CQC report explained · a nursing home
What the CQC found at The Mill House
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
What inspectors found, September 2019
Rated Good overall, but inspectors found that safety, including medicines, staffing and infection control, still requires improvement.
Inspectors carried out an unannounced inspection over two days. They spoke with people living in the home, relatives, staff and a visiting health professional. They reviewed care plans, medicines records, staff files and management records.
The overall rating was Good. Effective, caring, responsive and well-led care were also rated Good. The safe rating remained Requires Improvement because medicines records and storage were not always safe, some infection control practice was poor, and there were concerns about staffing at busy times.
The home had improved since its previous inspection in February 2019. It was no longer in breach of regulations. Inspectors found kind staff, personalised care, good training, support with food and drinks, activities and a more positive approach from the manager.
Kind and respectful care
People and relatives praised the staff. Inspectors saw warmth, kindness, dignity and respect in the way people were supported.
“People were supported by very caring and kind staff, who treated people as individuals and showed a genuine interest in them.” from the report
Personalised support
Care plans reflected people's individual needs and preferences. People were involved in decisions and supported to take part in activities they enjoyed.
“People's care planning was personalised and effective. There were examples of positive outcomes” from the report
Improved staff training
Staff had received a much fuller training programme and regular supervision. Inspectors found that staff had the knowledge and skills to meet people's needs.
“Staff had undergone a comprehensive programme of training since our last inspection.” from the report
Learning from incidents
Accidents and incidents were recorded, investigated and reviewed for patterns. The home used lessons learned to help reduce similar risks.
“Accidents and incidents were reported, recorded and investigated to find out why things had gone wrong and ensure appropriate action was taken to keep people safe.” from the report
Medicine records and storage
seriousMedicines were generally given safely, but records did not always contain clear or consistent information. Refrigerated medicines had been stored below the accepted temperature range, which could have made them unsafe.
“Medicines were administered safely by competent staff but records and storage of medicines did not always support safe administration.” from the report
Staffing at busy times
needs fixingInspectors saw staff working under pressure at lunchtime. Some people waited for drinks or may have been left without support for activities, and call bells were not always available in communal areas.
“Care staff told us they would benefit from additional resources as they felt they could not always address people's needs quickly, particularly at lunchtime.” from the report
Infection control
needs fixingMost staff followed good infection control practice, but inspectors saw one staff member serving ice cream without gloves and raised personal hygiene concerns about another staff member. Malodours were also noted in some areas.
“Most staff used good infection control and food hygiene practice. However, one member of staff was not wearing gloves when handling and serving ice-creams.” from the report
Electronic care records
minorSome care records were inconsistent or lacked detail. Monitoring of the new electronic system was not robust enough, and staff needed more training to use all its functions.
“More robust and documented monitoring of the electronic care records would drive further improvement.” from the report
- 01How are refrigerated medicines checked now, and what happens if they are stored outside the accepted temperature range?
- 02How do you make sure medicine records clearly show which creams to use, where to apply them, and any allergies or sensitivities?
- 03What staffing arrangements are in place at lunchtime and in communal areas, and how can people call for help there?
- 04What checks now make sure staff follow infection control and personal hygiene procedures?
- 05How are electronic care records audited, updated promptly and used consistently by all staff?
This was an unannounced inspection covering all five CQC questions and followed the previous Requires Improvement rating; the report says the home was no longer in breach of regulations at this inspection. This explanation was written from the published report of 4 September 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, February 2019
Rated Requires Improvement overall, with Inadequate leadership; inspectors found risks to safety, staffing and personalised care.
This was an unannounced comprehensive inspection on 11 and 18 December 2018. Inspectors observed care, spoke with people, relatives and staff, and reviewed care records, staff files and management records.
The report found serious shortfalls. Risks such as choking were not always properly recorded or managed. Staffing levels were not enough to meet people's needs promptly. Care was often task-focused, activities were limited, and people's privacy, dignity and choices were not always respected.
The overall rating was Requires Improvement. Safe, Effective, Caring and Responsive were all rated Requires Improvement. Well-led was rated Inadequate. This was a deterioration from the previous inspection in June 2016, when all five areas were rated Good.
Medicines
Inspectors found that medicines were stored, managed and administered safely. The home had a process for identifying and learning from medicines errors.
“There was an appropriate system in place to identify any shortfalls in medicines administration” from the report
Clean and safe premises
The environment and furniture appeared clean. Checks were carried out on areas such as fire safety, water systems and electrical equipment.
“The environment and furniture within it appeared hygienically clean and free from unpleasant odours.” from the report
Food and drink
People generally received enough suitable food and drink. Inspectors saw choices at mealtimes and support for people at risk of malnutrition.
“We observed that the meal time experience was pleasant and positive.” from the report
Visible new manager
The new manager was visible in the home. Staff said they felt better supported and able to raise concerns.
“The new manager was visible in the service and staff told us they felt better supported in their role.” from the report
Complaints
People and relatives were told how to complain. The complaints reviewed by inspectors had been investigated and answered appropriately.
“complaints had been investigated and responded to appropriately.” from the report
Risks were not managed
seriousCare plans did not reliably reflect changing needs. Inspectors found incorrect information about choking risks and observed unsafe support with food and movement.
“This could have caused confusion for staff about which one should be used.” from the report
Not enough staff
seriousPeople were sometimes left alone for long periods, with no staff nearby and no way to call for help. Staff said they did not have time to meet social and emotional needs.
“There were not sufficient numbers of staff deployed to meet people's complete needs.” from the report
Choices and consent
seriousStaff did not always support people to make choices or act in the least restrictive way. Inspectors found that some people were told how they would spend their time.
“Our observations demonstrated that staff did not always support people to make choices.” from the report
Privacy and dignity
seriousStaff discussed intimate personal care in communal areas and sometimes spoke about people in a patronising way. Care records also did not clearly show what people could do independently.
“People's dignity and respect was not always maintained by staff who spoke about people's intimate care needs in communal areas.” from the report
Limited activities
needs fixingPeople told inspectors they were bored. Activities were not personalised and did not consistently include people who stayed in their rooms, had poor sight or had limited mobility.
“The service was not providing people with opportunities to be engaged in meaningful activities.” from the report
Weak improvement checks
seriousThe provider knew about many problems before the inspection but did not act promptly or robustly enough. It was not clear how feedback from people and relatives led to improvements.
“action had not been taken promptly or robustly enough to protect people from harm.” from the report
- 01What has been changed to assess and manage choking risks, and how are staff shown the correct instructions for each person?
- 02How many staff are now available on each shift, and how do you make sure people are not left without a way to call for help?
- 03Have all staff received training on the Mental Capacity Act, safeguarding, moving and handling, and the specific health needs of people living here?
- 04How are care plans now updated and personalised, including people's preferences, life histories, communication and end of life wishes?
- 05What activities are now available for people who stay in their bedrooms, have poor sight or have limited mobility?
This was an unannounced comprehensive inspection covering all five key questions, and the report says all ratings had deteriorated from Good at the inspection on 20 June 2016. This explanation was written from the published report of 15 February 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.
Every inspection of The Mill House
3 rated inspections over 3 years: the service has held its Good rating throughout.
- September 2019Goodcurrent ratingup from Requires improvementSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- February 2019Requires improvementdown from GoodSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Inadequate
- August 2016GoodSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- May 2014
Report published without a new overall rating.
- January 2014
Report published without a new overall rating.
- October 2012
Registered with the Care Quality Commission on 8 October 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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