Millbrook House is a residential care home for 33 older people, some of whom have dementia. The building offers accommodation over three floors with lift access to each floor. People have access to communal lounge and dining areas, several other seating areas a conservatory and a large, fully accessible rear garden. There were four rooms which could be used for double occupancy and there were 25 people living at the home at the time of inspection.

At our last inspection we rated the service 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 were protected from the risks of abuse and staff understood how to report any concerns. Risks people faced were understood and safely managed and people received their medicines as prescribed. There were enough, safely recruited staff to support people and staff were familiar to people. Where there were any accidents or incidents, these were recorded and any actions and learning shared with staff.

People had their needs assessed before moving to Millbrook House and the information was used as the basis for care plans. People had choices about all aspects of their care and we observed staff seeking consent from people about their care and treatment. People were positive about the meal options available to them and had access to healthcare professionals where needed.

Staff were kind and compassionate in their approach and interactions were caring and tactile. Staff knew people well and understood peoples preferences. Visitors were welcomed and professionals involved with the service were positive about staff understanding of people’s needs and interactions. People had their privacy and dignity respected and were enabled to be as independent as they wished.

People were supported to spend time in a variety of social opportunities and there were plans in place to further consider individual social opportunities for people. People and relatives were involved in decisions about their support and care plans were regularly reviewed. Feedback indicated that people and relatives would be confident to raise concerns if they needed to. End of life preferences were recorded for each person.

The registered manager was in the process of considering new electronic care plan systems and was focussing on ensuring that any system chosen would enable Millbrook House to record personal preferences, likes and dislikes for people to ensure that care plans were individualised.

People, relatives and staff were positive about the management of the home and feedback was sought through meetings, surveys and informally. Staff were positive about their roles and responsibilities and received regular supervision and training. Quality assurance processes were regular and used to discuss as a management team where changes and actions were required.

Further information is in the detailed findings below.

This inspection took place on 2 and 4 February 2016. It was carried out by one inspector.

Millbrook House provides residential care for up to 33 older people. There were 28 people living in the home at the time of our visit, some of whom were living with dementia.

A new manager had been appointed in April 2015, their application to be a registered manager had been submitted. The previous registered manager had left in October 2015. 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.

At our last inspection of Millbrook House in December 2014 we had concerns that people did not have their risk of harm sufficiently assessed and staff did not have the appropriate guidance to support people in a way that minimised risks to people. We had concerns that the manager did not respond appropriately to allegations of abuse and therefore people were not protected from the risk of abuse. We had concerns about record keeping and there were insufficient quality monitoring systems in place.

We found the provider had made improvements since our last inspection in December 2014. All staff had received safeguarding training and the manager was aware of how to report safeguarding concerns to the appropriate authority. Records were improved, all care plans had been rewritten and there was a system for ensuring they were kept up to date. There were specific risk assessments to identify when a person was at risk of harm. When a person was identified as having a specific risk , there was clear guidance in the care plan how to manage the risk safely. However one person was identified as high risk of skin damage. The care plan did not give guidance for staff how to provide support in a way that prevented the risk occurring. The manager had introduced a new system for ensuring there was regular quality monitoring checks.

People’s risks were assessed and in most cases there was a plan to ensure care was provided safely. A variety of risks were assessed which included risk of falls, malnutrition and skin damage. We saw one person had been identified as a high risk of skin damage, there was not a care plan to identify how to manage the risk. Although staff were providing the appropriate care it was not recorded. We talked with the manager about this and they advised they would ensure the care plan was updated. Other people’s risks had a plan which provided staff with clear guidance how to reduce the risk.

The manager had introduced a system for monitoring the quality of the service and had identified some keys actions required to continue making improvements. People, relatives and staff participated in an annual quality questionnaire. The manager had collated responses and had taken actions.

Staff were aware what constitutes abuse and what actions they should take if they suspected someone was being abused.

There were enough staff to meet people’s needs. Feedback from people and relatives included “I’m here at odd times and there always seems enough staff.” Staff were unhurried and staffing rotas reflected the staffing requirements as assessed by the manager.

