This inspection took place on 16 January 2019 and was unannounced.

Millreed 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. The home provides nursing and personal care for up to 33 older people, some of who may be living with dementia. Accommodation is provided on two floors with passenger lift access between floors. There are communal areas on the ground floor, including a quiet room, lounge, conservatory and dining room. There were 24 people in the home when we inspected.

At our last inspection on 13 June 2018, we rated the service as ‘Inadequate’ and in ‘Special Measures’. We identified six regulatory breaches which related to staffing, safe care and treatment, recruitment, person-centred care, consent and good governance. Following the inspection the provider sent us an action plan which showed how the breaches would be addressed. This inspection was to check improvements had been made and to review the ratings.

At this inspection we found improvements had been made and the regulatory breaches had been met.

The service had a registered manager who had started in post in August 2018. 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.

Staff knew how to manage any risks to people and keep them safe. There were enough staff to ensure people received the care and support they needed. Medicines were managed safely which meant people received their medicines as prescribed. People’s nutritional and healthcare needs were met. Systems were in place to manage complaints.

The home was kept cleaned and well maintained. Some fire safety works had been identified by the fire authority and the provider was addressing these. The home had an ongoing refurbishment plan and we recommended the provider sought guidance on making the environment more dementia friendly.

People were supported to have maximum control and choice over their lives and staff supported them in the least restrictive way possible. Policies and systems in the service supported this practice.

Staff were recruited safely and received the training and support they required to fulfil their roles. Staff worked well together as a team and communication was good.

New care documentation had been introduced and people’s care records were more person-centred. This work was ongoing to ensure all care records fully reflected people’s current needs. Activity provision had improved and we saw people enjoying a range of activities on a group and individual basis.

People were happy with the care they received. Staff treated people with respect and compassion and maintained their privacy and dignity. There was a happy, relaxed atmosphere and staff had developed positive relationships with people.

Management and leadership of the service had improved. People, relatives and staff were unanimous in their praise of the registered manager. Effective audits systems were in place and the provider had an ongoing action plan to make further improvements to the quality of the care and service.

This inspection took place on 13 June 2018 and was unannounced.

At our last inspection on 3 May 2016 we rated the service as ‘Good’ and there were no regulatory breaches.

Millreed Lodge 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. The home provides nursing and personal care for up to 36 older people who may be living with dementia. Accommodation is provided on two floors with lift access between floors. There are communal areas on the ground floors, including lounges and a dining room. There were 27 people in the home when we inspected.

The home 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 standards had declined in some areas since our last inspection in 2016 and at this inspection we identified several regulatory breaches.

Medicines management was not safe which meant people were at risk of not receiving their medicines when they needed them.

Staff had received training in safeguarding and understood the reporting systems. Safeguarding incidents were reported to the local authority safeguarding team. We found risks to people were not always properly assessed or managed well, particularly in relation to fire safety. Following the inspection we referred our concerns to the fire authority.

We found there were not enough staff to keep people safe and meet their needs. We saw people were left unattended for long periods of time and had to find staff to assist with a person who was walking about and at risk of falling. Staff recruitment procedures were not always robust as checks had not been made to establish employment history or ensure appropriate references had been obtained.

Staff induction was not thorough and did not prepare staff for their roles. Staff were up to date with most of their training and specialised training for conditions such as epilepsy and diabetes, had been booked.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible; the policies and systems in the service did not support this practice.

People’s care records were not personalised and did not reflect people’s needs or preferences. There was not enough detail to guide staff about the care and support people required. People’s nutritional needs were met, although the completion and monitoring of food and fluid charts was poor. People had access to healthcare services and systems were in place to manage complaints.

People and relatives told us there were few activities which our observations confirmed. People and relatives told us staff were kind and caring. We saw some caring interactions but also practices which showed a lack of respect for people.

The provider’s systems and processes did not enable them to effectively assess, monitor and improve the service. They did not monitor and mitigate risk effectively.

We found shortfalls in the care and service provided to people. We identified six breaches in regulations – staffing, safe care and treatment, recruitment person-centred care, consent and good governance. The Care Quality Commission is considering the appropriate regulatory response to resolve the problems we found. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’.

Services in special measures will be k

We inspected Millreed Lodge Care Home on 3 May 2016 and the visit was unannounced. Our last inspection took place on 18 August 2015. At that time, we found the provider was not meeting the regulations in relation to privacy and dignity, safeguarding service users from abuse and improper treatment, safe care and treatment, good governance and staffing. We told the provider they had to make improvements and found on this inspection the necessary improvements had been made.

