Archived: Sevington Mill

Sevington Mill 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. Sevington Mill can accommodate 50 people. At the time of our inspection there were 36 people living at the service.

Accommodation is spread over 2 floors in a large detached property. There was a large communal lounge, dining area and conservatory where people could choose to spend their time.

There was no registered manager in post at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered persons have a legal responsibility for meeting the requirements of the Health and Social Care Act 2008 and associated Regulations about how the service is run. A new manager had been appointed in June 2018, they had applied to CQC to become registered as the manager at the time of this inspection.

Sevington Mill was last inspected June 2018. At that inspection it was rated as 'Requires Improvement' overall. At that inspection we found some improvements had been made, however their remained ongoing breaches of the Health and Social Care Act Regulated Activities Regulations 2014 in relation to Regulation 11; need for consent, Regulation 12; safe care and treatment and Regulation 17; good governance. Following that inspection the service was removed from Special Measures. We asked the provider to send us a report to tell us what actions they would take to ensure the ongoing breaches of regulation were met.

At this inspection we found that the improvements we saw in June 2018 had not been embedded or sustained. We found that there were continued breaches of regulation, along with a number of new breaches.

People were not kept safe from abuse or avoidable harm. Not all staff had received safeguarding training. Staff were able to tell us how to recognise and report safeguarding concerns. However, in practice they had not consistently reported concerns to management. Incidents and accidents were not fully analysed or reviewed by the manager and risk assessments had not been updated. Staff did not reflect and learn from accidents and incidents and there was a lack of reporting to the local authority or the Care Quality Commission (CQC).

Risks to people were not properly assessed. Risk assessments were not in place for skin integrity, falls or supporting people when their behaviour challenged, despite risks being known.

There were not enough staff to meet people’s needs and the provider had not used a recognised dependency tool to determine safe staffing levels. Staff were not recruited using safe and robust recruitment processes to assess the candidate’s suitability for the job.

Medicines management was not consistently safe. Temperature checks were not completed. Creams and ointments were not consistently stored safely and medicines were not always disposed of in a safe manner, in line with best practice. People did not always receive their medicines when they needed them, and those who ‘self-medicated’ were not assessed to ensure their competence.

Other areas of medicines management had improved. Medicine records were completed accurately, contained photos and guidance for staff. Medicine audits were completed by senior staff; and had identified some of the shortfalls we found. Competency checks were completed for staff responsible for administering medicines. Checks on the environment and equipment were completed.

People had not received full assessments of their needs and care planning did not consistently refer to best practice or evidence-based guidance to ensure effective outcomes were achieved. Staff had not received effective training, supervision, or appraisal to carry out their roles. Training in key areas such as behaviour that could challenge, end-of-life care or dementia care was insufficient and staff had not been assessed to ensure they had the appropriate skills and competencies to support people.

The management of nutrition and hydration was not effective. Food and fluid monitoring was not accurate nor consistently completed for each person who needed it. The service worked with healthcare professionals to ensure people received appropriate medical input, however guidance implemented as a result of this was not followed by staff. People’s healthcare needs were not always met. Staff did not always recognise or respond promptly when people were unwell.

People had not been supported to have maximum choice and control of their lives. The registered provider, manager and staff did not fully understand the principles the Mental Capacity Act 2005 and the policies and systems in the service did not support people to find the least restrictive options. Restrictions had been assessed incorrectly and DoLS applications had been submitted lawfully but the registered manager had made applications for each person without considering their individual needs appropriately.

Staff were busy and rushed, which often meant people’s emotional needs were not met. Through our observations we saw that staff mostly treated people with kindness. They recognised most people's needs well and caring interactions were seen. However, staff were not able to spend quality, meaningful time with people because they were too busy. People's involvement in care decisions and planning was not clearly evidenced. There was little adaptation to the premises to make them suitable for those living with dementia.

