Mill House

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

The service was not effective and remains inadequate. Not enough improvements had been made. We identified 1 breach of the legal regulations. Assessments did not always accurately reflect people’s needs, as they were not always updated or reviewed. Although some improvements had been made the provider was not always working within the principles of The Mental Capacity Act 2005 and people were not always lawfully restricted. However, staff understood and were aware of people’s health needs.

This service scored 33 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Staff raised concerns as they felt the assessments the manager and deputy completed did not always match people’s needs. Staff told us they were not involved with the assessment process. The manager was able to offer us limited feedback on the assessment process, they told us they completed these. They were unable to tell us how this was used to form and plan people's care. They were also unable to explain why assessments and care plans were not always reflective of people’s needs. Staff gave us examples and were aware how people communicated.

As part of the providers registration, they have to request CQC approval for people to be admitted or readmitted into the home. Readmission requests submitted to us for review have been of poor quality and on numerous occasions we have had to request specific action to be taken to enable us to make a decision about whether it is appropriate for people to return to Mill House. Assessments were completed when people moved into the home and clinical tools such skin risk assessments were used to identify individual risks to people. However, these were not always up to date and accurate. There was no evidence to show how people were involved with this process. Communication needs were assessed and plans were put in place to meet people's needs. Other plans contained some information around people’s preferences and how they liked to spend their time. People’s health needs had been considered in the assessment and care planning process.

We did not look at Delivering evidence-based care and treatment during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at How staff, teams and services work together during this assessment. The score for this quality statement is based on the previous rating for Effective.

People and relatives raised no concerns around the management of their health and wellbeing. One person told us, “If I need the doctor I just ask, and they send for the doctor”. A relative said, “Health professional’s visit. We’re all happy as my relation is happy here”.

Staff knew people and their health needs well and they were able to tell us when people were on restricted fluids and needed pressure relief. They told us they could ring health professionals themselves if they were concerned about people’s health and wellbeing. The manager explained the new system that had been introduced to monitor people’s care. They told us seniors on each shift were responsible for this, including if people had eaten and drank enough.

We did not look at Monitoring and improving outcomes during this assessment. The score for this quality statement is based on the previous rating for Effective.

People told us staff asked for their consent before providing care and support. One person said, “They do ask me if it’s ok before they help me with anything or do anything for me.” Relatives raised no concerns around the consent processes.

Staff knew how to gain consent from people. However, no one was able to demonstrate that they fully understood mental capacity and DoLS. The manager told us capacity assessments and DoLS had been completed.

People's rights were not consistently protected in line with the Mental Capacity Act 2005 (MCA). Some capacity assessments and best interest decisions were in place however these were also used when people had no cognitive impairment and used to capture their agreement and consent. This showed a lack of understanding about when the MCA should be applied. Although some improvements had been made, the manager had still not assessed all people's capacity to consent to their care and there were not always applications made to the authorising body when people were having their liberty restricted. For example, with the use of closed-circuit television (CCTV). This meant people were subject to restrictions which had not been lawfully authorised.