Millfields Residential Care Home

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions to at least good. The action plan was submitted as requested and gave detail about the actions they had already taken and were addressing in relation to making sure people were safe, people received adequate nutrition, people’s rights were upheld as required by the Mental Capacity Act, people’s needs in relation to privacy and dignity were met and making sure the service was well led.

Millfields Residential Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Millfields Residential Care Home provides accommodation and personal care for up to 38 older people, some of whom are living with dementia. Accommodation is provided over two floors with communal areas, including two lounges and a dining room, on the ground floor. There were 30 people using the service when we visited. This included one person who was in hospital.

Since the last inspection a new registered manager had been appointed. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.’

People living at the service told us they felt safe. Staff had received safeguarding training and knew what to do if they thought somebody was at risk.

Medicines were generally managed safely. Action was taken during the inspection to improve systems for safe and appropriate storage.

Risk assessments had been completed to mitigate risks to people's safety.

There was a robust system for monitoring and detailing accidents and incidents with lessons learned and action plans formulated where required.

The premises were clean, well maintained and appropriate safety checks were in place.

Effective recruitment processes were in place and systems for staff training had been developed to make sure staff had the skills and knowledge they needed to provide good and effective care.

Staff were well supported through effective training, regular supervisions and annual appraisals.

Staffing levels were kept under review to make sure they were responsive to the needs of the people living at the service.

People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. We saw evidence of consent being sought and best interest meetings where appropriate.

People were complimentary of the care and support they received. Staff were respectful of people’s privacy and dignity needs.

People enjoyed the food at the home and their dietary needs were assessed and met.

Care was planned and delivered with a person-centred approach and people were supported with their wishes in relation to the care they received at the end of their lives.

People enjoyed a range of meaningful activities and had choice of communal areas in which to spend their time.

The service was managed well. There was an inclusive culture and people’s views and opinions were sought and valued.

At the last inspection in November 2017 we rated the service as ‘Requires Improvement’. We identified one regulatory breach which related to good governance.

Prior to the inspection we had received some concerns from a relative and a visiting healthcare professional. The concerns related to staffing levels, pressure area care, cleanliness and dignity and respect. As a result of these concerns the inspection was brought forward to check people were receiving the care and support they required, that regulations were being met and to review the ratings.

Millfields Residential Care Home provides accommodation and personal care for up to 38 older people, some of whom are living with dementia. Accommodation is provided over two floors with communal areas, including two lounges and a dining room, on the ground floor. There were 28 people using the service when we visited. This included three people who were in hospital and two people who were in for respite care.

The home had a registered manager however they were not present on the day of the inspection and we were informed the registered manager was leaving on 25 August 2017. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The area manager told us they would be taking over the management of the home.

People gave mixed feedback about the staffing levels as some said they felt there were enough staff and others told us they often had to wait for assistance. We saw there were times when there were no staff present in communal areas where people did not have access to a call bell. We found there were not always enough staff deployed to meet people's needs.

Risks to people were not always well managed as we found risk assessments were not always up to date or accurate. Staff had received training in safeguarding and understood the reporting systems. The majority of safeguarding incidents had been reported to the local authority safeguarding team, although we found one which had not. However, immediate action had been taken to make sure the person involved in the incident was safe.

Many areas of the home had been refurbished and further improvements were planned. Most areas of the home were clean and odour free although we found isolated areas where there were malodours.

Effective systems were in place to make sure people received their medicines when they needed them.

Safe recruitment processes made sure staff were suitable to work in the care service. Staff received induction, ongoing training and support through supervision and appraisal systems.

People’s care records were variable, some were detailed and person-centred, whereas others were not always accurate or up-to-date. People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible; the policies and systems in the service did not support this practice.

A range of activities were provided and people told us they enjoyed these. However, people also told us they wanted more opportunities to go out.

People told us they enjoyed the food. However, we found the dietary needs of people who were nutritionally at risk were not being met. People had access to healthcare services such as GPs and other specialists.

People praised the staff and we observed some kind and caring interactions between staff and people who used the service. However, we also saw occasions where staff showed a lack of respect for people and compromised their privacy and dignity.

We found there was a lack of consistent leadership. Quality assurance systems were not always effective which meant issues were not always identified or resolved.

We found shortfalls in the care and service provided to people. We identified five breaches in regulations – staffing, dignity and respect, consent, nutrition and good governance. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

Millfields Residential Care Home provides accommodation, personal care and support for up to 38 older people, some of whom might also have a physical disability and / or dementia. On the day of our inspection there were 30 people living at Millfields 27 people were living there permanently and three people were staying on a temporary basis.

There was no registered manager at the location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. Day to day management was provided by the operations manager until a new registered manager was recruited.

At our previous inspection we found the service was not providing safe care and treatment as the registered provider had not ensured the premises and equipment were safe or clean. We also found issues with the safe administration of medicines. At this inspection we found significant improvements in the cleanliness of the environment and equipment had been cleaned and some items replaced. The registered provider was planning a programme of refurbishments, to be completed once a decision had been made by the Commission in relation to the enforcement action being taken against the provider.

We found improvements in the management of medicines had been made. Medication was administered appropriately and all staff who administered medication had received training and had been assessed as competent to administer medicines. Further improvements were required around the recording of the administration of creams and some ‘as required’ medicines.

Standardised risk assessments had been undertaken for those people at risk of malnutrition and pressure sores. The home completed risk assessments when other risks such as choking, medication, fire and falls had been identified. Moving and handling risk assessments and care plans had improved from the previous inspection although further improvements were on-going. One person who was at the home for a temporary respite stay had not had their risks adequately assessed and recorded in relation to the method staff were to follow due to their fluctuating abilities.

