• Care Home
  • Care home

Mill House

Overall: Inadequate read more about inspection ratings

51 Mount Pleasant, Bilston, West Midlands, WV14 7LS (01902) 493436

Provided and run by:
Mr Ragavendrawo Ramdoo & Mrs Bernadette Ramdoo

Important:

We issued an urgent notice of decision to vary a condition on Mr Ragavendrawo Ramdoo & Mrs Bernadette Ramdoo on 24 June 2024 for failing to ensure people were safe and exposing them to the risk of harm at Mill House.

Important: We are carrying out a review of quality at Mill House. We will publish a report when our review is complete. Find out more about our inspection reports.

All Inspections

During an assessment under our new approach

Date of assessment 20 June 2024 to 21 June 2024. This inspection was prompted in part by notification of an incident following which a person using the service sustained a serious injury. This incident is subject to further investigation by CQC as to whether any regulatory action should be taken. As a result, this inspection did not examine the circumstances of the incident. However, the information shared with CQC about the incident indicated potential concerns about the management of risk of falls and when people were displaying periods of emotional distress. This inspection examined those risks. The service remains rated as inadequate. Since our last assessment, the provider had not taken the necessary action needed to keep people safe. Risks to people were not always identified or actioned and they were exposed to the risk of harm. We found 1 breach of the legal regulations in relation to safe care and treatment. In instances where CQC have decided to take civil or criminal enforcement action against a provider, we will publish this information on our website after any representations and/or appeals have been concluded.

During an assessment under our new approach

Date of assessment 7 March 2024 to 14 March 2024. This assessment was carried out to follow up on action we told the provider to take at the last inspection. The service remains rated as inadequate. Mill House is a residential care home providing personal care to up to 24 people in 1 adapted building. The service provides support to older people some of whom are living with dementia. At the time of our inspection there were 19 people using the service. People remained at risk of harm. Since our last inspection, the provider had commissioned the services of a consultant. The systems that had been introduced since our last inspection were not effective in identifying areas for improvement and we found the same concerns as those identified at our last inspection. Risks to people were not always identified or actioned. There were not enough staff to keep people safe. There were still concerns with the environment. Safeguarding procedures were not always followed which placed people at risk of potential abuse. Staff still did not always have the training required to support people. When needed people did not always have their mental capacity considered or decisions made in their best interests. It was unclear when Deprivation of Liberty Safeguards were in place. People’s needs were assessed, however these were not always accurate and up to date and therefore not person-centred or individual to people. However, the home was clean, people were happy with the care they received and staff knew them well. When people had health needs they had access to health professionals. We found 5 breaches of the legal regulations in relation to safeguarding, safe care and treatment, need for consent, staffing and governance. In instances where CQC have decided to take civil or criminal enforcement action against a provider, we will publish this information on our website after any representations and/or appeals have been concluded.

23 August 2023

During an inspection looking at part of the service

About the service

Mill House is a residential care home providing personal and nursing care to up to 24 people in one adapted building. The service provides support to older people some of who are living with dementia. At the time of our inspection there were 24 people using the service.

People’s experience of using this service and what we found

Risks to people were not safely managed. Risks had not always been assessed or monitored and staff were not consistently provided with guidance to reduce those risks.

People were not receiving safe care. Staff did not have sufficient information to be able to ensure they understood how to manage risks to people from distress and anxiety, falls, pressure injuries and specific health conditions.

Incidents of potential abuse were not investigated and reported to the appropriate body for investigation. Where potential abuse had been identified by staff this had not been acted upon to ensure people were safeguarded from the risk of harm.

There was insufficient staff to ensure people had their needs met when they required support. We saw people were left unsupervised when they should have monitored continually by staff to keep them safe.

The service was not in good repair and there were concerns with infection control measures in place. People's medicines administration was not consistently documented.

When incidents and accidents occurred staff were recording these but there were no actions taken to review these and prevent reoccurrence.

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 and in their best interests; the policies and systems in the service did not support this practice.

People were supported to access health professional visits however where guidance was given to support people with their health needs this was not always clearly documented within people's care plans.

People did not consistently have their needs assessed and care plans put in place to meet their needs.

Staff training was not consistently up to date and there was inconsistent evidence of checks on staff competency.