The service was not meeting the accessible information standard (AIS) and some people’s care plan documentation was not written in a way they could understand. Complaints were not responded to effectively and there was no information about how to make a complaint available in an accessible format to meet the needs of people living with dementia.

Activities were limited. People sat in chairs, either in their rooms or the communal areas, for most parts of the day with little stimulation. People were not appropriately supported at the end of their lives. End of life care plans were basic and not based around the person’s wishes.

The manager and registered provider failed to ensure that staff shared a clear vision for providing high quality person-centred care. The culture of the service was not empowering for people, relatives, or staff.

The service was not well led. Governance systems were not effective and service audits were not analysed to give oversight of the service or followed up to ensure that improvements were made. Statutory notifications had not consistently been submitted to the CQC. Staff had not been supported or their skills and knowledge developed and little work had been done to encourage learning and best practice from working in partnership with other professionals and health care providers.

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. 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 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 for any of the five key questions it will no longer be in special measures.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We are considering our regulatory response to our findings and will publish our actions when this has been completed.

Residential accommodation and personal care were provided for up to 50 older people. Sevington Mill is a family run ‘care home.' People in care home services receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. The accommodation spanned two floors and some rooms had on-suite facilities. A lift was available for people to travel between floors. There were 38 people living in the service when we inspected. Some people had memory loss or health issues associated with ageing.

We carried out our last comprehensive inspection of this service on 08 December 2017 and we gave the service an overall rating of ‘Requires Improvement.’ The service was rated ‘Inadequate’ in the well led domain for the second consecutive comprehensive inspection. We placed the service in 'special measures' on 25 April 2018. We do this when services have been rated as 'Inadequate' in any key question over two consecutive comprehensive inspections. The ‘Inadequate’ rating does not need to be in the same question at each of these inspections for us to place services 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, 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.

At our last comprehensive inspection of this service on 08 December 2017 we found some improvements. However, we found two continued breaches of the legal requirements of the Health and Social Care Act (Regulated Activities) Regulations 2014 from our previous inspection on 27 March 2017. The first continued breach related to Regulation 12, safe care and treatment - there was a continued failure to risk assess people’s mobility, nutritional needs and infection, safely manage risks from fire, the environment and manage medicines safely. The second continued breach related to Regulation 17, good governance - the provider had not ensured that effective governance systems were in operation to identify shortfalls and make improvements to the quality and safety of care. Accurate records had not been kept in relation to people’s care.

At our last comprehensive inspection of this service on 08 December 2017 we also found a further three breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014. These were in relation to Regulation 9, person-centred care - planning for end of life was not recorded; Regulation 10, dignity and respect - people’s right to privacy and to be treated in a dignified way were not always upheld and Regulation 11, need for consent - people’s capacity to give consent and make their own decisions had not been assessed.

Following the comprehensive inspection on 08 December 2017, we issued a requirement notice in relation to Regulation 9, person-centred care. In relation to Regulation 10, dignity and respect, Regulation 11, need for consent, Regulation 12, safe care and treatment and Regulation 17, good governance, we imposed a condition on the providers registration requiring the registered person to undertake monthly audits of the service and send a written report to the Care Quality Commission. At the time of this inspection the provider had met the condition.

At our inspection on 08 December 2017, we also made a recommendation about the recording of complaints.

The provider sent us an improvement action plan telling us how they intended to meet the legal requirements of the Health and Social Care Act (Regulated Activities) Regulations 2014. They told us they would meet the regulations by 01 August 2018.

At this inspection we found some improvements had been made. The provider was now meeting Regulations 9 and 10 of the Health and Social Care Act (Regulated Activities) Regulations 2014. The provider has acted on our recommendation. However, at this inspection we found continued breaches of the Health and Social Care Act Regulated Activities Regulations 2014 in relation to Regulation 11, need for consent, Regulation 12, safe care and treatment and Regulation 17, good governance.

