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CQC report explained · a nursing home, run by Healthcare Homes

Mill Lane Nursing and Residential Home

79 Garrison Road, Felixstowe, IP11 7RW

Goodpublished 5 July 2023, 3 years ago

Rated Good: inspectors found the service performing well and meeting their expectations.

The five questions inspectors ask
Safe?
Good
People had risk assessments and staff had guidance to reduce risks such as falls, choking and pressure ulcers. Medicines were given as prescribed, and audits identified and addressed discrepancies.
Effective?
Good
This question was not inspected during this focused visit. Its previous rating was carried forward when calculating the overall rating.
Caring?
Good
This question was not inspected during this focused visit. Its previous rating was carried forward when calculating the overall rating.
Responsive?
Good
This question was not inspected during this focused visit. Its previous rating was carried forward when calculating the overall rating.
Well-led?
Good
The manager and provider had audits and monitoring systems, sought people's views and used feedback to improve the service. A new manager was in post and was applying to register.
The latest report, explained

What inspectors found, July 2023

Rated Good in a focused inspection; inspectors found safe care and strong oversight, but management was changing and some records had gaps.

This was an unannounced focused inspection on 15 June 2023. Inspectors looked only at Safe and Well-led. They spoke with people, relatives and staff, observed care, and checked care, medicines, recruitment, safety and management records.

Inspectors found systems to reduce abuse and manage risks. Staff were available, recruited safely and supported people with medicines as prescribed. The home was clean, visits had no restrictions, and accidents and incidents were reviewed for learning.

The home was rated Good overall, with Safe rated Good and Well-led rated Good. The other three questions were not inspected at this visit, so their previous ratings were used to calculate the overall rating. A serious incident had prompted the inspection, but its circumstances were not examined in this report.

What inspectors praised
  • Risk management

    Care records included assessments and guidance for important risks. Inspectors observed staff supporting people to move safely.

    People's care records included risk assessments which guided staff in how the assessed risks were to be mitigated.from the report
  • Staff availability

    Inspectors saw staff respond promptly to requests for help. Relatives said there were enough staff to meet people's needs.

    During our inspection we saw staff were available to attend to people's requests for assistance promptly, this included call bells.from the report
  • Medicines

    People received their medicines as prescribed. Monitoring and audits were used to find and address problems.

    People received their medicines as prescribed. Protocols provided guidance for staff to follow when administering, as required (PRN) medicines.from the report
  • Learning from incidents

    Accidents and incidents were recorded and reviewed for patterns. The home put actions in place to reduce future risks.

    Incidents and accidents were recorded, monitored by the manager and analysed.from the report
  • People's involvement

    People and relatives could share their views through complaints, surveys, compliments and meetings. Feedback was used to make improvements.

    People and relatives had the opportunity to share their views about the service in complaints, compliments, surveys and meetings.from the report
What inspectors were concerned about
  • Manager registration

    needs fixing

    There was no registered manager at the inspection. A new manager had been in post for 10 weeks and was applying to register.

    At the time of our inspection there was not a registered manager in post.from the report
  • Care records

    needs fixing

    Records showing the administration of creams had gaps. The records improved after the manager intervened.

    The manager had identified records of the administration of creams had gaps, once they had intervened, the records had improved.from the report
  • Communication

    minor

    One staff member said communication from management could be improved so that staff received the same messages about changes.

    However, another staff member said they felt communication from management could be improved, to ensure all staff received the same messages about changes made.from the report
Questions to ask them, based on this report
  1. 01Has the new manager's application to register with CQC been completed, and who is overseeing the home until then?
  2. 02How are cream administration records checked now, and have any further gaps been found?
  3. 03What changes have been made to ensure all staff receive the same information from management?
  4. 04What is the current position of CQC's further investigation into the serious incident mentioned in the report?
  5. 05How many agency staff are currently being used, and how are regular staff being maintained for consistency?

This was an unannounced focused inspection of Safe and Well-led only; the other three ratings were carried over from the previous inspection published in 2019. This explanation was written from the published report of 5 July 2023 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.

The story over the years

Every inspection of Mill Lane Nursing and Residential Home

4 rated inspections over 8 years: the service has improved, from Requires improvement to Good.

  1. July 2023Goodcurrent ratingstayed Good
    Safe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good

    Read what inspectors found at Mill Lane Nursing and Residential Home

  2. February 2019Goodstayed Good
    Safe: GoodWell-led: Good

    We are reading this report · the original is on cqc.org.uk

  3. August 2016Goodup from Requires improvement
    Safe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good

    Read this report on cqc.org.uk

  4. September 2015Requires improvement
    Safe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: Requires improvementWell-led: Requires improvement

    Read this report on cqc.org.uk

  5. June 2014

    Report published without a new overall rating.

    Read this report on cqc.org.uk

  6. February 2014

    Report published without a new overall rating.

    Read this report on cqc.org.uk

  7. December 2013

    Report published without a new overall rating.

    Read this report on cqc.org.uk

  8. September 2013

    Report published without a new overall rating.

    Read this report on cqc.org.uk

  9. April 2013

    Report published without a new overall rating.

    Read this report on cqc.org.uk

  10. December 2012

    Report published without a new overall rating.

    Read this report on cqc.org.uk

  11. August 2012

    Report published without a new overall rating.

    Read this report on cqc.org.uk

  12. July 2011

    Report published without a new overall rating.

    Read this report on cqc.org.uk

  13. December 2010

    Registered with the Care Quality Commission on 23 December 2010.

Ratings and report dates from the Care Quality Commission. A service can also be visited without a new rating being published, so the timeline shows published inspections, not every contact the CQC has had with the service.

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