About the service: Little Millfield’s 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. Little Millfield's can accommodate up to five people who may have a learning disability, in one adapted building. At the time of the inspection, there were four people using the service.

People’s experience of using this service:

¿ People’s relatives were happy with the service their family member received. Comments made were, “The staff are very good at supporting [Name]. They are very safe.” Another said, “The staff are welcoming. They do interact with [Name] and know them well.”

¿ The service would benefit from improvements to the environment. The environment was run down and needed to be modernised and redecorated. The registered provider had plans in place to undertake this work and told us this should commence within the next six months.

¿ We found the bathrooms, and some people's bedrooms needed to have a deep clean.

¿ The service had systems in place to keep people safe and staff followed these guidelines when they supported people.

¿ Enough staff were available to meet people’s care needs. People received their medication as prescribed and on time.

¿ Staff had been recruited safely with the skills and knowledge to give care and support to people.

¿ People’s health and emotional needs were assessed and monitored.

¿ The service worked with relevant health care professionals and people received the support they needed to have a nutritional diet that met their individual choices.

¿ There were systems in place to drive improvement and audits were carried out on a regular basis, which looked at the quality of the service people received.

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

¿ Staff treated people with dignity and respect and were sensitive to their needs. Staff were able to anticipate people’s needs in an individualised way.

¿ A range of activities was provided, which included accessing the local community.

¿ The registered manager was aware of the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice, and independence.

Rating at last inspection: This service was last rated Good. (4 October 2016)

Why we inspected: This was a planned inspection based on the previous rating.

Follow up: We will continue to monitor the service through the information we receive. Please see the action we have told the provider to take section towards the end of the report.

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

The inspection took place on 8 April 2016 and 13 April 2016 and was unannounced.

Little Millfields provides accommodation and personal care for up to five people who have learning disabilities or who are on the autistic spectrum. The service does not provide nursing care. At the time of our inspection there were five people using the service.

There was a registered manager in post at the service. 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 to manage the service on a day-to-day basis by the home manager.

People were safe because the management team and staff understood their responsibilities in identifying abuse. People received safe care that met their assessed needs.

People were safe because staff supported them to understand how to keep safe and staff knew how to manage risk effectively.

There were sufficient staff who had been recruited safely and who had the correct skills and knowledge to safely meet people’s needs.

The provider had systems in place to manage medicines and people were supported to take their prescribed medicines safely.

People’s health and social needs were managed effectively with input from relevant health care professionals and people had sufficient food and drink that met their individual needs.

The Care Quality Commission (CQC) monitors the operation of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS) which apply to care homes. We found the provider was following the MCA code of practice.

The management team supported staff to provide care that was centred on the person and staff understood their responsibility to treat people as individuals.

People were treated with kindness and respect by staff who knew them well. Staff respected people’s choices and took their preferences into account when providing support. People were encouraged to enjoy pastimes and interests of their choice and were supported to maintain relationships with friends and family so that they were not socially isolated.

Staff had good relationships with people who used the service and were attentive to their needs. People’s privacy and dignity was respected.

There was an open culture and the management team encouraged and supported staff to provide care that was centred on the individual.

The provider had systems in place to check the quality of the service and take the views and concerns of people and their relatives into account to make improvements to the service.

The provider had systems in place so that people could raise concerns and there were opportunities available for people or their representatives to give their feedback about the service.

The registered manager and the home manager were visible and actively involved in supporting people and staff. Staff were positive about their roles and their views were valued by the management team.

The people who lived at Little Millfields had complex needs and were unable to discuss their care with us which meant they could not tell us their experiences. We noted from their facial expressions and gestures that they were happy.

Staff knew people well and the way they communicated with people showed us they understood people’s specific needs. We saw that there were respectful and caring interactions between members of staff and people living in the home. Staff listened to them and provided care and support in ways that met their needs and took into account their individual preferences

.

The environment at Little Millfields was comfortable and people’s bedrooms were decorated according to their preferences.

Staffing levels were sufficient to meet the needs of people who lived at Little Millfields; staff received the training they needed to ensure they had the skills and knowledge to provide safe and effective care.

Little Millfields was well run by a competent management team and there were effective processes to monitor the quality of the service. They listened to people and took their views into account to make improvements.

We were unable to speak with most people living at Little Millfields because they had complex needs and limited verbal communication. We gathered evidence of people’s experiences of the service by listening and observing everyday life to help us understand what it was like for people living there.

We saw that people appeared comfortable with staff and others living in the home. We could see that people were confident and happy.

During our inspection we saw that people were supported to express their views and choices in whatever way they were able. Staff showed a good understanding of people’s needs and their individual ways of communicating. We saw that people received good care and that staff treated them with respect.

We found that systems to recruit staff were appropriate and staff received the training they needed to provide care and support safely.

Some of the people living at Little Millfields were not able to communicate with us

verbally and some chose not to talk with us. They shared their views through gestures, facial expressions and body language wherever possible. We saw people were engaged in a range of activities, relaxed and comfortable with staff and other people using the service.