Archived: Millhouse

Updated 1 September 2015

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection was carried out on 01 July and 03 July 2015. Our inspection was unannounced. This was a focussed inspection to follow up on actions we had asked the provider to take to improve the service people received and also following concerns we had received since the last inspection.

The inspection team included two inspectors. The team also included an expert-by-experience who had personal experience of caring for older people. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service.

We gathered and reviewed information about the service before the inspection including information from the local authority, information from whistle blowers and our last report.

During our inspection we observed care in communal areas. We examined records including staff rotas; management records and care records for five people. We looked around the premises and spoke with six people, five staff, two workmen who were undertaking repairs, the acting manager and the provider. We also spoke with three relatives, a district nurse and a visitor.

Updated 1 September 2015

The inspection was carried out on 01 and 03 July 2015. Our inspection was unannounced. This was a focussed inspection to follow up on actions we had asked the provider to take to improve the service people received.

Millhouse is located on the outskirts of Faversham and provides care and support for up to 24 older people with dementia. Some people had sensory impairments, limited mobility and one person received care in bed. Accommodation is set out over two floors with lift access to the first floor. On the day of our inspection there were 17 people living at the home.

The registered manager had left the service in April 2015. A registered manager is a person who has registered with the Care Quality Commission to manage the home. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the home is run. The provider had employed an acting manager to oversee the day to day running of the home.

At our previous inspection on 12 November 2014 we found breaches of nine regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. These correspond with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 which came into force on 1 April 2015. We took enforcement action and required the provider to make improvements. We issued two warning notices in relation to the safety and suitability of the premises and the cleanliness of the premises and told the provider to comply with the regulations by 30 January 2015. We found seven further breaches of regulations. We asked the provider to take action in relation to person centred care, suitability of equipment, records, staffing levels, support to staff, recruitment and quality assurance.

The provider sent us an action plan on 29 April 2015 which stated that they would comply with the regulations by 12 June 2015.

At this inspection we found that some minor improvements had been made but the provider had not completed all the actions they told us they would take within the timescales they had given us. In particular they had not met the requirements of the warning notices we issued at out last inspection. As a result, they were breaching regulations relating to fundamental standards of care.

People made complimentary comments about the service they received. People told us they felt safe and well looked after. However, our own observations and the records we looked at did not always match the positive descriptions people had given us. Most of the relatives who we spoke with during our visit were satisfied with the service.

Work had begun to improve the premises, this had not been done in a timely manner. General repairs had not been reported or actioned in a timely manner.

Cleaning standards in the home had improved. However, some rooms had not been cleaned effectively to remove strong odours and we found dirty equipment such as commodes. The sluice machine had not been relocated away from the laundry area to ensure that laundry could be separated from clinical waste. People and staff were unable to wash their hands effectively because some bathrooms did not have soap or hand gel.

Staff had undertaken safeguarding training but they did not have access to all the information they needed about how to report abuse, including contact details for the Local Authority safeguarding team. Staff were aware of their roles and responsibilities with regards to safeguarding people.

Effective systems were not in place to enable the provider to assess, monitor and improve the quality and safety of the service. The provider was not aware of environmental issues in the home and had therefore not instructed contractors to carry out repairs and maintenance.

Risks to people’s safety and wellbeing were not always managed effectively to make sure they were protected from harm. People were at risk of heat exhaustion because the central heating was on during a heat wave and there were no fans available.

The provider did not follow safe recruitment practice. Essential documentation was not available for all staff employed. Gaps in recruitment had not been explored to check staff suitability for their role.

Medicines administration had not been recorded effectively. One person’s prescribed cream had not been signed as administered for three weeks. Medicines were not monitored effectively to ensure that they had been kept at the correct temperature.

The provider did not have an effective system to assess how many staff were required to meet people’s needs and to arrange for enough staff to be on duty at all times.

Staff had received training relevant to their roles such as infection control and the Mental Capacity Act 2005. However, staff had not received training in de-escalation and managing behaviours that may challenge to enable them to safely support people whose behaviours could have a negative effect on themselves or others.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The provider had submitted Deprivation of Liberty Safeguards (DoLS) applications for most people, but had not informed CQC that these had been authorised, as they are required to do.

The complaints procedure was out of date and did not provide information about all of the external authorities people could talk to if they were unhappy about the service. Complaints had not been appropriately recorded and investigated. People told us they would speak to the acting manager if they wished to complain.

Records relating to people’s care and the management of the home were not well organised, adequately maintained or stored securely.

People and their relatives were involved in planning their care, although records did not demonstrate this.

People were not always provided with personalised care. They were not provided with sufficient, meaningful activities to promote their wellbeing.

People’s health needs were well met. They had access to health professionals when they needed it.

Staff were cheerful and patient in their approach and had a good rapport with people. The atmosphere in the home was generally calm and relaxed and there were lots of smiles and laughter.

People were supported to maintain their relationships with people who mattered to them. Visitors were welcomed at the service at any reasonable time and were complimentary about the care their relatives received.

People who able to voice their own views and opinions were consulted through resident’s meetings and their views taken into account in the way the service was run. People who were unable to voice their own views and opinions and their relatives had not been asked for their views and opinions about the home.

Most staff had received the essential training and updates required, such as food hygiene and fire safety training, to meet people’s needs.

People were generally complimentary about the food and drinks were readily available throughout the day.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The overall rating for this provider is ‘Inadequate’. This means that it has been placed into ‘Special measures’ by CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve.

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

Services placed in special measures will be inspected again within six months. The service will be kept under review and if needed could be escalated to urgent enforcement action