We inspected Millreed Lodge Care Home on 18 August 2015 and the visit was unannounced.
Our last inspection took place on 14 October 2013 and, at that time, we found the regulations we looked at were being met.
Millreed Lodge Care Home provides nursing care and accommodation for up to 33 older people and people living with dementia. At the time of our visit there were 30 people in residence. The accommodation is arranged over two floors and there is a passenger lift. Some of the bedrooms have en-suite toilet facilities. The lounge and dining areas are on the ground floor.
The service has a registered manager. 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.
We found staff were being recruited safely, however, people told us there were not enough staff and this was confirmed in our observations. Staff training, formal supervisions and appraisals were not up to date. Staff told us they did feel supported as the registered manager had an ‘open door’ policy. People told us some staff were better trained than others.
People told us staff respected their privacy and dignity, however, we saw staff practices which showed a lack of respect for people.
People told us they were happy with the care and support they received most of the time, but said sometimes they had to wait longer than they would wish to for staff to assist them to the toilet. We found some people did not have a care plan and for others the care plan was out of date. Risk assessments had not always been completed or plans put in place to show what action had been taken to mitigate any risk to people. People’s care and support was being delivered based on staff’s knowledge of the individual. Without care plans and risk assessments there was a risk people’s care needs would not be identified and responded to.
People told us their health care needs were being met and doctors or community matrons were called if they were unwell. We found the medication system was not well managed and there was no assurance people were receiving all of their medication as prescribed by their doctor.
We found there were areas of the home which were shabby, areas that were potentially unsafe and identified infection prevention issues.
We found the service was not meeting the legal requirements relating to Deprivation of Liberty Safeguards (DoLS). People were being prevented from leaving the home without the necessary authorisations being in place.
The cook had a good knowledge of people’s dietary preferences and spoke with them directly about the meals on offer. People told us the meals were good and we saw plenty of drinks and fresh fruit were available.
Visitors told us they were always made to feel welcome and could have a meal with their relative if they wished.
People told us if they had any concerns they would tell a member of staff and felt action would be taken to resolve any issues.
There were very few activities on offer to keep people stimulated and contact with care staff was only made in response to requests from the individual or when staff were attending to people’s personal care.
We found there was a lack of provider oversight and very few checks were being made on the overall operation and quality of the service. The registered manager had not kept up with the internal audits and records were not up to date. This meant there was no on-going improvement plan to develop the service. We also found people using the service and their relatives were being asked for their views about the service but no action had been taken in response. This meant people views were not valued or acted upon.
Overall, we found significant shortfalls in the care and service provided to people. We identified five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The Care Quality Commission is considering the appropriate regulatory response to resolve the problems we found.
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 timeframe.
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. The 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 so 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 in any of the five key questions it will no longer be in special measures.