People and relatives told us there had been a lack of staff over the weekend and the previous few days. It was not clear whether this was as a result of the vomiting bug at the home which had affected both staff and people living there. The operations manager told us they had changed the roles of staff to make more effective use of staff at busy times and they would look again at the deployment of staff. They did not use a dependency tool which could provide evidence staffing levels were appropriate to meet people’s needs although they agreed to implement one.

Accidents and incidents were recorded and the operations manager analysed these in order to determine themes and reduce the risk of further incidents.

Staff undertook a thorough induction when they first started working in the home and we saw this was evidenced in the staff files we reviewed. Staff completed the Care Certificate and the operations manager was the assessor for the certificate. Staff received on-going supervision, appraisal and training to ensure they had the skills to perform in their roles.

We found the service was not adequately recording the monitoring food and fluid intake for a person at risk of malnutrition and hydration.

The home had a plan in place for refurbishments to modernise the home including making it more dementia friendly to improve the wellbeing of the people living there.

At the previous inspection we found the service was not compliant with the Mental Capacity Act 2005. Since this inspection, the operations manager had undertaken the two stage mental capacity assessment in relation to medicines, finance arrangements and consent to live at the service. Most people had capacity to consent to day to day care if they were supported to make decisions such as what to wear and what to eat. The operations manager had written to relatives of people living at the service in relation to lasting powers of attorney and requested a copy of the paperwork. They told us they would implement a system to ensure all staff were aware of what decisions they could make on behalf of people who lacked capacity and those whose family members had the authority to do so.

We found all the staff to be caring in their approach to the people who lived there and staff treated people with dignity and respect. Staff knew the people they supported very well and were keen for people to feel they were at home.

There had been improvements in the record keeping at the service but we still found some records which lacked detail to promote safe and person centred care. This demonstrated a breach of Regulation 17 of the Health and Social Care Act (Regulated Activities) Regulations 2014.

We found a significant improvement in the audits undertaken at the service and these audits demonstrated the service was monitoring and improving the quality of the service provided. The service regularly sought feedback from people using the service and their relatives to inform improvements at the home.

There was no registered manager at the home and the operations manager was providing day to day management. They were providing leadership and management to staff and recognised this needed to be sustained once a new registered manager was in post to ensure the service continued to improve.

You can see what action we told the provider to take at the back of the full version of the report.

Millfields Residential Care Home provides accommodation, personal care and support for up to 38 older people, some of whom might also have a physical disability and or dementia. On the day of our inspection there were 29 people living at Millfields.

There was a registered manager in post at the time of our inspection. A registered manager is a person who was registered with the Care Quality Commission to manage the service. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. We found the standards of care in the service had deteriorated significantly since our last inspection. There were multiple breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The building was not secure as there was no lock on the front door and a glass panel in an external fire door was smashed

.

The registered manager and staff had limited knowledge of their responsibilities in regard to the Mental Capacity Act 2005 (MCA) and the associated Deprivation of Liberty Safeguards (DoLS.) particularly with regards to lasting power of attorney.

We found risk had not been adequately or accurately assessed in relation to moving and handling. Risk assessments did not reflect the current needs of people or describe the equipment which was required.

Equipment and furniture in the home was in need of repair. There was a lack of cleanliness throughout the service and a malodour was present throughout the building.

Medication was received and stored correctly, however we saw that two tablets had been dropped on the floor. This meant people were not supervised sufficiently when taking medications. We saw that prescribed creams and lotions were not being signed for, this meant there was no way of knowing if they had been applied.

We found people in the service were not treated with dignity and respect. Bedroom doors were left open when people were using commodes. We saw people were being supported to get dressed before five am and then getting back into bed in their day clothes.

The people living in the service were not asked for their consent for care to be carried out.

Decision specific capacity assessments were not carried out for the people living in the service to measure whether they were able to make their own decisions and which decisions they were able to make.

The registered manager was unaware of their responsibilities in regards to the MCA and DoLs. In regards to lasting power of attorney the manager was not aware that documentation was required to determine which decisions the power of attorney related too.

The registered manager was not always aware of safeguarding incidents. We saw that staff were recording incidents but not making the manager aware. This led to a lack of management oversight.

There was a lack of meaningful activities. We saw people sleeping in chairs throughout our inspection. We saw chair exercises offered to people, however this did not keep people’s attention. The room lay out meant the person delivering the class had to move around to explain the exercise to each individual, losing the attention of others.

The manager told us there had been no complaints and no documentation regarding complaints. However we found reference to complaints in meeting minutes, demonstrating that complaints had not been actioned in line with the company’s policy.

We saw audits for medication, hourly rounds, accident and incidents, and safeguarding. However they were not robust or accurate and no analysis or learning was taking place.

The overall rating for this service is 'Inadequate' and the service is therefore in 'Special measures'. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this time frame. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement or there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration. For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

We found that people's needs were assessed and care was planned and delivered in line with their individual care plan, which ensured people's safety and welfare. We saw that staff had a positive attitude towards the people who used the service. We observed throughout the visit that staff took time to answer questions and engage with people. We found that the home had a relaxed and comfortable atmosphere.

We saw staff engaged with people in a kind and friendly way which allowed people time to choose what they wanted to eat and drink. Even though people had made their menu choice in the morning, staff still gave them the opportunity to make a different choice of food.

On the day of our visit we found the home was clean, tidy and odour free. People and relatives we spoke with told us the home was always like this. We spoke with staff who told us there was plenty of easily accessible personal protective equipment. Staff also told us they received infection control training annually.

We reviewed the training records / matrix and saw that staff had completed their mandatory training; also staff were currently undertaking other relevant training.