This inspection took place on 21 June 2018 and was unannounced. Our last inspection of this service took place in August 2017. At that inspection we identified breaches of regulation in relation to staffing, dignity and respect, consent, nutrition and good governance.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions to at least good. The action plan was submitted as requested and gave detail about the actions they had already taken and were addressing in relation to making sure people were safe, people received adequate nutrition, people’s rights were upheld as required by the Mental Capacity Act, people’s needs in relation to privacy and dignity were met and making sure the service was well led.

Millfields Residential 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.

Millfields Residential Care Home provides accommodation and personal care for up to 38 older people, some of whom are living with dementia. Accommodation is provided over two floors with communal areas, including two lounges and a dining room, on the ground floor. There were 30 people using the service when we visited. This included one person who was in hospital.

Since the last inspection a new registered manager had been appointed. 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 at the service told us they felt safe. Staff had received safeguarding training and knew what to do if they thought somebody was at risk.

Medicines were generally managed safely. Action was taken during the inspection to improve systems for safe and appropriate storage.

Risk assessments had been completed to mitigate risks to people's safety.

There was a robust system for monitoring and detailing accidents and incidents with lessons learned and action plans formulated where required.

The premises were clean, well maintained and appropriate safety checks were in place.

Effective recruitment processes were in place and systems for staff training had been developed to make sure staff had the skills and knowledge they needed to provide good and effective care.

Staff were well supported through effective training, regular supervisions and annual appraisals.

Staffing levels were kept under review to make sure they were responsive to the needs of the people living at the service.

People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. We saw evidence of consent being sought and best interest meetings where appropriate.

People were complimentary of the care and support they received. Staff were respectful of people’s privacy and dignity needs.

People enjoyed the food at the home and their dietary needs were assessed and met.

Care was planned and delivered with a person-centred approach and people were supported with their wishes in relation to the care they received at the end of their lives.

People enjoyed a range of meaningful activities and had choice of communal areas in which to spend their time.

The service was managed well. There was an inclusive culture and people’s views and opinions were sought and valued.

This inspection took place on 22 August 2017 and was unannounced.

At the last inspection in November 2017 we rated the service as ‘Requires Improvement’. We identified one regulatory breach which related to good governance.

Prior to the inspection we had received some concerns from a relative and a visiting healthcare professional. The concerns related to staffing levels, pressure area care, cleanliness and dignity and respect. As a result of these concerns the inspection was brought forward to check people were receiving the care and support they required, that regulations were being met and to review the ratings.

Millfields Residential Care Home provides accommodation and personal care for up to 38 older people, some of whom are living with dementia. Accommodation is provided over two floors with communal areas, including two lounges and a dining room, on the ground floor. There were 28 people using the service when we visited. This included three people who were in hospital and two people who were in for respite care.

The home had a registered manager however they were not present on the day of the inspection and we were informed the registered manager was leaving on 25 August 2017. 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. The area manager told us they would be taking over the management of the home.

People gave mixed feedback about the staffing levels as some said they felt there were enough staff and others told us they often had to wait for assistance. We saw there were times when there were no staff present in communal areas where people did not have access to a call bell. We found there were not always enough staff deployed to meet people's needs.

Risks to people were not always well managed as we found risk assessments were not always up to date or accurate. Staff had received training in safeguarding and understood the reporting systems. The majority of safeguarding incidents had been reported to the local authority safeguarding team, although we found one which had not. However, immediate action had been taken to make sure the person involved in the incident was safe.

Many areas of the home had been refurbished and further improvements were planned. Most areas of the home were clean and odour free although we found isolated areas where there were malodours.

Effective systems were in place to make sure people received their medicines when they needed them.

Safe recruitment processes made sure staff were suitable to work in the care service. Staff received induction, ongoing training and support through supervision and appraisal systems.

People’s care records were variable, some were detailed and person-centred, whereas others were not always accurate or up-to-date. People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible; the policies and systems in the service did not support this practice.

A range of activities were provided and people told us they enjoyed these. However, people also told us they wanted more opportunities to go out.

People told us they enjoyed the food. However, we found the dietary needs of people who were nutritionally at risk were not being met. People had access to healthcare services such as GPs and other specialists.

People praised the staff and we observed some kind and caring interactions between staff and people who used the service. However, we also saw occasions where staff showed a lack of respect for people and compromised their privacy and dignity.

We found there was a lack of consistent leadership. Quality assurance systems were not always effective which meant issues were

The inspection took place on 22 and 24 November 2016 and was unannounced. The service had been inspected on 31 May and 2 June 2016 and we found the registered provider had not ensured the premises and equipment were safe, the administration of medicines was not safe and they were not assessing, detecting or controlling the spread of infections. In addition, the registered provider did not seek consent to care and treatment from the relevant persons, and people were not treated with dignity and respect. They had not ensured the premises and equipment were clean, secure suitable, properly used, properly maintained or appropriately located. We also found the registered provider did not have effective systems in place to assess, monitor, and improve the safety of the service and there were insufficient numbers of staff to meet people’s needs or safeguard people from abuse. At this inspection we found improvements had been made at Millfields with an action plan in place to achieve further required improvements.

Millfields Residential Care Home provides accommodation, personal care and support for up to 38 older people, some of whom might also have a physical disability and / or dementia. On the day of our inspection there were 30 people living at Millfields 27 people were living there permanently and three people were staying on a temporary basis.

There was no registered manager at the location. 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. Day to day management was provided by the operations manager until a new registered manager was recruited.

At our previous inspection we found the service was not providing safe care and treatment as the registered provider had not ensured the premises and equipment were safe or clean. We also found issues with the safe administration of medicines. At this inspection we found significant improvements in the cleanliness of the environment and equipment had been cleaned and some items replaced. The registered provider was planning a programme of refurbishments, to be completed once a decision had been made by the Commission in relation to the enforcement action being taken against the provider.

