OSJCT Millbrook Lodge

Updated 5 May 2018

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.

The inspection site visit took place on 27 February 2018 and ended on this day. The inspection was unannounced. Two inspectors and an expert-by-experience visited the home and carried out the inspection. An expert-by-experience (EXE) is a person who has personal experience of using or caring for someone who uses this type of care service. The EXE has looked after relatives with complex needs and who continues to work with people who live with dementia.

Prior to the inspection visit we reviewed the information we held about the service. This included all notifications received from the service since the last inspection. The provider must, by law, inform us of significant events which have an impact on people in the home. We did not request a Provider Information Return (PIR) prior to this inspection. A PIR is a form which gives some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report. We also reviewed information we had received from one member of the public and from commissioners of the service.

We spoke with nine people who lived at the home, but we also used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us. We spoke with three groups of visitors and relatives and two further relatives on their own. We spoke with five care staff, three nurses [two day nurses and one night nurse], one member of the housekeeping team, the chef, both activities co-ordinators and a self-employed hairdresser. We spoke with members of the management team which included the registered manager, deputy manager and an operations manager.

We reviewed nine people’s care files, which included care plans, risk assessments and other relevant care records. We reviewed records pertaining to the Mental Capacity Act 2005 for five people. We reviewed the staff training record and three staff recruitment files. We also reviewed a selection of audits which included medicines, 'dining experience', the last infection control audit, care plans and catering audits. We reviewed records kept for each complaint received by the home.

We were provided with a copy of the provider’s bed rail policy. We requested and received further information from the home in relation to bed rail risk assessments. We were also provided with reports on the findings of the last satisfaction survey completed on people, their relatives, friends and the staff. We attended one staff hand-over meeting.

Updated 5 May 2018

This inspection took place on 27 February 2018 and was unannounced.

Following the last inspection on 10 and 11 January 2017 we rated the home ‘Requires Improvement’ overall. We asked the provider to complete an action plan to show us what they would do and by when, to improve the key questions Is the service safe? and Is the service well-led? to at least good. We found improvements had been made to both these key questions. However, in is the service safe?, where people had made a decision to continue to use equipment [bed rails], which did not reach the required safety height, records did not reflect that people had been fully informed of the potential impact on them when continuing to use these. We did find improvements in records relating to medicines and the use of drink thickeners. Although, staff required a better awareness of the potential risks to some people when supporting them to eat safely. In is the service well-led? we found audits were used to identify shortfalls and to drive improvement.

Millbrook Lodge is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Millbrook Lodge can accommodate up to 80 people, in one building, which is split into four separate units, each of which have separate adapted facilities. Three of these units care for people with nursing needs and one unit for people without nursing needs, where some also lived with dementia. Each unit provides single bedrooms which have private toilet and washing facilities. On each unit is a lounge, dining room with kitchenette area and additional communal bathrooms and toilets. The home provides a large and secure adapted garden. On the ground floor there was a central lounge with a tea room area and a separate hair dressing salon.

The home had a registered manager who had been in post since 2014. 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.

At this inspection we rated the service ‘Good’ overall.

People told us they felt safe. Risks to people were identified and managed appropriately. Where people were able to make decisions, about risks which may have an impact on them, they were supported to do this. We have made a recommendation about the records kept about the information given to people, which supports them to make independent and informed decisions about the use of bed rails. People received their medicines safely and clear records were kept in relation to these. This reduced the risk of potential errors associated with medicines.

Risks relating to people’s nutrition and the potential risk of choking on food or drink had been assessed and action taken to reduce these. Staff were well supported and received training in order to meet people’s needs. We have made a recommendation about reviewing the training given to staff in relation to supporting people who are at high risk of choking.

People had good access to medical support and other health and social care professionals when needed. The principles of the Mental Capacity Act were met. 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.

Care was provided in a kind and compassionate way. Staff took into consideration people’s wishes and preferences and tailored their care around these. People’s dignity and privacy was upheld and their diverse needs and beliefs supported. Relatives and friends were made to feel welcomed and were seen as integral to supporting people’s wellbeing.

People and where appropriate, their relatives, were involved in planning their care. Care plans gave staff guidance on how people wished their care to be delivered. People were supported to take part in activities, which they enjoyed and enabled them to be socially included. Arrangements were in place for complaints and areas of dissatisfaction to be raised, listened to and resolved, where possible. People were supported to have a dignified and comfortable death. End of life wishes and preferences were discussed and met. Relatives and those who mattered to people were supported at the time of a person’s death and afterwards.

The service was led by a proactive registered manager. They were involved in initiatives and projects which improved the services provided to people who lived in the home, but which also made a wider contribution to improvements in adult social care generally. They were an effective communicator who could also listen, reflect on and use the feedback provided by people, visitors and staff to improve the service. They valued their staff and empowered them to challenge practices and to make ideas and suggestions. They went out of their way to make sure people’s individual life achievements and contributions were recognised and celebrated.

The registered manager ensured the home was in a position to maintain best practice and that it continued to have links with professionals, forums, agencies and places of learning, which could support this. There were arrangements in place to monitor performance, which they continually reflected on in order to drive further improvement. Strong links with the community had been made which benefited those who lived in the home. The home provided the local community with a valuable resource, but was also in the position to act as a resource for other adult social care services and professionals.