The inspection took place on 27th and 28th November 2018 and the first day was unannounced. This was the first inspection carried out under this provider. The home was inspected under the previous provider in September 2017 when it was rated requires improvement overall. At this inspection we found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to safe care and treatment and good governance.

Mill View is a care home providing nursing and personal care. It is situated about half a mile from Bolton town centre. The home is situated in its own grounds with garden areas and car parking available at the front of the home.

Mill View Care Home 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 care home accommodates up to 180 people within six separate houses. Each house caters for different needs including residential care, specialist dementia care and nursing. One the day of the inspection there were 164 people using 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. There was a registered manager in place at the home.

Some of the documentation relating to medicines was not accurate and some medicines not given safely. Care files included relevant health and personal information. However, there were some inconsistencies and gaps with regard to care plans and risk assessments.

People told us they felt safe at the service. Safeguarding and whistle blowing policies were in place and staff had received training and were aware of how to raise a concern. Health and safety measures were in place.

Staffing levels were sufficient to meet the needs of people who used the service. The recruitment system was robust. General and individual risk assessments were in place.

The home was clean and tidy and infection control measures were in place. However, a number of infection outbreaks had been experienced by the home.

Staff regularly took mandatory training refresher courses and supplementary training was delivered as required. We saw evidence of staff supervisions and appraisals.

Nutrition and hydration needs were addressed by the service and there were choices of meals and drinks on offer throughout the day. People’s specific dietary needs were adhered to.

The service was working within the legal requirements of The Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).

Staff interactions with people who used the service were patient and kind. Privacy and dignity was respected. The home had appropriate policies around confidentiality and data protection and staff were aware of its importance.

There was an appropriate policy and procedure in place with regard to equality and diversity and staff had undertaken training. Communication needs were recorded within care plans and information could be produced in a number of different formats to suit people’s needs.

People were involved in their care and support planning and reviews. People who used the service were encouraged to be as independent as possible. All appropriate equipment was in place for people to aid people’s independence. The equipment was well maintained and in good working order.

People told us they felt the service was responsive. Care files included person-centred information and people’s choices were respected.

Activities had improved at the home and were offered seven days and two evenings per week. We saw evidence that the service was looking at more meaningful one to one activities