There was not a registered manager employed at the service. A registered manager is a person who has registered with CQC 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. However, the registered provider had recently employed an experienced manager who intended to register as the manager of the service. The manager and the registered provider were based at the service.

The provider had been making improvements to the service, for example they had employed a manager with experience of managing services rated as good. They had also changed the management structure in the service to gain more management oversight.

There were policies in place for the safe administration of medicines. Staff were aware of these policies and had been trained to administer medicines safely. However, we found that there were still errors with the management of medicines.

Environmental infection risks were assessed and control protocols were in place and understood by staff to ensure that infections were contained if they occurred. However, risks relating to infections that may relate to people’s individual catheter care needs were not fully assessed and minimised.

There were adaptations within the premises, but some parts of the grounds and some parts of the service were not properly maintained. We made a recommendation about this.

The provider had made improvements to the assessment and recording of people’s capacity and gaining consent under the Mental Capacity Act 2005, however, best interest decisions were not always recorded. Staff understood their responsibilities in preventing abuse.

People were supported to have maximum 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.

Staff had received training in relation to the management of challenging behaviours and about the needs of the people they were caring for. Staff were supported to develop their skills and experience.

Since our last inspection the system for managing incidents and accidents had been improved. Incidents and accidents were recorded and checked by the manager to see what steps could be taken to prevent incidents or accidents happening again.

General and individual risks were assessed and management plans were implemented by staff to protect people from harm. The risk from infection from waterborne illness [Legionella] had been minimised.

The manager and care staff used their experience and knowledge of people’s needs to assess how they planned people’s care.

The provider had reviewed key policies including those that covered contingency planning in the event of foreseeable emergencies.

The provider had a system in place to assess people’s needs and to work out the required staffing levels. End of life care plans were developed with specialist support. However, accurate records to monitor people’s health and wellbeing were not always kept.

People had access to food of their choice, snacks and drinks. People had access to GPs and their health and wellbeing was supported by prompt referrals and access to medical care if they became unwell.

Staff were welcoming and friendly. Activities were planned to keep people mentally active and maintain skills or hobbies. People and their relatives described staff as friendly and compassionate. Staff delivered care and support calmly and confidently.

Staff upheld people’s right to privacy and to choose who was involved in their care. People’s right to do things for themselves was respected. People, their relatives and health care professionals were often asked about their experiences of the service.

There were policies about equality, diversity and human rights, and to guide people if they wanted to make a complaint about the service.

Safe recruitment practices had been followed before staff started working at the service.

The management and staff delivered care in line with the provider’s care ethos.

During this inspection, we found three continued breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations. You can see what action we told the provider to take at the back of the full version of the report.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

There was a manager in post who was registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the CQC 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.

At the last inspection on 27 March 2017 we found breaches of regulation relating to personalised care, the safe care and treatment of people, including the management of risk and medicines, staffing and governance. We found that improvements had been made to the staffing arrangements for the service and the registered provider was complying with this regulation. We found that sufficient improvements had not been made to the safe care and treatment of people, personalised care and governance and the registered provider continued to breach these regulations. Some of these breaches of regulation were continuing from previous inspections in July 2016.

The registered provider had not always ensured that risks to people’s safety and welfare were appropriately managed. People were not always supported to manage their prescribed safely.

The registered provider had not always ensured that consent was sought following the correct procedures. They had not always ensured that the principles of the Mental Capacity Act 2005 (MCA) were adhered to when assessing people’s capacity to make decisions and give consent to care and treatment.

The registered provider had not ensured that accurate and complete records were maintained in respect of people’s health needs. People did not always have care plans written to support them with their specific needs at the end of their life.

The registered provider had not always ensured that people living with dementia had care plans that ensured their care was delivered in line with evidence based guidance. Staff had not received training in the Equality Act 2010 and there was no information in people’s care plans to ensure people were not discriminated against.

Staff knew people well and had positive relationships with them. However, they did not always treat people with respect or promote their dignity and privacy.

