CQC report explained · a residential care home
What the CQC found at The Mill House Care Home
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Good
- People were protected from avoidable harm. Staff knew people's risks, there were enough staff, medicines were generally administered safely and infection control arrangements were effective, although some risk and medicine records needed improvement.
- Effective?
- Good
- This question was not inspected during this visit. Its previous rating was used when calculating the overall rating.
- Caring?
- Good
- This question was not inspected during this visit. Its previous rating was used when calculating the overall rating.
- Responsive?
- Good
- Care was personalised and people were supported with their routines, relationships, hobbies and interests. People and relatives could raise concerns, and inspectors found that staff responded to people's needs.
- Well-led?
- Requires improvement
- The home had improved its quality checks, but these did not always identify gaps in risk assessments, care records and medicine recording. Some information in electronic records conflicted with care plans.
What inspectors found, September 2022
The Mill House Care Home was rated Good overall; inspectors found safe, kind and responsive care, but the home's leadership and checking systems still needed improvement.
Inspectors visited on 1 and 2 September 2022. The first visit was unannounced and the second was announced. They spoke with people living at the home, relatives, staff and managers, and checked care records, medicine records, recruitment files, safety checks and infection control.
The overall rating improved from Requires Improvement to Good. Inspectors found enough staff, safe care, good infection control and prompt access to healthcare. People were supported to follow their interests, take part in activities and make everyday choices. Staff knew people well and treated them in a relaxed and personal way.
The Well-led rating remained Requires Improvement. Some risk assessments, care records and medicine records were not always complete or accurate. The home's audits and checks had not found all these problems, although the manager took action during the inspection to improve several records and medicine processes.
Staff knew people well
There were enough staff and the home used a consistent team. Inspectors saw staff responding promptly and attentively to people's physical and emotional needs.
“There were enough staff to meet the needs of the people living at the home.” from the report
Personalised activities
People were supported to take part in activities suited to their interests and personalities. These included trips, gardening, book clubs, quizzes, faith visits and animal visits.
“Activities, engagement and personalising care through stimulation and support was a strength at the service.” from the report
People felt safe
People said they were happy with their care and felt safe. Staff understood how to report concerns and how to involve outside agencies if needed.
“People we spoke with told us they were happy with their care and support and that they felt safe when staff supported them.” from the report
Good healthcare links
People could see GPs, community nurses and advanced nurse practitioners. Inspectors saw evidence that referrals were made promptly.
“Positive links with a local GP practice ensured people were reviewed and seen promptly.” from the report
Risk assessments were not always complete
needs fixingTwo risk assessments needed updating. In some cases, risks linked to falls or activities had not been recorded, although staff knew how to support people safely.
“We found two risk assessments that required updating to ensure those risks continued to be managed safely.” from the report
Medicine records needed more detail
needs fixingInspectors found two examples where the use of pain patches and topical creams was not recorded clearly enough. The manager acted during the visit to improve the process.
“Medicines audits were completed but we found pain patch medicines were not administered in line with manufacturers guidelines.” from the report
Checks did not find every problem
needs fixingThe home's audits and quality checks had not identified some of the gaps in medicines, care planning and risk assessments. This is why Well-led remained Requires Improvement.
“However, further improvements to some quality assurance systems were needed because some of the issues we found related to medicines, care planning and risk assessments at this visit had not always been identified from completed checks.” from the report
Some information conflicted
needs fixingInformation on electronic handheld records did not always match care plans, including information about thickened fluids. The manager corrected the records during the inspection.
“For example, some people that required thickened fluids, electronic information did not always match the care plan.” from the report
- 01How do you now check that every person's risk assessment is complete and updated after a fall or a change in their needs?
- 02How are pain patches and topical creams recorded, including where and when they are applied?
- 03How do managers make sure audits identify problems in medicines, care plans and risk assessments?
- 04How do you ensure electronic records always match the person's care plan, especially where thickened fluids are needed?
- 05How does the booking system work for relatives who need to visit at short notice?
This was a focused inspection of Safe, Responsive and Well-led; Effective and Caring were not inspected and their previous ratings were carried forward when calculating the overall rating. This explanation was written from the published report of 27 September 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, January 2020
Rated Requires Improvement; inspectors found kind and effective care, but safety, personalised support and management checks needed improvement.
