The inspection visit took place on 5 October 2016 and was an unannounced inspection. The home is registered to provide accommodation with personal care for up to 53 people. On the day of our visit there were 30 people living at the home, some of whom were living with dementia. The home is also registered to provide nursing services and normally operated across two buildings. At the time of our inspection only the main building was in use, and no one was in receipt of nursing care.

There was a registered manager in post at the home. They were on annual leave on the day of our visit and we spoke with them via telephone on 10 October 2016. 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.

Our previous inspection on 10 March 2015 found a breach of three legal requirements. We asked the provider to make improvements to ensure care records were up-to-date and individual to people’s needs. We also asked them to take action to ensure people who lacked the ability to make decisions had in place the appropriate processes in line with current legislation. Finally we asked the provider to improve the auditing and monitoring in place to ensure quality care was delivered and effective action was in place when it was not.

We found at this inspection that sufficient improvements had been made regarding these areas. This meant that at this inspection we concluded that the provider was no longer in breach of any legal requirements.

People and their relatives told us that people were safe at the home. Staff were trained in adult safeguarding procedures and knew what to do if they considered someone was at risk of harm, or if they needed to report concerns.

There were systems in place to identify risks and protect people from harm. Risk assessments were in place and carried out by staff that were competent to do so. Risk assessments recorded what action staff should take if someone was at risk and referrals were made to appropriate health care professionals to minimise risk going forward.

There were sufficient staff to keep people safe and meet their needs, and the management team had in place safe recruitment procedures. Staff were competent with medicines management and could explain the processes that were followed. Policies and procedures were in place to guide staff in relation to the Mental Capacity Act 2005. The management team understood that there should be processes in place for ensuring decisions were made in people’s best interests. Staff sought consent from people and recorded this.

Staff were caring, knew people well, and supported people in a dignified and respectful way. Staff maintained people’s privacy. People and their relatives felt that staff were understanding of people’s needs and had positive working relationships with people.

The service provided individualised care according to each person’s needs and preferences. People and their relatives were involved in assessment and reviews of their needs. When people wanted to make changes to their care records staff supported with this.

People and staff knew how to raise concerns and these were dealt with appropriately. The views of people, relatives, health and social care professionals were sought as part of the quality assurance process. Quality assurance systems were in place to regularly review the quality of the service that was provided.

This inspection took place on 10 March 2015 and was unannounced. Millbridge is a residential care home providing nursing and personal care and support for up to 53 older people, some of whom may live with dementia.

The home has not had a registered manager since September 2013, although there had been a manager in post since April 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 and that staff supported them in a way that they liked. Staff were aware of safeguarding people from abuse and how to report issues of concern.

Individual risks to people were not always assessed adequately by staff and there was not enough information about how to reduce risks around different areas of the home.

There were enough staff available at most times to meet people’s needs. However, staff members were not able to spend time with people or meet their social needs.

All of the required recruitment checks had been obtained for all new staff to ensure they were suitable to work with people.

Medicines were safely stored and administered, and staff members who gave out medicines had been trained. Not all medicines were safely given out.

Staff members received other training, in a format that provided them with the opportunity to ask questions and practice new skills. Staff felt supported although they did not all receive supervision from the manager, which did not provide time for personal development.

The CQC is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) Deprivation of Liberty Safeguards (DoLS) and to report on what we find. The service was not meeting the requirements of DoLS. Inadequate action had been taken to comply with a condition of one DoLS or to ensure authorisation was obtained for other people.

Staff members understood the MCA and presumed people had the capacity to make decisions first. However, where someone lacked capacity, there were no written records to guide staff about who else could make the decision or how to support the person to be able to make the decision.

People enjoyed their meals and were given choices about what they ate. Drinks were readily available to ensure people were hydrated. Not all staff members assisted people appropriately.

Staff members mostly worked together with health professionals in the community to ensure suitable health provision was in place for people. Not all recommendations to refer to health care professionals were followed.

Most staff were caring, kind, respectful and courteous, although not all staff members communicated with people well. Staff members knew people well, what they liked and how they wanted to be treated. People’s privacy and dignity was respected.

People’s needs were responded to well and care tasks were carried out thoroughly by staff. Care plans, however, did not all contain enough information to support individual people with their needs. People’s social needs were not met and they did not have the opportunity to go outside when they wanted.

A complaints procedure was available and appropriate action was taken when complaints were made, although records of these were not available.

The manager was supportive and approachable, and people or their relatives could speak with her at any time.

The home did not properly monitor care and other records to assess the risks to people and ensure that these were reduced as much as possible.

We have made a recommendation about adequate staffing levels.

An adult social care inspector carried out this inspection. The focus of the inspection was to follow up action we had previously taken in regard to the quality of care plans, safe medicine storage, the way in which the provider monitored the quality of the service provided and to answer three of the five key questions; is the service safe, effective and well led?

