We carried out an inspection of Mill Lodge Residential Care Home on 16 and 17 October 2018. The first day was unannounced.

Mill Lodge Residential Care Home is located in the town of Great Harwood, near Blackburn. There are facilities on two floors, which could be accessed by a passenger lift. There was a small seating area and car parking to the front of the house.

Mill Lodge Residential Care Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as a 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 care home accommodates 16 older people, some of whom were living with dementia. At the time of the inspection, there were 11 people living in the home. Nursing care is not provided by the service.

The service was managed by a registered manager who is also one of the service providers. 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.

At the last inspection carried out on 2 and 5 February 2018, we found breaches of the regulations in respect of medicines management, risk management and a lack of effective monitoring systems. We also found the service had failed to notify CQC about serious incidents and deaths in the service. The provider was served with a penalty notice (fine) for failing to send us notifications in relation to notifiable incidents and events in the home.

At the last inspection, the overall rating for the service was 'Inadequate' and the service was placed in special measures. This meant the service was kept under review and an inspection would be undertaken within six months to ensure significant improvements have been made. At that time, we asked the provider to complete an action plan to show what they would do to improve the service and by when.

Following the last inspection, regular meetings had been held with the registered persons, CQC, the local authority safeguarding team and the commissioners of services. The clinical commissioning group medicines optimisation team, infection prevention control team and local commissioners of services had worked with the management team and staff to support them with improvements. The provider had voluntarily suspended admissions to the home until the commissioners were satisfied that significant improvements had been made. A recent agreement was in place to allow a restricted number of admissions to the home. An action plan was available to support further improvements and was regularly updated by the provider and shared with local commissioners and CQC.

At this inspection, we found the rating had improved to ‘Requires Improvement’.

We found the registered manager and staff had made a number of needed improvements since our last inspection. However, some of these improvements had been introduced over a short period of time and further work was needed to embed these processes into the day to day practice at the home. In addition, our findings demonstrated there was a continued breach of the regulations in respect of management of medicines and a lack of effective monitoring systems. We also found an breach of the regulation in respect of records management. You can see what action we asked the provider to take at the back of the full version of the report.

New quality assurance and auditing processes had been introduced to help the registered manager to effectively identify and respond to matters needing attention. We saw evidence of regular monitoring that had identified shortfalls in the service and appropriate action had been taken to address the shortfalls. However, the audit tools had not identified the shortfalls found duri

This unannounced inspection took place on 02 and 05 February 2018.

Mill Lodge Residential Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a 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 care home accommodates 16 people. At the time of the inspection, there were 11 people who received support with personal care as nursing care is not provided at this home.

The service was managed by a registered manager who is also one of the service providers. 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 the last inspection in October 2016, the service was rated ‘Good’.

At this inspection we found that the quality and safety of the service had deteriorated. We found shortfalls in relation to the management of risks associated to receiving care. This was because staff had not always sought medical advice when people had suffered unwitnessed falls and had failed to report serious injuries to safeguarding authorities; quality assurance systems were not effective in identifying shortfalls or areas where the service was not meeting regulations and failure to drive improvements. There was a failure to notify the Care Quality Commission of serious incidents in the service and notifications of death had not been submitted.

We found there were five breaches of the Regulations. These were breaches of Regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and a breach of Regulation 16 and 18 of Care Quality Commission (Registration) Regulations 2009. You can see what action we told the registered provider to take at the back of the full version of the report. Full information about CQC’s regulatory response to the more serious 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 kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, it 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.

The systems and processes for monitoring and assessing quality in the ho

We carried out an unannounced inspection at Mill Lodge Residential Care Home on the 23 August 2016.

Mill Lodge Residential Care Home is situated in a residential area towards the outskirts of Great Harwood, Lancashire. The accommodation includes a small lounge and a dining room with a conservatory. There is one double bedroom and 14 single bedrooms over two floors. A passenger lift provides access to the first floor. The home accommodates older people who may also have dementia.

At the time of this inspection there was a registered manager who had been in post since December 2010. 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 registered manager was supported in her role by the home’s assistant manager.

The service was last inspected on the 18 June 2014. We found it was meeting all legal requirements applicable at that time.

During this inspection, we found the service was meeting the current regulations.

People indicated they felt safe whilst living at the service. People also added they were happy with the care they received and felt the care received was delivered by professional, caring and compassionate staff.

The provider ensured processes were in place to maintain a safe and appropriate environment for the people using the service, their visitors and staff members. Training was in place for staff to ensure they were competent in recognising the signs of abuse and could appropriately and confidently respond to any safeguarding concerns and notify the relevant authorities when required.

The service conformed to the requirements of fire safety by ensuring fire audits were up to date and relevant checks were carried out on a weekly basis to fire equipment and lighting. People using the service had personal evacuation risk assessments in situ and an additional contingency plan provided direction about what to do in the case of an emergency or failure in utility services or equipment.

The service had sufficient number of staff to support the operation of the service and provide people with safe and personalised care. People told us they never felt rushed and staff were responsive to their needs. A suitable amount of training was offered to all staff to ensure staff were equipped with the correct skills and knowledge to effectively support people in an informed, confident and self-assured manner. Recruitment processes were suitable and designed to protect people using the service by ensuring appropriate steps were taken to verify new employee’s character and fitness to work.

