspectors found that earlier problems with record keeping and stakeholder meetings had been addressed.
What inspectors found, March 2019
Millstream House was rated Good; inspectors found safe, kind and personalised care, with clear improvement since the last inspection.
This was an unannounced comprehensive inspection on 19 and 20 February 2019. One inspector and an expert by experience spoke with six people, a visiting relative and staff. They reviewed care and medicines records, staff files, surveys, meetings and management records.
The inspectors rated the home Good in all five areas: Safe, Effective, Caring, Responsive and Well-led. They found people were safe, medicines records had improved, care plans were up to date, and people were supported with health care, activities, choices and relationships.
The home had previously been rated Requires Improvement after a breach about record keeping and recommendations about medicines records and meetings. At this inspection, the inspectors found the required improvements had been made and the breach had been met.
Improved medicines records
Inspectors found that medicines administration records were completed each time medicines were given, with no gaps or omissions. Staff were trained and medicines were stored safely.
“Medicines administration records (MARs) were completed by staff each time medicines were given.” from the report
Respectful care
People described staff as kind and caring. Inspectors saw positive, inclusive interactions and found that privacy, dignity and independence were respected.
“The interactions between people and staff were positive, caring and inclusive.” from the report
Personalised support
People had current support plans and were involved in decisions about their care. Staff supported individual interests, relationships and activities in the community.
“People had support plans in place, which reflected their current needs.” from the report
People's involvement
People were consulted about the service through meetings and questionnaires. Staff and relatives were also given ways to share their views.
“People were involved in the running of the service and were consulted on key issues that may affect them.” from the report
Quality monitoring
The management team used audits and action plans to identify and complete improvements. The report says the earlier record keeping problem had been corrected.
“We found the audits routinely identified areas they could improve upon and the manager produced action plans, which clearly detailed what needed to be done and when action had been taken.” from the report
Inspectors raised no specific concerns in this report.
- 01How will you assess and support my relative's particular needs relating to Huntington's Disease or acquired brain injury?
- 02How are medicines checked today, and how do you make sure records remain complete?
- 03What activities and community opportunities would be available for my relative, based on their interests and abilities?
- 04How often will my relative's support plan and health needs be reviewed, and how will relatives be involved?
- 05How can residents and relatives raise concerns, and how are the monthly meetings used to make changes?
This was an unannounced comprehensive inspection covering all five CQC questions and both the care provided and the premises. This explanation was written from the published report of 22 March 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.
What inspectors found, March 2018
Requires Improvement; inspectors found kind and responsive care, but medicines records and wider record keeping were not reliable enough.
This was an unannounced, comprehensive inspection on 06 February 2018. Inspectors observed care, spoke with people, relatives and staff, and checked care records, medicines records, staff files, audits, rotas and policies.
People were supported by enough staff and were treated with kindness, dignity and respect. Care plans were personalised and regularly reviewed. People were supported with food, healthcare, activities, communication and personal choices.
The main problems were medicines recording and record keeping. Some handwritten medicine instructions were not checked and signed by a second member of staff. Important care, health, fire drill and staff-reading records were also not consistently up to date.
The overall rating was Requires Improvement. Effective, Caring and Responsive were rated Good. Safe and Well-led were rated Requires Improvement. The home breached Regulation 17 because it did not keep accurate, complete and up-to-date records.
Kind and respectful staff
Inspectors saw staff treat people with kindness, respect and humour. People's privacy and dignity were maintained during personal care.
“We saw staff always treated people with kindness, respect and a sense of humour.” from the report
Enough staff
Rotas and observations showed enough staff were available to meet people's needs. The home appeared calm and staff were not rushed.
“There continued to be enough staff to support people.” from the report
Personalised care
Care plans described people's daily needs, preferences, communication, health and social support. Staff followed the guidance seen by inspectors.
“Each person had an up to date, personalised support plan, which set out how their care and support needs should be met by staff.” from the report
Support with health and food
People received help to eat and drink enough and staff followed specialist dietary advice. Healthcare appointments and professional input were recorded.
“This meant that staff had been following specialist guidelines in order to meet people's needs.” from the report
Activities and relationships
People were encouraged to pursue interests, take part in activities and maintain important relationships. Visitors were made welcome.
“Staff encouraged people to actively participate in activities, pursue their interests and to maintain relationships with people that mattered to them.” from the report
Medicine records were not always checked
seriousSome handwritten medicine directions were not checked and signed by a second member of staff. This meant the records could not be verified against the GP's prescription.
“This meant that the entry on the MAR sheet could not be verified as being prescribed by the GP.” from the report
Care records were not kept reliably
seriousSome records were out of date or incomplete. For example, one dietary and hydration review was from 2016, and only five of 38 named staff had signed to show they had read care plans.
“However, records continued not to be maintained accurately completed and contemporaneous in respect of each person.” from the report
Meetings were inconsistent
needs fixingResident, family and staff meetings had not taken place regularly. Inspectors said this meant the provider was not listening to people, staff and relatives as often as it should.
“This meant that the provider had not been listening to people, staff and relatives as often as they should.” from the report
Weekend cleaning was raised
minorOne person said cleaning was not always good at weekends. Managers said they had identified this through audits and were reviewing it.
“The cleaner only works 5 days a week, and at weekends it's not too good” from the report
- 01How are handwritten medicine instructions now checked and signed by two staff before medicines are given?
- 02What has been done to make sure every care, health and medicines record is accurate and up to date?
- 03How will you make sure residents', relatives' and staff meetings happen regularly?
- 04What actions were included in the report sent to CQC after this inspection, and what evidence shows they are complete?
- 05How are weekend cleaning standards checked and any problems followed up?
This was an unannounced comprehensive inspection covering all five CQC questions and both the premises and care provided. This explanation was written from the published report of 14 March 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.
Every inspection of Millstream House
5 rated inspections over 4 years: the service has improved, from Requires improvement to Good.
- March 2019Goodcurrent ratingup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- March 2018Requires improvementdown from GoodSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- April 2017Goodstayed GoodWell-led: Good
- January 2016Goodup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- June 2015Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- May 2014
Registered with the Care Quality Commission on 9 May 2014.
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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