Below is a summary of what we found. The summary describes what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

Medicines were stored appropriately and records were maintained adequately to show all storage areas were kept at the correct temperature.

Is the service effective?

Care records had been updated and these provided detailed information about people's care needs and preferences, and provided clear guidance to staff members.

Is the service well led?

There had been a survey to gather the views of people who used the service since our last inspection. This showed that people were happy with the service they received. Analysis had taken place of the survey results although these had not been forwarded to the organisation’s head office.

There had been no complaints made since our previous inspection and therefore analysis of them was not possible, although the service had not analysed any trends or themes resulting from previous complaints.

An adult social care inspector carried out this inspection. The focus of the inspection was to answer the five key questions; is the service safe, effective, caring, responsive and well led?

Below is a summary of what we found. The summary describes what people using the service, relatives and staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

Risk assessments for care needs were completed and provided appropriate actions for the identified risk to be reduced. Applications had been appropriately made in regard to Deprivation of Liberty Safeguards for people whose liberty was restricted. Staff members and the manager showed they had appropriate knowledge regarding new guidance.

Medicines were stored appropriately, although records were not maintained adequately to show all storage areas were kept at the correct temperature. Administration records were kept and people received their medicines in a safe way.

People using the service said there were enough staff available to meet their needs. Information from staff members, the manager and records shows that there were enough staff available with the skills and training to care for people.

Is the service effective?

People told us that staff members obtained their consent before supporting them with care or treatment. Care records showed that people were able to make decisions for themselves.

People told us that staff members helped them with everything they needed assistance with. They told us that they were satisfied with the care they received. Care records provided adequate information about people's care needs and preferences, although improvement was still required to provide clear guidance. The manager had started this process.

Health needs were responded to and people had access to health care professionals if they needed this. Care records contained information about the health care professionals involved with people's care.

Is the service caring?

People said that staff members were polite and kind; they respected people's privacy and dignity, and involved them in their care. We observed interactions between people and staff members and we found that the members of staff were patient and understanding of people’s individual needs. Staff members knew people's care needs and their personal preferences when we spoke with them.

Our observations also showed that staff members were respectful towards people using the service. People told us that staff were respectful and that their privacy was maintained.

Is the service responsive?

We saw that people's individual physical and mental support, care and treatment needs were assessed and mostly planned for. Their individual choices and preferences regarding their support and care were valued and respected.

Is the service well led?

There had been no annual survey or meetings to gather the views of people using the service since our last inspection, although these have now been scheduled. There were other systems in place to monitor and assess the quality of the service provided, although the service had not analysed or had regard to any trends or themes resulting from complaints.

People said that most staff members were polite, kind and respectful. They confirmed that their privacy and dignity was usually respected, although we found one example where this could be changed to improve the person’s privacy. They stated they were supported to make decisions regarding their immediate care needs and wishes, although care records contained little information to show how people were involved in making choices about their care.

People told us that staff members obtained their consent before supporting them with care or treatment. However, care records did not record which decisions people were able to make for themselves and there was not enough information when people did not have the capacity to make decisions.

Although people said they were happy with the care and support they received, care records were not completed well enough to provide enough information to staff. Assessments were completed, although these did not always accurately reflect the person they related to and therefore they did not always identify actions that were required to reduce risks. Care records were not written in enough detail to provide clear guidance to staff members and information particular to each person was often missing.

Staff members received supervision and training from to ensure they had the skills and support to properly carry out their roles and care for people.

People we spoke with told us they were satisfied with the quality of care provided to them at Millbridge. One person we spoke with told us, “I am very well looked after here, I like it very much and I can do just as I please”. People also told us that staff members respected their privacy and dignity.

During our inspection we saw that people had access to care services provided by staff at the home and also those offered by visiting healthcare professionals.

We saw that people lived in a safe, comfortable home with access to large, well managed gardens that helped stimulate people’s senses.

We found that appropriate checks were undertaken before staff members were employed to work with vulnerable adults. We also saw that staff members were appropriately trained to offer people appropriate care and support.

People were regularly asked for their views on the way services were provided at the home, and the provider actively took those views into account and acted on them where appropriate.

People we spoke with told us they were treated with dignity and respect. Staff encouraged people to retain their independence but were available when needed. People said that they could choose how and where to spend their time and there were no strict times for getting up and going to bed.

Generally people were very happy with the level of support they received at Millbridge. They told us that staff understood their needs and supported them in the way they preferred. People said that staff looked after their healthcare needs. For example, one person told us that staff were quite good about making sure they received the special diet they needed.

We heard mixed comments about the meals. The majority were positive but we were also told that the standard of the meals could be variable and there was a lack of variety. One person told us that they did not think they were good value for money.

The people we asked told us that staff treated them well and they felt safe in the home. People said they thought there were enough staff on duty and most said they did not have to wait too long for a response to the staff call bell. One person commented that the waiting time was dependent on the time of day. The majority of the people we spoke with said that they thought staff had the correct training to understand their needs.