Medicines were stored and administered correctly and there were systems in place to monitor that medicines had been given to the right person at the right time. People who were able to self-administer medicines were supported to do so.

People had access to healthcare when they needed it; healthcare professionals told us the home referred people quickly and appropriately.

People were treated with dignity and respect and their privacy was maintained. There were positive interactions between people and staff.

People received personalised care and staff treated them as individuals. They had knowledge about them an

People we spoke with told us that they were happy with the care and support that they received. On the day of our visit we observed staff talking with people who use the service, with relatives and with two visiting professionals. We observed staff interacting with people in a friendly and respectful manner. One relative told us that the "staff were always helpful and polite". Another said staff were "brilliant" and "the manager goes out of their way to help us, and is wonderful".

People who use the service had their needs assessed and a detailed support plan which focussed on their abilities, needs and choices was in place. People told us that staff understood their needs well.

Accurate records were not always in place for each person who uses the service. For example, not all consent forms were signed.

We saw that people had access to appropriate specialist advice and guidance. Records showed that where one person had made a decision to not follow the advice given by the provider, the decision had been respected.

Procedures were in place to manage medication effectively. The provider might like to note that we found recording gaps on two medication administration records.

When a person's needs changed we saw that the provider obtained the equipment needed to meet their current needs. The provider told us that they informed people who use the service when additional equipment costs were to be passed to them directly.

We saw evidence in individual care plans that the provider was respecting and involving people. We observed people being treated with respect and their views being sought. People told us "we are well looked after" and "we are treated with respect".

We were told by family representatives that "they try to involve people in activities" and we saw the provider made a variety of activities available for people. We found the provider was providing personalised care, treatment and support.

There was guidance in the home on safeguarding people from abuse. Staff members spoken to knew how to report any concerns regarding abuse. Staff members told us that they felt it was important to protect people as they were vulnerable.

Guidance on infection control and cleanliness was in place and we found the provider had systems in place to ensure the home was clean and hygienic and that the risk of infection was minimised.

We found by looking at staff rotas and training records and speaking with the provider that there was sufficient qualified, skilled and experienced staff to provide care and support for people.

There was a system in place to seek the views of people, family representatives and staff and we found the provider had made changes as a result. We found the provider was investigating comments and complaints and accidents and incidents and was learning from these in order to improve the care, treatment and support provided to people.

This inspection took place on 3 and 4 December 2014 and was unannounced. Millbrook House provides accommodation and personal care for up to 33 older people. There were 28 people living there when we visited. This provider is required to recruit a registered manager for this type of service. 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 and associated Regulations about how the service is run.

At the last inspection on 16 December 2013, we asked the provider to take action to make improvements to ensure accurate and appropriate records were maintained. At this inspection some improvements had been made but there were still some records that were not accurate or had not been completed. This put people at risk of inappropriate or unsafe care.

People were not safe living in the home because not all safeguarding concerns had been reported to the local authority. During the inspection we identified concerns about how some people were supported to remain safe and about some staff practice. We reported these concerns to the local authority safeguarding authority following our inspection.

There were enough staff to meet people’s needs. Recruitment checks were completed before staff worked unsupervised at the home. All staff told us there were enough staff to meet people’s needs. People told us that staff assisted them when they needed help. People received their medicines when they required them and medicines were stored safely.

Some people, who did not have mental capacity to make specific decisions, had their legal rights protected. Best interest decisions involved people’s representatives and health care professionals in accordance with the principles of the Mental Capacity Act 2005.

The service was caring. People and their representatives spoke highly about the staff. People told us that staff were caring and were always there to help. People were supported by staff to meet their social and welfare needs. People were supported to take part in activities in the home, go out on trips and at times supported on a one to one basis with their social needs.

Staff were not always trained to meet people’s needs. Some staff had not received training required to carry out their role.

There were insufficient monitoring of incidents to identify any actions necessary to meet people’s changing needs. There were limited audits of care records to identify actions that were required to ensure people’s needs were responded to. Staff gave us mixed feedback about how the service was managed.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, which corresponds to Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 . These were in relation to safeguarding people, meeting people’s needs, records and not monitoring the quality of the service effectively. You can see what action we told the provider to take at the back of the full version of this report.