There was limited management oversight in the service and quality and safety systems were not robust. Issues were not always identified in a timely manner which meant actions were not taken leaving people at risk of harm.

Governance systems in place to manage the service had not identified all the concerns we found during the inspection. CQC had not been notified of significant events as required.

People received enough to eat and drink and told us they enjoyed the food. Recruitment processes were safe to ensure only suitable people were employed.

Rating at last inspection and update

The last rating for this service was requires improvement (published 8 February 2022)

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found the provider remained in breach of regulations.

Why we inspected

We received concerns in relation to medicines, infection control and staffing. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to inadequate based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe, effective and well-led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We have identified breaches in relation to safe care and treatment, protecting people from abuse, consenting to care, staffing and governance at the home at this inspection.

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.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.

23 November 2021

During an inspection looking at part of the service

About the service

Mill House is a care home providing support with personal care needs to a maximum of 24 older people. Accommodation is provided in a purpose built two storey building and at the time of the inspection, 22 people were using the service, some of whom were living with dementia.

People's experience of using this service and what we found

Risks to people's safety and well-being were not fully considered and plans to mitigate risks were not in place. Infection prevention and control procedures did not ensure people would be protected from the risk of infection. People were not protected from harm when using equipment at the home.

Systems in place to monitor the quality and safety of the service were not effective. The provider had failed to act on the breaches of regulations identified at our last inspection.

People received their medicines when they needed them, and systems were in place to ensure that medicines were stored and administered safely and that adequate supplies were available. People were protected from the risk of abuse. Accidents and incidents were investigated to identify measure to prevent re-occurrences. Staff were recruited safely.

People received care in accordance with their needs and preferences. People were supported to maintain contact with their friends and families. There were opportunities for social stimulation. People felt their concerns and complaints would be listened to and responded to. People had plans relating to end of life care decisions where required.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection.

The last ratings for this service was requires improvement (report published 24 October 2019) and there were two breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection not enough improvement had been made and the provider was still in breach of regulations.

Why we inspected

We undertook this focussed inspection due to concerns we had received about the management of Mill House. As a result, we undertook a focused inspection to review the key questions of safe, responsive and well-led only. The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe and well led key sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

The overall rating for the service has remained the same. This is based on the findings at this inspection.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Mill House on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection.

We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so. We have identified breaches in relation to safe care and treatment, premises and equipment and good governance at this inspection. 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.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

17 September 2019

During a routine inspection

Mill House is a care home providing personal care and accommodation to 24 older adults. Care is provided on two floors, with bedrooms and communal areas on both floors. Some of the people are living with dementia. The service can support up to 24 people.

People’s experience of using this service and what we found

Medicines were not always managed in a safe way, when needed guidance for as required medicines was not always in place. People did not always receive their medicines as prescribed. Risks to the environment including infection control concerns had not always been assessed or identified. The audits completed in the home were not always effective in identifying areas of improvement. The provider did not always seek feedback from people living at the home or use this information to make changes. People felt there could be more to do and there was a lack of activities taking place during our inspection.

Some individual risks to people were considered and these were reviewed and some lessons were learnt when things went wrong. Staff understood safeguarding and when people may be at risk of harm. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service support this practice.

People were supported by sufficient kind and caring staff who had the relevant skills. Peoples independence was encouraged and their privacy and dignity maintained. Staff knew people well, the support they needed and their preferences. People enjoyed the food and were offered a choice. People had access to health professionals when needed.

Staff felt supported and listened to. There was a registered manager in place who understood their responsibility around registration with us. Complaints were responded to in line with the providers procedure.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (16 January 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have found evidence that the provider needs to make improvements. Please see the safe, responsive and well led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

We have identified breaches in relation to the management of medicines and environmental risks. We also found concerns with the governance in the home as systems and audits were not always in place to identify areas of improvement.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

15 December 2016

During a routine inspection

This unannounced inspection took place on 15 December 2016. At our last inspection visit in October 2015 we found the provider was meeting the regulations. Mill House is a care home which provides accommodation and personal care for up to 24 people. At the time of our inspection 21 people lived at the home.

The home had a registered manager in post. 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.