Not all the people using the service were clear about the management arrangements for the home. The leadership of the service had not been effective in identifying and improving shortfalls. There were breaches of regulation that were continuing from previous inspections.

Staff received appropriate training and support and were enabled to develop their knowledge and skills through qualifications. However, training in the Mental Capacity Act had not been effective in ensuring staff followed good practice. Staff were supported in their roles.

There were sufficient numbers of staff working in the service to meet people’s needs. The registered provider ensured that staff were safe and suitable to work with people.

People were safeguarded from harm and abuse. The registered provider worked with the local safeguarding team to respond to allegations of abuse.

The registered provider ensured that the risk of infection in the service was assessed and managed. The premises were well maintained and equipment had been checked regularly to ensure it was suitable and safe. There were effective systems in place for managing emergencies in the service.

Staff supported people effectively when they were distressed or anxious. They understood people’s individual communication needs and supported them to make their views known. Staff supported people’s right to personal relationships and took action to reduce the risk of social isolation. People were supported to spend their time how they wished. There was a programme of group activities available that people could take part in if they wished to. Staff supported people to continue with their hobbies. There were links with the local community.

The premises were homely and comfortable. Some improvements had been made to help people manage independently in the home including clear signs to help people find their way around.

People were supported to access healthcare professionals as needed. The registered provider worked well with partner agencies to plan and provide care. People had a balanced diet and enough to eat and drink. People told us they enjoyed their meals.

People were supported to have maximum 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. People were involved in writing their care plan. The routines of the service were flexible and person centred. People were asked their views of the service. They knew how to make a complaint if they needed to and were confident they would be listened to. We made a recommendation about the recording of complaints.

The overall rating for this service is ‘Requires improvement’. However, we are placing the service in 'special measures'. We do this when services have been rated as 'Inadequate' in any key question over two consecutive comprehensive inspections. The ‘Inadequate’ rating does not need to be in the same question at each of these inspections for us to place services 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.

This is the second consecutive time the service has been rated Requires Improvement.

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

Sevington Mill is registered to provide personal care and accommodation for up to 50 older people. There were 39 people using the service during our inspection; some of whom were living with dementia and/or conditions such as diabetes or impaired mobility.

Sevington Mill is a very large detached property situated in a residential area outside Ashford. There was a comfortable lounge/dining room with armchairs and a TV, a separate dining area and a bright conservatory where people could sit and enjoy views of the garden.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Registered persons have a legal responsibility for meeting the requirements of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People and relatives gave us mixed feedback about the safety of the service. We found some aspects that were not safe and required improvement to address them.

There were not enough staff deployed to consistently meet people’s needs. Morning medicines rounds took from 8am until 10:30am to complete, taking two senior staff off the floor for that period. Call bells rang for up to 15 minutes before they were answered.

Some risks to people had not been properly reduced. Special air flow mattresses were not all on the correct settings to provide people with appropriate relief from pressure on their skin. Water temperatures were found to exceed safe limits, but were rectified during the inspection.

Records about wound care and other areas were scant and did not provide a full picture about people’s care and treatment. Some people’s meals were delivered to them cold, which they said happened regularly.

Staff supervision did not always include opportunities for staff to discuss training needs. Records showed that only one staff had received training about care of dying people. End of life preferences and choices were not as full or detailed as they could be.

There was no designated activities staff and activities for people were insufficient. Care and catering staff were providing entertainment where possible. There was not enough social stimulation for people who stayed in their rooms.

Actions arising from the last inspection had not been fully completed, leaving some risks to people’s safety and well-being unaddressed. There had been insufficient oversight to pick up on the shortfalls found during this inspection and the service had been rated as requires improvement or less at four inspections over a two year period.

Equipment had been regularly safety-checked and accidents and incidents were properly documented. Staff knew how to recognise abuse and how to report it.

