Mill House 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 service provides care and support but not nursing care to people with mental health needs in their own rooms within a communal building. At the time of our inspection 20 people were receiving a service.

At the last inspection of 13 September 2015, the service was rated Good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

People continued to be safe at the service because staff had received training and were aware of procedures to safeguard people from abuse and manage risks to their health. Each person had a care plan and staff were aware of people’s individual needs. There were enough suitably knowledgeable staff to support people that had been recruited safely. People received their medicines as prescribed.

Staff received training and supervision to enable them to provide the support to people with regard to their assessed needs. People gave consent to the support they received. People were given support to manage their nutrition and accessed healthcare services when required.

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

The staff were empathic and treated people with understanding. People’s privacy and dignity were respected. Staff encouraged people to maintain and develop their independent living skills.

People continued to receive support that met their individual needs and preferences. Each person had an assessment of their needs and care plan which was updated regularly. Staff encouraged people to pursue their hobbies and interests. People knew how to raise a complaint and were confident any concerns raised would be addressed and resolved.

An open and positive culture was maintained by the service. The registered manager led and supported the staff team to focus upon person-centred support. Quality checks and audits remained in place so that issues were identified and resolutions for improvements put in place.

Further information is in the detailed findings below.

Mill House is registered to provide accommodation and personal care for up to 22 people. There were 22 people living in the home when we visited. Accommodation is provided over two floors. There are communal toilets and bathrooms for people to use. All bedrooms are for single occupancy with some having ensuite facilities. There are communal areas, including lounge areas, a dining room and a large garden area for people and their guests to use.

The last inspection took place on 4 September 2013 during which we found that Regulation 10 HSCA 2008 (Regulated Activities) Regulations 2010 regarding the maintenance of the premises was not being met. The provider sent us an action plan informing us that improvements would be completed by 1 July 2014. At this inspection on 23 September 2015 we found that the required improvements had been made.

There was 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 that they felt safe living at the home. Staff were knowledgeable about the procedures to ensure that people were protected from harm. Staff were also aware of whistleblowing procedures and would have no hesitation in reporting any concerns. People received their medication as prescribed.

There were sufficient numbers of suitably qualified staff employed at the home. The provider’s recruitment process ensured that only staff who had been deemed suitable to work with people at the home were employed following satisfactory recruitment checks had been completed.

The CQC is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. We found that the registered manager and all staff were knowledgeable about when a request for a DoLS application would be required. The registered manager told us that there were no applications currently submitted to the relevant local authorities but they aware of who to contact should they need to submit an application.

Staff respected and maintained people’s privacy at all times. People were provided with care and support as required and people did not have to wait for long periods of time before having their care needs met. This meant that people’s dignity was respected and that their care needs were met in a timely manner.

People’s assessed care and support needs were planned and met by staff who had a good understanding of how and when to provide people’s care whilst respecting their independence. Care records were detailed and up to date so that staff were provided with guidelines to care for people in the right way.

People were supported to access a range of health care professionals. These included appointments with a range of healthcare professionals. Risk assessments were in place to ensure that people could be safely supported at all times.

People were provided with a varied menu and had a range of meals and healthy options to choose from. There was a sufficient quantity of food and drinks and snacks made available to people at all times.

People’s care was provided by staff in a caring, kind and compassionate way. People’s hobbies and interests had been identified and were supported by staff in a way which involved people to prevent them from becoming socially isolated.

The home had a complaints procedure available for people and their relatives to use and all staff were aware of the procedure. Prompt action was taken to address people’s concerns and prevent any potential for recurrence.

There was an open culture within the home and people were able to talk and raise any issues with the staff. People were provided with several ways that they could comment on the quality of their care. This included regular contact with the provider, registered manager, staff and completing annual quality assurance surveys. The provider sought the views of healthcare professionals as a way of identifying improvement. Where people suggested improvements, these had been implemented promptly and to the person’s satisfaction.

People told us that the home was a comfortable place to live and that they liked living there. We found that the first phase of refurbishment of the environment had taken place and that improvements had been made. We noted that the completion of the second phase of refurbishment of the environment would ensure that the remaining improvements that were needed would be implemented.

Our observations showed us that staff members were responsive to the needs of people and that they were given the support and attention they needed. We saw that people had a positive experience of being included in conversations, decision making and activities.

We found that plans of care contained the information staff members needed to ensure that the health and safety of people was promoted and protected.

People spoken with told us that they were provided with the care and support they needed and that the staff were friendly and very kind.

People told us that the home was a comfortable place to live and that they liked living there. We found that some improvements were needed to the environment.

Staff members were well led, trained and supported to provide an appropriate standard of care and support through effective management, supervision and staff team meetings.

Quality audits were being carried out to ensure the views of people were gathered on the quality of the service provided, that people were safe and that policies and procedures were being followed.

During our inspection of 27 September 2012 people told us they liked living at Mill House and thought of it as their home. They also told us that staff were always friendly toward them.

One person we spoke with told us, "I like it here. I like to go out on my own and buy a newspaper and listen to music in my room or in the day room". Another person we spoke with told us, "It's a nice place to live. The food is always good and I get well looked after by staff".