People told us they felt safe in the home. Staff we spoke with were aware of their responsibilities to keep people safe and report any allegations of abuse. People’s individual risks were assessed. There were sufficient numbers of staff to meet people’s needs. People received their medicines as prescribed and systems were in place to store and dispose of medicines safely. The provider had processes in place to ensure staff were recruited safely and that they had the training and skills to meet people’s needs. Staff obtained consent before they provided care. Staff understood people’s decisions when supporting people and worked to ensure people’s best interests were met. People enjoyed their food and had choices regarding their meals. People were supported to access health care professionals to meet their health needs.

People said staff were kind and caring and treated them with dignity and respect. People felt involved in their day to day choices and were supported by staff to maintain their independence. People and their relatives were involved in developing their care plans and people received care that met their needs. People told us they were happy living at the home and took part in a number of different activities. People and relatives knew how to raise any concerns and were confident any issues would be addressed.

People and staff told us the registered manager was approachable and supportive. Staff understood their roles and responsibilities. People and their relatives were encouraged to share their opinions about the quality of the service received. Effective audit systems were in place to assess and monitor the quality of service provided.

1 and 2 October 2015

During a routine inspection

Our inspection took place on 1 and 2 October 2015 and was unannounced. We last inspected the service on 28 September 2013. We did not ask the provider to make any improvements at this inspection.

Mill House provides personal care and accommodation for up to 24 older people, some who may live with dementia. There were 22 people living at the service when we carried out our inspection.

The service had a registered manager at the time of our inspection. 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.

People told us that they felt safe and they were treated well by staff. The registered manager and staff had a good understanding of how to keep people safe and escalate any concerns appropriately. People said they had to wait for assistance at night on occasions and staff did not always have time to support them with their pastimes and stimulation. People told us they were given their medicines when needed.

People told us, and we saw care and support was provided in a way that showed staff were kind and considerate. Staff were knowledgeable about people’s care and support needs, and were supported with appropriate training. People were supported to make their own decisions and choices by staff who understood and promoted people’s rights and worked in their best interests. People’s healthcare needs were promoted and regular appointments with healthcare professionals were maintained.

People told us they enjoyed the food and drink they were provided with and this was provided when requested and in sufficient quantities. We saw staff provided appropriate assistance to people that needed help to eat and drink and there were systems in place to ensure people at risk of weight loss were monitored, although we saw the availability of staffing did impact on staff ability to consistently provide people support with their meals when needed.

People told us the staff were kind to them. We saw people had developed positive working relationships with the staff who supported them. People told us that they were well cared for and staff understood what was important to them. Staff demonstrated a good knowledge of what was important for people and what was recorded in their care records. The confidentially of people’s information was compromised when staff shared information about people.

People's needs were assessed and their support plans provided staff with guidance about how they wanted their individual needs met. People participated in a range of activities and pastimes that reflected their individual interests and preferences, although staff did not always have time to support people with these pastimes.. People knew who to speak with if they had any concerns and were confident these would be addressed.

The provider assessed and monitored the quality of the service. There were systems in place to gain people’s views on the service. There were also systems in place to monitor the quality of the service such as a range of management audits. People and staff told us they found the registered manager and other senior staff approachable and we saw the registered manager was visible within the service. Staff felt well supported and were aware of the provider’s values and vision in striving to provide good quality care. The provider had not always formalised their plans for improvement of the service in a way that could be easily shared with stakeholders.

6 November 2013

During a routine inspection

At the time of our inspection the provider did not have a registered manager in post.

We spoke with six people who lived at the home and two visiting relatives. We observed how care was provided to people and looked at five people's care records. We spoke with four staff, the acting manager and the provider. We also looked at other records relating to the management of the home.

People told us they were asked for their consent in respect of daily routines. We saw that staff gained consent from people who were not able to express their views through observation of their reactions. One person told us, 'Staff are very good, they do ask permission'.

People and a visitor we spoke with expressed satisfaction with the care and support that staff provided to people. We saw people were provided with care and support as set out in their care plans. One person told us that, 'Staff are okay, they are very helpful'.

People told us they had a choice of meals and were happy with the meals that they had. We saw that people who were more dependent were supported to ensure they had sufficient nutrition and hydration.

Staff told us that they were well supported by the provider and received sufficient training to ensure they were able to care for people safely and to an appropriate standard.

We saw the provider had effective systems to assess and monitor the quality of service.

7 December 2012

During a routine inspection

We spoke with three people that lived at the home, one visitor, three staff and the acting manager during our inspection.

