The inspection took place on 09 March 2015 and it was unannounced.
Millstream House is a residential care home located in Strood. The home provides accommodation for up to 22 people who have a diagnosis of Huntington’s Disease and acquired brain injury. The home is set out over three floors, with lift access throughout. Some people had mobility difficulties, sensory impairments and some received their care in bed. There were 14 people living at the home.
The home had 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.
The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 came into force on 1 April 2015. They replaced the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
People said they felt safe living in the home. One person told us, “Staff are very good here and I am happy”. Relatives told us that their family members received safe care.
There were insufficient numbers of staff working at the home at times. Every person had high levels of care and support needs and required additional support when accessing the community. Staff had to complete other tasks which reduced the time they were able to spend with the people.
Staff were clear about their roles and responsibilities and knew who to report to if they suspected abuse. The safeguarding policy did not detail the names and numbers of organisations that abuse should be reported to and did not link to the local authority multiagency safeguarding vulnerable adult’s policy, protocols and guidance. We have made a recommendation about reviewing safeguarding policies and procedures.
Each person had an individual risk assessment. However, these had not always been updated or reviewed when people’s needs changed to make sure they were protected from harm. We made a recommendation about reviewing and updating risk assessments.
When people required their food and fluid intake to be monitored this was not always recorded clearly. One person’s drink had not been thickened in accordance with the dietician’s advice and placed the person at risk of choking and dehydration.
Some people’s care plans had been reviewed and updated regularly to reflect changes in people’s health. However, some care plans had not. Staff would not have up to date details on each person’s care needs. Records were not always maintained to acceptable standards. We found records that had not been completed accurately.
There was a complaints procedure in place. Information about how to complain was displayed in the entrance lobby so that people knew how to make a complaint. People were asked about their views through meetings and annual surveys. Complaint investigation records were not available for us to view so we were unable to check what the details of complaints investigations.
There were procedures to follow in the event of a fire so that staff knew how to protect and evacuate people. The home was clean, tidy and well-presented following redecoration. A healthcare professional told us that the home’s décor had significantly improved and was light and airy. Maintenance records showed that repairs were carried out promptly.
Medicines were stored and administered safely so that people received the medicines they needed.
The provider followed safe recruitment procedures to ensure that staff working with people were suitable for their roles. Staff had received training relevant to their role and had the skills and competence to provide care and support to people. Staff received good support from their manager and regular supervision.
The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Best interests meetings had taken place with relevant people. Where people were subject to a DoLS, the registered manager had made appropriate applications. The registered manager understood when an application should be made was aware of a Supreme Court Judgement which widened and clarified the definition of a deprivation of liberty.
Staff understood how to protect people’s rights. Where people had difficulty communicating staff knew how to communicate in ways people could understand. Staff listened to and respected decisions made by people. People’s care files included personalised decision making profiles and a decision making agreement. These showed how relatives were involved when people lacked capacity.
People were offered a choice of meals and were given regular drinks throughout the day. There was plenty of food including appropriate foods for people with a specific dietary requirement. The cook understood how to fortify foods for people at risk of malnutrition. People’s weight had been regularly monitored and their nutritional needs had been reviewed by healthcare professionals.
People received medical assistance from healthcare professionals including district nurses, optician, chiropodist, psychiatrist and their GP. They attended hospital appointments when needed. The home worked closely with a local hospice to ensure that people’s preferences and choices for their end of life care were recorded.
People were treated with respect and dignity, kindness and compassion. Their personal records were stored securely.
People gave mixed feedback about the activities available. The activities coordinator organised a range of activities for people to choose from. However, people who were not able to verbally communicate spent periods of up to two hours at a time with no engagement in activities.
Relatives told us that they had been involved with developing and reviewing care plans. They told us they could visit at any time and were kept informed about their family member. Care files included detailed assessments of people’s needs and reflected what people could do for themselves. People’s daily records showed that staff had provided responsive care which met their needs.
People felt the home was well run. Staff felt confident to raise concerns if they had any. They were aware of the whistleblowing policy.
The staff team and home had been recognised in a number of ways. The local authority had received positive comments from relatives which led to the home winning a ‘Pride in Medway’ award in 2013. Further positive comments had been received by the provider in 2014 which resulted in the staff team at Millstream House winning ‘team of the year’.
There were effective quality assurance systems and the registered manager carried out regular checks on the home to make sure people received a good service. A consultation and improvement plan had been developed to show actions that had been taken when shortfalls had been identified.
You can see what action we told the provider to take at the back of the full version of this report.