This inspection took place on 25 and 26 April 2017 and was unannounced on the first day and announced the second day. The last inspection took place on 29 March 2016 and at that time we found the home was in breach of Regulation regarding good governance. This inspection was carried out to see what improvements had been made since the last inspection. At this inspection we found the provider had made improvements in the required area and was no longer in breach of the regulatory requirements.

Mill Lodge Care Centre provides nursing care for up to 42 older people, including some who are living with dementia. There were 39 people living at the home when we visited. Accommodation is provided in single en-suite bedrooms in two separate units; one on the ground floor and the other on the first floor. Lift access is provided between the floors. There is a communal lounge and dining room on each floor as well as toilets and bathroom facilities. A central kitchen and laundry are located on the ground floor. There is secure parking as well as garden areas.

The home had a registered manager. 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 living in the home told us they felt safe and well cared for. We found there were enough staff to support people effectively. The staff were knowledgeable about the individual needs of people and knew how to recognise signs of abuse.

The registered manager and provider followed a robust recruitment procedure to ensure new staff were suitable to work with vulnerable people. People were supported with their medicines in a safe way.

The premises and equipment were appropriately maintained and we noted safety checks were carried out regularly. Risks to people's health and safety had been identified, assessed and managed safely. However some staff did not always follow procedure when moving people in wheelchairs.

Staff followed the principles of the Mental Capacity Act 2005 to ensure that people's rights were protected and they were encouraged to make decisions for themselves.

People had their nutritional needs met and were offered a choice at every meal time. People were offered a varied diet and were provided with sufficient drinks and snacks. People with specific nutritional needs received support in line with their care plan. However one person was not receiving the meals they required to meet their cultural need.

Staff were able to maintain and develop their skills by on-going training. Staff spoken with told us they had access to a range of learning opportunities and said they were well supported by the registered manager and the provider.

We saw staff were caring, positive, encouraging and attentive when communicating and supporting people. Visitors were made welcome in the home and people were supported to maintain relationships with their friends and relatives.

Care records and risk assessments were person-centred and were an accurate reflection of the person's care and support needs. The care plans were written with the person so they were able to influence the delivery of their care. Care plans included people’s likes and preferences and were reviewed regularly to reflect changes to the person's needs and circumstances. People had good access to healthcare professionals.

People knew how to raise concerns and complaints if they needed and appropriate action was taken to address issues that were raised. People's views of the service were sought and responded to appropriately.

There was an open and friendly atmosphere in the home which showed the staff and registered manager had developed good relationships and knew people well. We observed staff treating people with respect whilst assisting th

This inspection took place on 29 March 2016 and was unannounced. . At the last inspection on 22 and 23 January 2015 we rated the service as ‘Requires improvement’ and identified five regulatory breaches which related to safeguarding, staffing, person-centred care, dignity and respect and good governance. Following the inspection the provider sent us an action plan which stated the breaches would be addressed by 15 May 2015. This inspection was to check improvements had been made and to review the ratings.

Mill Lodge Care Centre provides nursing care for up to 42 older people, including some who are living with dementia. There were 37 people living at the home when we visited. Accommodation is provided in single en-suite bedrooms in two separate units, one on the ground floor and the other on the first floor. Lift access is provided between the floors. There is a communal lounge and dining room on each floor as well as toilets and bathroom facilities. A central kitchen and laundry are located on the ground floor. There is secure parking and garden areas.

The home did not have a registered manager. The registered manager resigned in December 2014. A manager had been appointed when we inspected in January 2015 and they remained in post until October 2015 but were not registered with the Commission. A new manager started in post in December 2015 and has submitted an application to register with the Commission. 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. Risks were well managed and there were sufficient staff to meet people’s needs and preferences. A staffing tool considered people’s dependencies and staffing levels were adjusted according to people’s needs.

Staff understood how to recognise and report abuse which helped make sure people were protected. We saw any allegations of abuse had been dealt with appropriately and reported to the local authority safeguarding team.

People told us they received their medicines when they needed them and we saw safe medicine systems were in place.

The home was clean and well maintained. Systems were in place to ensure the premises and equipment were serviced regularly so they were safe for use.

Staff knew people’s needs well and received the induction, training and support they required to fulfil their roles. Recruitment practices ensured people were suitable to work in the care service.

Generally people told us they liked the food although one person said they found it ‘a bit repetitive’. Menus showed a range of meals with snacks and drinks available in between meals. People’s weight was monitored to ensure they received enough to eat and drink.

People had access to healthcare services and we saw specialist advice was sought in a timely manner. For example, referrals to dieticians when people had lost weight.

The home was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS) and acting within the legal framework of the Mental Capacity Act (MCA).

People and relatives praised the care provided and spoke of the kindness and caring attitude of the staff. People were treated with respect and their privacy and dignity was maintained.

People received person-centred care. A range of activities were available although feedback from people was mixed with some stating there was little to do, whereas others felt there was sufficient.

People knew how to make a complaint. Two relatives told us of concerns they had raised which had been dealt with by the manager.