The service had processes in place for appropriate and safe administration of medicines. Staff were adequately trained in medicines administration. Medicines were stored safely and in line with current guidance. People had been consulted about their dietary requirements and preferences and we saw choice was given at every mealtime. We saw appropriate referrals had been made to dieticians and instructions were strictly followed in cases where people had known dietary requirements.

Staff displayed an awareness of the Mental Capacity Act 2005 and had completed appropriate training. Appropriate referrals had been submitted to the local authority by the home's manager and a good audit trail was seen.

The provider had considered and implemented adequate documentation to support the development of the care planning process and support the delivery of care. This was done by providing a detailed plan covering essential information care staff needed to follow, each plan was individual to the person’s need and were kept under regular review. Effective systems were implemented to maintained people's independence with daily living skills.

Staff interacted and en

The purpose of this inspection was to check that the provider had complied with the warning notice in respect of supporting workers issued following the last inspection. During our inspection visit we spoke with three members of staff, the manager and a person employed by an external organisation. We also looked at staff records.

Care workers told us that training was on-going. One care worker said, “We’re doing a lot of training.” We saw records which identified when members of staff had completed training and when further training was required.

There were records to demonstrate that a programme of staff appraisal and supervision was in place. Two care workers told us they had found their appraisal meetings helpful.

Our inspection on 13 January 2014 found that significant areas of the home were dusty and dirty and appropriate procedures for the prevention and control of infection were not in place. Some areas of the home were cold and general maintenance of the premises was below an acceptable standard. We visited the home again on 14 March 2014 to check whether the necessary improvements had been made.

We found that significant improvements in the standard of cleanliness in the home had been made since the last inspection. The home was clean, tidy and free from offensive odours. There was evidence to demonstrate that all members of staff had commenced training in the prevention and control of infection.

We saw that an extensive programme of redecoration and refurbishment of the home was in progress in order to improve the environment for people using the service. One visitor told us their relative had a nice room and they were happy with the care provided.

We found that members of staff were not receiving the training and support from management they needed in order to provide safe and effective care for people using the service.

We found that improvements to care planning had been made. We saw that care plans had been written sensitively and described people in respectful terms. One person told us they enjoyed the meals and received all the help they needed. She said, “The staff are brilliant.”

We saw that significant areas of the home were dusty and dirty. Appropriate procedures for the prevention and control of infection were not in place. This meant the provider had failed to maintain appropriate standards of cleanliness and hygiene in relation to the premises.

We found that some areas of the home were cold in particular the bedrooms. One person said, “I sit on my hands to keep them warm.” Repairs to furniture and fittings were required in some areas of the home. This meant the provider had not protected the people living in the home from the risks associated with unsafe premises.

Four people told us they liked living at Mill Lodge. One person said, “They look after us.” However, we saw that care records were not always completed in respectful terms. There was also a lack of meaningful activities for people with a dementia.

We found that suitable arrangements were in place for the safe keeping and handling of medicines.

We noted that recruitment procedures were thorough in order to protect people from the employment of unsuitable staff.

We saw that systems were in place to monitor the quality of the service provided. There was evidence to demonstrate that people were consulted about the care and facilities provided at the home.

People using the service told us they liked living at Mill Lodge and were satisfied with the care they received. One person said, “They look after you very well.”

We found some unsafe practices in the management of medication which could put people using the service at risk.

We observed members of staff speaking to people in a polite and friendly manner. One person told us she didn’t have to wait long when she rang the call bell for assistance.

Although we found that some improvements had been made to the system for monitoring the quality of the service provided this did not include the standard of cleanliness. We found several areas of the home were contaminated with dirt and dust.

People told us they were generally satisfied with the care and support they received at Mill Lodge. Two of the comments we received were: “It’s very good” and “It’s okay”.

People were enabled to make some decisions about matters which affected them. People were encouraged to maintain their independence skills. They told us they liked the food provided and they had choice menus. They told us they were treated with respect and their privacy was maintained. However we found there were some practices which did not effectively promote choices, privacy and independence.

We found some parts of the home were unclean, untidy and in disrepair which did not promote the wellbeing of people living in the home. However, the manager assured us action would be taken to address these matters.

People told us the care was good, they were getting support with their healthcare needs and they had ongoing attention from health care professionals. However we found some care plan records were not detailed and up to date, which meant peoples’ needs and choices may not be known and properly planned for.

People said they felt safe living at the home and they liked the staff. We found people using the service were supported by trained, capable staff.

We found there were shortfalls in systems for monitoring and checking the quality of the service. This meant reasonable steps were not being taken to ensure people receive safe, appropriate care.

People living in the home told us they liked living there. Staff were helpful and kind and treated them well. The help they got was what they wanted and needed. They told us they were “well looked after”. They were supported to access other health and social care services they needed.

Relatives and visitors to the home also considered people were cared for very well. Written comments such as, “My mother is treated with utmost care, patience and dignity”. And, “My family are very happy with the care shown to my 89 year old mother. She is well looked after and the home has a friendly family feel about it”, were made. One GP wrote, “I’ve been impressed with the attention to detail staff at Mill lodge show.”

People pleased themselves what they wanted to do. Staff took into account their views and respected their right to privacy and independence. We saw staff communicated well and appropriately with people. They responded to all requests for assistance in a timely manner.

People were cared for by staff that were carefully recruited, trained and supported. This helped to make sure their safety and well being was considered.

There were arrangements in place to safeguard people and staff had been trained. People were assessed to make sure they are given the right support and represented in their best interest. People were supported to give their views on how well the service met their needs.