Records about fluid intake had improved and there were plenty of drinks available. Some people said they enjoyed their meals and tables were pleasantly laid up with cloths and flowers.

Staff had received mandatory training in a range of subjects and 16 staff had achieved National Vocational Qualification (NVQ) in health and social care.

People’s consent to their care and treatment had been appropriately sought and staff acted in accordance with requirements of the Mental Capacity Act 2005 (MCA).

Staff were considerate and kind and people and relatives praised them for their efforts. People’s privacy and dignity were consistently respected and they were encouraged to be as independent as possible.

Complaints were managed effectively and feedback was sought and acted upon.

We found a number of breaches of Regulation and made the following recommendations:

We recommend that the provider reviews the lunchtime service with a view to ensuring that all people receive their meals at a suitable temperature.

We recommend that the provider expands the supervision process to include feedback from staff about their own developmental needs and any concerns.

We recommend that the provider schedules end of life care training for all care staff from a reputable source.

Sevington Mill is registered to provide personal care and accommodation for up to 50 people. There were 33 people using the service during our inspection who were living with a range of care needs. These included diabetes, Parkinson’s and mobility support; and some people were living with early stage dementia.

Sevinton Mill is a large, detached premises situated in a residential area just outside Ashford. The service had a large open plan communal lounge available with comfortable seating and a TV for people. There were separate dining areas and a bright conservatory with further comfortable seating.

There was not a registered manager in post at the time of the inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. 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. There was however, a manager who had been running the service since January 2016; and who had applied to the CQC to register.

Sevington Mill was last inspected in November 2015, when it was rated as Inadequate. The service was placed into special measures as a result. The provider sent us an action plan to tell us how they would address the breaches in Regulation identified at that inspection. This stated that all remedial actions would be completed by 30 March 2016.

At this inspection we found that much improvement was evident around the service; but some issues highlighted at our last inspection had not been put right.

The management of medicines was significantly better, but there remained issues with creams applications. Some information about medicines interactions and signs of over and under dosing was missing from records; which created risks to people.

Assessments of other risks to people had been carried out and actions to minimise them were generally in place. However, air flow mattresses for people prone to skin wounds had been set at the wrong levels; meaning people did not receive the therapeutic benefits of the equipment.

Recruitment processes were still not sufficiently robust to provide assurance about staffs’ backgrounds.

Records of people’s food and fluid intake were sometimes scant or were not detailed enough to provide an accurate picture of people’s nutrition and hydration. People told us they enjoyed the meals on offer and could choose off-menu alternatives. There were plenty of drinks freely available.

The principles of the Mental Capacity Act had not been followed with regard to obtaining consent, but Deprivation of Liberty Safeguards (DoLS) had been appropriately sought.

The service was clean and hygienic throughout and laundry was better-managed.

Staffing levels had been increased following our last inspection and competency was checked through practical supervision. Training was up to date and more effective because it took into account the different ways in which staff learned.

People’s healthcare had been monitored and they had regular appointments with opticians, chiropodists and dentists. Staff were caring and considerate and went out of their way to make people comfortable. People’s privacy and dignity was respected and staff were mindful of people’s preferences.

Care plans were person-centred and detailed and were an accurate reflection of the care people received. Information about people’s life histories had been complied to give staff a sense of people’s personalities and achievements. People engaged in a variety of group and individual activities depending on their choice.

Complaints had been managed effectively and people and relatives knew how to raise any concerns. However, the service was not consistently well-led. Audits designed to identify shortfalls in the quality and safety of the service had not always been effective and management oversight needed to be improved to make sure that people were safe and had their needs fully met.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of this report.

As this service is no longer rated as inadequate, it will be taken out of special measures. Although we acknowledge that this is an improving service, there are still areas which need to be addressed to ensure people's health, safety and well-being is protected. We identified a number of continued breaches of Regulations. We will continue to monitor Sevington Mill to check that improvements continue and are sustained.