People, staff and relatives praised the manager who they described as friendly, open and accessible. We saw the manager led by example and staff said they felt supported. Quality assurance p

Before people received any care, support or treatment they were routinely asked for their consent. Members of staff told us they always explained all procedures and treatments. People had contributed their preferences and their experiences were taken into account in relation to how care and support was delivered. One person told us, “I choose to eat in my room.” Another person told us, “I can tell them if I want something different.”

People’s needs were assessed and care and support was planned and delivered in line with their individual care needs. The care plans contained a good level of information setting out exactly how each person should be supported to ensure their needs were met. One person told us, “I am well looked after. I am happy as I can be.” Another person told us, “They certainly do look after me. It feels like home.”

Appropriate arrangements were in place in relation to management of medicines. The home had clear guidance that outlined how medicines should be obtained and protocols that staff must follow. Staff we spoke with said they had received medication training. People we spoke with said they received their medication on time and when they needed it. One person told us, “I get my medication on time, they are on the ball.”

We found people were supported by sufficient numbers of qualified, skilled and experienced staff which met people’s needs. People we spoke with told us there were generally enough staff to help them when they needed support.

There were quality monitoring programmes in place, which included people giving feedback about their care, support and treatment. This provided a good overview of the quality of the service’s provided.

We spoke with 10 people who live at the home, four relatives and three members of staff. These are some of the things they told us:

“The staff do their best but I think they are short staffed sometimes.”

“Sometimes I have to wait longer than I would like for staff to come and help me.”

“There is a choice of menu and you can have what you want.”

“The home is always clean and tidy.”

“If I had any problems I would tell the manager and she would sort it out. When I did raise something with her it was dealt with straight away.”

“We get some entertainment and the quizzes are very good. We had a Halloween party, the staff dressed up and it was very good.”

“Staff are very helpful, patient and friendly.”

“The food is good and there is plenty of it.”

“When my friend visits they can have a meal with me if they want to.”

This inspection took place on 22 & 23 January 2015 and was unannounced. At the last inspection on 5 September 2013 the home was found to be meeting the requirements we assessed.

Mill Lodge Care Centre provides nursing care for up to 42 older people, including some who are living with dementia. There were 41 people living at the home when we visited, which included one person who was in hospital. Accommodation is provided in single ensuite bedrooms in two separate units, one on the ground floor and the other on the first floor. Lift access is provided between the floors. There is a communal lounge and dining room on each floor as well as toilets and bathroom facilities. A central kitchen and laundry are located on the ground floor. There is secure parking and garden areas.

The home did not have a registered manager. The registered manager resigned in December 2014 and a new manager had been appointed who had been in post four days when we inspected but had worked at the home as a support manager since September 2014. 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, although they said they thought more staff were needed and this was confirmed by our observations. We found staff understood safeguarding and knew how to recognise and report abuse. However concerns were raised with us about how one accident was dealt with by staff and we identified two safeguarding incidents where it was not clear if appropriate action had been taken with regard to staff involved in these incidents. Following the inspection we made a safeguarding referral and spoke with the regional director. We received evidence from the provider which showed they had liaised with the safeguarding team and these issues had been addressed.

People received their medicines when they needed them and arrangements for managing medicines were safe, although we found three discrepancies in the recording of medicine stock levels, which meant some medicines were unaccounted for.

Staff understood the legal requirements relating to the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). DoLS authorisations were in place for two people and other applications had been made for an assessment to ensure people were not unlawfully deprived of their liberty.

Staff recruitment processes made sure staff were safe and suitable to work with people. Staff received induction and ongoing training and support to meet people’s needs.

People were involved in planning their care and some care records were detailed, however others records we saw had contradictory information which meant there was a risk people may not receive consistent care. People had access to healthcare services and we found staff were prompt in bringing in healthcare professionals when people’s needs changed.

People’s dietary needs were met, although people told us the food was variable in quality. We found mealtimes were not a relaxed and sociable occasion and people did not always receive the support they needed to eat their meals in a dignified way.

People told us staff were kind and caring and although we observed some good interactions we also saw some staff did not respond in a caring way to people and showed a lack of respect.

Although staff had started to involve people in activities, we found a lack of social engagement and activity for people on the upstairs unit, the majority of whom stayed in their rooms. The manager told us they were looking at ways in which this could be addressed.

We looked round the home and found the premises were clean and well maintained. Records we

saw showed equipment was regularly serviced and environmental risk assessments had been completed. However, although the home was decorated and furnished to a high standard we considered further adaptations were needed to help people living with dementia find their way around. For example, by the use of appropriate signage, lighting and colour schemes.

The provider’s quality assurance systems had identified many of the issues we found at this inspection and we saw actions had been identified to address the shortfalls which the new manager told us they were in the process of implementing. Our discussions with the regional director following the inspection and evidence they sent showed they had taken immediate action to address concerns we had raised at the feedback session at the end of the inspection and progress was being monitored by unannounced visits from the governance team.

We identified a number of breaches of regulations. You can see what action we have told the provider to take at the back of the full version of the report.