We found improvements in the management of medicines had been made. Medication was administered appropriately and all staff who administered medication had received training and had been assessed as competent to administer medicines. Further improvements were required around the recording of the administration of creams and some ‘as required’ medicines.

Standardised risk assessments had been undertaken for those people at risk of malnutrition and pressure sores. The home completed risk assessments when other risks such as choking, medication, fire and falls had been identified. Moving and handling risk assessments and care plans had improved from the previous inspection although further improvements were on-going. One person who was at the home for a temporary respite stay had not had their risks adequately assessed and recorded in relation to the method staff were to follow due to their fluctuating abilities.

People and relatives told us there had been a lack of staff over the weekend and the previous few days. It was not clear whether this was as a result of the vomiting bug at the home which had affected both staff and people living there. The operations manager told us they had changed the roles of staff to make more effective use of staff at busy times and they would look again at the deployment of staff. They did not use a dependency tool which could provide evidence staffing levels were appropriate to meet people’s needs although they agreed to implement one.

Accidents and incidents were recorded an

The inspection took place on 31 May and 3 June 2016 and was unannounced. The service was last inspected on 9 August 2013.This was a focussed inspection and the service was found to be compliant with all health and social care regulations.

Millfields Residential Care Home provides accommodation, personal care and support for up to 38 older people, some of whom might also have a physical disability and or dementia. On the day of our inspection there were 29 people living at Millfields.

There was a registered manager in post at the time of our inspection. A registered manager is a person who was 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. We found the standards of care in the service had deteriorated significantly since our last inspection. There were multiple breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The building was not secure as there was no lock on the front door and a glass panel in an external fire door was smashed

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The registered manager and staff had limited knowledge of their responsibilities in regard to the Mental Capacity Act 2005 (MCA) and the associated Deprivation of Liberty Safeguards (DoLS.) particularly with regards to lasting power of attorney.

We found risk had not been adequately or accurately assessed in relation to moving and handling. Risk assessments did not reflect the current needs of people or describe the equipment which was required.

Equipment and furniture in the home was in need of repair. There was a lack of cleanliness throughout the service and a malodour was present throughout the building.

Medication was received and stored correctly, however we saw that two tablets had been dropped on the floor. This meant people were not supervised sufficiently when taking medications. We saw that prescribed creams and lotions were not being signed for, this meant there was no way of knowing if they had been applied.

We found people in the service were not treated with dignity and respect. Bedroom doors were left open when people were using commodes. We saw people were being supported to get dressed before five am and then getting back into bed in their day clothes.

The people living in the service were not asked for their consent for care to be carried out.

Decision specific capacity assessments were not carried out for the people living in the service to measure whether they were able to make their own decisions and which decisions they were able to make.

The registered manager was unaware of their responsibilities in regards to the MCA and DoLs. In regards to lasting power of attorney the manager was not aware that documentation was required to determine which decisions the power of attorney related too.

The registered manager was not always aware of safeguarding incidents. We saw that staff were recording incidents but not making the manager aware. This led to a lack of management oversight.

There was a lack of meaningful activities. We saw people sleeping in chairs throughout our inspection. We saw chair exercises offered to people, however this did not keep people’s attention. The room lay out meant the person delivering the class had to move around to explain the exercise to each individual, losing the attention of others.

The manager told us there had been no complaints and no documentation regarding complaints. However we found reference to complaints in meeting minutes, demonstrating that complaints had not been actioned in line with the company’s policy.

We saw audits for medication, hourly rounds, accident and incidents, and safeguarding. However they were not robust or accurate and no analysis or learning was taking place.

The overall rating for this service is 'Inadequate' and

We spoke with the registered manager, a community nurse, four members of staff, three relatives / visitors and three people who used the service. During our visit we observed staff spoke with people in a kind manner, with respect and ensured people's diversity, values and human rights were respected.

We found that people's needs were assessed and care was planned and delivered in line with their individual care plan, which ensured people's safety and welfare. We saw that staff had a positive attitude towards the people who used the service. We observed throughout the visit that staff took time to answer questions and engage with people. We found that the home had a relaxed and comfortable atmosphere.

We saw staff engaged with people in a kind and friendly way which allowed people time to choose what they wanted to eat and drink. Even though people had made their menu choice in the morning, staff still gave them the opportunity to make a different choice of food.

On the day of our visit we found the home was clean, tidy and odour free. People and relatives we spoke with told us the home was always like this. We spoke with staff who told us there was plenty of easily accessible personal protective equipment. Staff also told us they received infection control training annually.

We reviewed the training records / matrix and saw that staff had completed their mandatory training; also staff were currently undertaking other relevant training.

People we spoke to said they liked living in the home.One person said 'I have lived in the home for a number of years and have never had any problems.' Another person said 'The home is excellent, the staff are wonderful, the food is very good .' People we could not communicate with were relaxed and comfortable.

Two visiting Physiotherapists said they visit the home regularly and any care plans they compiled were followed. They said 'We have never had any issues with the home and people appear to be well cared for'.

People we spoke with said they are happy with their own rooms. People we could not communicate with were observed relaxing in the lounges and dining room and were happy and comfortable.

People we spoke with said they liked the people caring for them. One person said' the staff are excellent and you could not wish for better people to care for you ' People who use the service we spoke to said they are treated with respect and dignity .The returned satisfaction surveys confirmed this. The surveys also showed that people think the staff are approachable and caring. They also said staff are friendly and polite.

The surveys showed that people know how to make a complaint but have never had to do so. People told us ' if I have any problems I tell someone and it is dealt with right away'