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 19 people in residence and two people were in hospital.

The accommodation is arranged over two floors and there is a passenger lift. All 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 and there were enough staff to take care of people and to keep the home clean. Staff were receiving appropriate training and they told us the training was good and relevant to their various roles. Staff told us they felt supported by the registered manager and area manager and were receiving formal supervision where their could discuss their on-going development needs.

People who used the service and their relatives told us staff were helpful, friendly and caring. We saw people were treated with respect and compassion. They also told us they felt safe with the care they were provided with. We found there were appropriate systems in place to protect people from risk of harm.

The cook had a good knowledge of people’s dietary needs and preferences. People told us there was a choice of meals and the food was good. We also saw there was plenty of drinks and snacks available for people in between meals.

Care plans were up to date and detailed exactly what care and support people wanted and needed. Risk assessments were in place and showed what action had been taken to mitigate any risks which had been identified. People who used the service and relatives told us they were happy with the care and support being provided. We saw people looked well groomed and well cared for.

People’s healthcare needs were being met and medicines were being managed safely.

Activities were on offer to keep people occupied both on a group and individual basis. The activities co-ordinator was aware of people’s interests and was providing relevant sessions for them.

We found the service was meeting the legal requirements relating to Deprivation of Liberty Safeguards (DoLS).

We saw some redecoration and refurbishment had taken place since our last inspection to improve the living and bedroom accommodation. We also saw there was a plan in place to continue with a programme of environmental improvements.

People told us the cleanliness of the building had improved . We found the home to be clean, tidy and odour free.

Visitors told us they were made to feel welcome and could visit at any time.

A complaints procedure was in place and people told us if they had any concerns they would tell the registered manager.

We saw systems had been introduced to monitor the quality of the service. We saw these were identifying areas for improvement and actions had been taken to address any shortfalls identified. People using the service and relatives were being consulted about the way the service was being managed and their views were being acted upon. We concluded as the audits were relatively new the provider needs to ensure the development of their quality systems continues so they can be

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.

We spoke with five people living in the home, two relatives and six members of staff. These were some of the things they told us:

“The staff are very good; I get the help that I need.”

“The home is kept clean and tidy.”

“The food is good and there is always a choice.”

“I am satisfied with the care and support my relative gets here. The staff have also made sure that I am alright.”

“I am always made to feel welcome when I visit and I can have a meal with my relative.”

“We have a good staff team here and I love my job. I would be happy for my relative to live here.”

“We are like a family and I enjoy coming to work.”

We found that people’s care was being planned and delivered in the way they preferred. The medication system was being managed safely and people received their medication at the correct times.

Our conversations with people and staff, together with observations on the day of our inspection evidenced that there were not always enough staff on duty.

The provider had appropriate systems in place for gathering and evaluating information about the quality of care the service provided.

People were protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were maintained.

We did not speak to people using the service during this inspection visit because at the last two visits in September 2012 and May 2012, people told us received they good good care.

During this inspection we looked only at care records and observed care. The care records we looked at provided a detailed description of the care people required. There were systems in place to ensure any referrals to health and social care professionals were made swiftly. We observed positive interaction between care staff and people using the service. We saw people were offered drinks, had their personal care needs responded to in a timely manner and staff explained to people what they were doing.

We spoke with five people living in the home and these are some of the things they told us:

“The food is very good. I am very happy here it’s very nice. People are right good with me.”

“I can do what I want. The staff are very kind, we are well looked after. The foods not bad either.”

“I had a choice of three homes, the manager from here came to see me in hospital and I decided to come here. Any complaints I had have been sorted out.”

“The food, staff and accommodation are good.”

We used a number of different methods to help us understand the experience of people using the service, because some people using the service had complex needs which meant that they were not able to tell us their experiences.

People who were able told us that they felt safe living at the home and that they were happy with the accommodation provided. They also told us that they were happy living at the home and staff looked after them very well.

We spoke with several relatives and they told us they were happy with the standard of care people receive at Millreed Lodge. One person said “I cannot fault the care and support my relative receives” another said “The manager and staff have a good understanding of people’s needs and in my opinion people are very well cared for.”

We spoke with two visiting healthcare professionals and they told us that they had no concerns about the standard of care provided at the home.