Inspectors visited without notice on 16, 24 and 30 October 2019. They spoke with people, relatives, staff and professionals, observed care, and checked care, medicines, recruitment and management records.
People and most relatives were positive about the care. Staff were described as kind and respectful. The home was clean, staffing levels were sufficient, training was provided, and people could access healthcare, activities and outdoor areas.
There were important shortfalls. Trailing wires created a possible trip hazard for people at risk of falling. Fire alarm checks did not always follow the home's own procedures. Some medicines were not stored or recorded properly, and some people in their bedrooms did not receive meals in a suitable way.
The overall rating was Requires Improvement. Effective and Caring were rated Good. Safe, Responsive and Well-led were rated Requires Improvement. This was a fall from Outstanding at the previous inspection, published in April 2017.
Kind and respectful staff
People and relatives were mostly positive about the care. Inspectors saw staff speaking kindly, showing interest in people's welfare and respecting privacy and dignity.
“Staff were seen to be kind and caring as well as polite and courteous to people.” from the report
Enough staff
Inspectors found enough staff on duty to meet people's needs. Recruitment checks were also described as robust.
“Sufficient staff were on duty to meet the needs of people living at the home.” from the report
Good activities and communication
People could take part in activities such as trips, arts and crafts, music and manicures. Information was available in large print and braille.
“These events included a trip to a garden centre, arts and crafts, listening to music and manicures.” from the report
Healthcare support
The home worked with doctors, nurses and specialists. Relatives said healthcare professionals were involved when needed.
“The registered manager and staff worked alongside healthcare professionals to ensure people's needs were met.” from the report
Clean environment
The home was clean and tidy, with staff using protective equipment to reduce infection risks.
“The environment was seen to be clean and tidy.” from the report
Trip hazards in bedrooms
seriousWires from sensor mats trailed across bedroom floors. This was a particular concern for people already assessed as being at risk of falling.
“Leads from the pressure mat to the call bell panel were seen in people's bedrooms to trail across the floor, therefore creating a potential trip hazard.” from the report
Fire alarm checks
seriousFire alarm testing did not always happen as often as the home's own procedures required. The testing system did not ensure all break glass points were checked in sequence.
“Although checks were undertaken of the fire alarm system these were not always carried out in line with the provider's own guidelines” from the report
Medicine storage and records
seriousSome medicines needed better storage. Inspectors also found missing opening dates and incomplete records of varied doses.
“Some medicines required additional storage arrangements to be in place.” from the report
Meals in bedrooms
needs fixingSome people did not receive meals in a suitable way. One meal was cold and another person ate with the meal resting on their chest.
“We saw one person eating their lunch with the meal resting on their chest.” from the report
Food and drink records
needs fixingRecords did not always show what people had eaten or drunk, or the amount of fluid they were expected to drink.
“Food and fluid records were not always maintained to evidence what people had eaten and drunk.” from the report
Management checks missed problems
needs fixingQuality checks were in place but had not found all the issues identified by inspectors, including fire alarm testing, medicines storage and bedroom risks.
“However, areas needing improvement were identified as part of the inspection such as in relation to the storage of certain medicines and shortfalls with the fire alarm testing.” from the report
- 01How have you removed or safely secured the trailing wires from bedroom sensor mats?
- 02How are you now making sure every fire alarm break glass point is tested at the required frequency?
- 03What changes have been made to medicine storage and to recording opening dates and varied doses?
- 04How do you make sure people eating in their bedrooms receive a suitable table, a covered meal and food at the right temperature?
- 05How do your audits now check that food and fluid records are complete and that people's individual targets are clear?
This was an unannounced planned inspection covering all five key questions; Safe, Responsive and Well-led had fallen from their previous ratings, while Effective and Caring remained Good. This explanation was written from the published report of 17 January 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 The Mill House Care Home
4 rated inspections over 8 years: the service has held its Good rating throughout.
- September 2022Goodcurrent ratingup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- January 2020Requires improvementdown from OutstandingSafe: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- April 2017Outstandingup from GoodSafe: GoodEffective: GoodCaring: GoodResponsive: OutstandingWell-led: Outstanding
- January 2015GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- January 2014
Report published without a new overall rating.
- January 2013
Report published without a new overall rating.
- December 2011
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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