The inspection took place on 1 June 2016. The inspection was unannounced.The Millfield Retirement Home (The Millfield) is situated in a residential area close to the centre of the Lakeland town of Keswick.
The Millfield is a former private house which has been converted to provide personal care and accommodation for up to 45, mainly older people, people living with dementia, mental health issues or physical disabilities.
Accommodation is spread over three floors and includes private bedrooms, some of which have en-suite facilities. There are communal lounges, a conservatory and dining areas as well as specially equipped communal bathrooms. Entrance ramps, stair lifts and a passenger lift help ensure people can access all areas of the home including the gardens.
At our last inspection of this service on 29 August 2013 the service was compliant in all of the areas we inspected.
There is a registered manager at the home. 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.
All of the people who used this service, who we spoke to during our inspection, told us that the staff were “very good” they also said that they were “very well looked after.” People who used this service did not raise any concerns with us during our inspection visit. Although one person did think that lunch and tea were quite close together.
A visitor to the home told us; “This is an excellent home. The girls (staff) are great and very patient.”
The day time care workers thought that the staffing levels during the day were sufficient and that they had time to care for people and meet their needs appropriately. However, the night time care workers had a different view. They were concerned about the amount of domestic tasks that they were expected to carry out in addition to providing care and support to people during the night. However, people using this service did not raise this as a concern.
We observed daytime staff supporting people who used this service in some of the communal areas. We saw that staff were respectful of people’s privacy and dignity and only intervened when necessary or when people requested their help. This meant that people who used this service were supported and encouraged to remain as independent as possible.
On the day of our inspection the home was clean, tidy and there were no unpleasant odours.
The registered provider had safeguarding procedures in place and staff at the home had received training and updates to help them identify and effectively report abuse allegations or concerns.
In the sample of care records we looked at we found that there were some aspects that needed to be reviewed and updated to reflect people’s current support needs and preferences. The registered manager had started to address these matters before we left the home on the day of our inspection visit.
We found that medicines were managed and handled safely. People were able to store their own medicines safely in their own rooms. There was some confusion around the use of covert medication and we have made a recommendation about this.
Most of the staff we spoke to at the home told us that they were well supported by the registered manager. We noted that they received regular supervision and staff meetings took place. Staff were supported in keeping their skills updated and there was a training plan in place. We looked at the way in which the service recruited new staff and found that this process was managed effectively. This meant that only suitable people were employed to work at The Millfield.
There was one person living at The Millfield who was subject to Deprivation of Liberty Safeguard. The registered manager had followed the correct processes, in line with the requirements of the Mental Capacity Act 2005. Care homes are required to notify us about any applications they make to deprive a person of their liberty under the Mental Capacity Act 2005 and about the outcome of those applications. The registered provider had done this.
“Do not actively resuscitate” orders did not consistently follow current guidance. There was confusing information regarding one person’s wishes and others had not had their “DNACPR” orders reviewed as required.
People who used this service were well supported with their nutritional needs. Healthcare professionals were consulted where people had been identified as being at risk of poor nutrition.
The accommodation at the home included various communal areas and an accessible garden. Adaptations and specialised equipment was available to help keep people safe or assist them in accessing the facilities at The Millfield.
We noted that the windows at the home had not been fitted with appropriate window restrictors to help prevent people accidentally falling out.
People who used this service told us that they could receive visitors at any time. People also told us that they went out with their families or out into the local community by themselves.
There was a complaints process in place at the service. We did not receive any complaints during our visit to the service. We checked the information we held about the service, we found that we had not received any complaints during the last 12 months. The format of the home’s complaint procedure may not meet the communication needs of everyone who used this service.
The registered manager had carried out various audits to monitor the quality of the service. Where shortfalls had been identified action plans had been developed to help drive improvements to the service. People who used the service were able to comment on their experiences and quality of the service they experienced. We saw that this had been done via questionnaires and meetings.
We have made a recommendation about the use of covert or disguised medicines.
We have made a recommendation about the use of “do not attempt cardio pulmonary resuscitation orders” (DNACPRs).
We have made a recommendation that the service considers current guidance from reputable sources to ensure the home is compliant with health and safety legislation.
We have made a recommendation that the service seek advice and guidance from a reputable source about providing information to people who use this service, in a format that meets their needs.