We saw staff engaged positively with people and took steps to promote people's privacy and dignity. We saw that staff knocked bedroom doors before entering people's rooms, spoke to people respectfully and routinely offered them choices. People also told us how staff enabled them to retain their independence where possible.

People told us that they were happy with the care and support they received saying, 'It's alright' at the home and, 'Staff are very good really'. A visitor told us that they had,'Every confidence' with the service.

We saw that people's needs were assessed and their care was planned and delivered in line with their care plans. We found that people had regular access to health professionals for advice and treatment.

People felt able to share their views and raise any comments with the home. We saw that the manager responded appropriately to comments or concerns that people made to them. There were also systems in place to identify, assess and manage risks to the health, safety and welfare of people who use the service and others. This included making sure there was sufficient and safe equipment available that was needed to ensure people's needs were met safely.

22 July 2011

During an inspection looking at part of the service

People told us at the time of our last review of compliance that the home is always clean and there are never any smells. They also told us that their beds are changed on a regular basis. One person commented on having watched cleaners do their job, and was satisfied with the way this was done. One person living at the home has participated in infection control training with the staff, their certificate displayed on a wall in the home.

People we spoke during the course of our last review of compliance told us that they were happy with their bedrooms, one saying that the availability of ensuite facilities was a benefit. One person told us that they liked sitting in the garden which they could access when wished. We were also told that people are able to bring their own furniture in and personalise their rooms should they wish.

People told us that they are confident in the homes current manager. Other professionals have told us that the service has improved since the current acting manager has been at the home, this meaning outcomes for people living there have improved.

A relative of a person living at the home told us that 'it's a very good home' and that the manager was 'brilliant'.

6 April 2011 and 10 September 2012

During an inspection in response to concerns

People we spoke to told us that they're satisfied with the care and support that they receive. They also told us that they were able to make choices around their day to day routine and how their support was provided.

We heard that staff "care pretty well' are "kind to them" and "staff very helpful". We were told that they "do hair, do nails, make sure have decent clothes on, If want anything will get." and "get what I want they're all pretty good in here, happy with care arrangements, couldn't be much better its alright'.

People told us that they're encouraged to be independent and undertake their own care where able, with staff encouraging them. We also heard that the people thought that the care has improved since last summer and there are more activities for people to take part in.

None of the people we spoke to said they had seen their care plan, although none were concerned about this and told us they felt involved in their care.

People we spoke to had differing views as to the quality of the food available to them at the home some telling us it was 'adequate' and not as good as they used to have at home. Others told us that the 'food is pretty good' and the 'meat melts in your mouth', with foods very easy to digest. Everyone we spoke to told us they had a choice of foods available to them, with staff asking them what they wanted prior to the meal. People also told us that they could choose where they had their meals.

People told us that meals that are prepared for those who have difficulty digesting or chewing their foods are well presented with separate foods not mixed together but presented 'like a proper meal'.

People told us that they feel safe living at Mill House. One person told us that they 'Know she is safe here' in respect of their relative who lived at the home, and 'never see poor treatment of residents'. Another person told us of an issue of concern that they raised with the acting manager and said that they 'did something about it as soon as she knew'; with the outcome that the person was left with confidence in management and the way they protected people at the home.

Others also told us that they have choices and there are no restrictions at the home, and it was said that if wished to go out, and there was a risk due to frailty staff would go out with people if not at the time, by arrangement.

People told us that the home is always clean and there are never any smells. They also told us that their beds are changed on a regular basis. One person commented on having watched cleaners do their job, and was satisfied with the way this was done.

People we spoke to told us that they were happy with their bedrooms, one saying that the availability of ensuite facilities was a benefit. One person told us that they liked sitting in the garden which they could access when wished. We were also told that people are able to bring their own furniture in and personalise their rooms should they wish.

People told us that they receive assistance from staff when needed and they respond to calls for assistance. We heard that 'staff come quickly when called' and that 'usually staff quick at coming'. People told us that there are two staff available at night and they are aware that they check on them.

People raised a number of concerns earlier last year about how their care was provided, this indicating staff skill and knowledge was lacking. Examples of this related to how people were handled and how people's rights were promoted. Comments made to us by people living at the home at the time of our visits showed that there was confidence and satisfaction with the way staff cared for them, indicating that the former concerns have been addressed.