Mills Meadow provides accommodation, care and support for up to 60 older people. People who live in the service have a range of needs which include; living with dementia, those who have a physical disability, and/or people who require palliative end of life care. There were 52 people living in the service when we carried out an unannounced inspection on 7 September 2016.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 of 30 April 2015 found that improvements were needed to ensure people were consistently supported by sufficient numbers of staff with the knowledge and skills to meet their needs. Further improvements were needed to provide people with a positive meal time experience and to ensure their wellbeing and social needs were met. There was also concern that people’s records did not consistently reflect changes to their needs and preferences. Systems in place to monitor the quality and safety of the service provided required improvement to drive the service forward. The provider wrote to us and told us how they were addressing these shortfalls. During this inspection we found that improvements had been made.

People received care and support that was personalised to them and met their individual needs and wishes. Staff respected people’s privacy and dignity and interacted with people in a caring, compassionate and professional manner. They were knowledgeable about people’s choices, views and preferences. The atmosphere in the service was friendly and welcoming.

People were safe and staff knew what actions to take to protect them from abuse. The provider had processes in place to identify and manage risk. Assessments had been carried out and personalised care records were in place which reflected individual needs and preferences.

Recruitment checks on staff were carried out with sufficient numbers employed who had the knowledge and skills to meet people’s needs.

Appropriate arrangements were in place to ensure people’s medicines were obtained, stored and administered safely. People were encouraged to attend appointments with other health care professionals to maintain their health and well-being. Where people required assistance with their dietary needs there were systems in place to provide this support safely.

People and or their representatives, where appropriate, were involved in making decisions about their care and support arrangements. As a result people received care and support which was planned and delivered to meet their specific needs. Staff listened to people and acted on what they said.

The service was meeting the requirements of the Deprivation of Liberty Safeguards (DoLs). Support workers understood the need to obtain consent when providing care. Appropriate mental capacity assessments and best interest decisions had been undertaken by relevant professionals. This ensured that the decision was taken in accordance with the Mental Capacity Act (MCA) 2005, DoLs and associated Codes of Practice.

There was a complaints procedure in place and people knew how to voice their concerns if they were unhappy with the care they received. People’s feedback was valued and acted on. There was visible leadership within the service and a clear management structure. The service had a quality assurance system with identified shortfalls addressed promptly which helped the service to continually improve.

Mills Meadow provides accommodation and personal care for up to 30 older people who require 24 hour support and care. Some people are living with dementia.

There were 29 people living in the service when we inspected on 30 April 2015. This was an unannounced inspection.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, in relation to ensuring people were consistently supported by sufficient numbers of staff with the knowledge and skills to meet their needs. You can see what action we told the provider to take at the back of the full version of this report.

People’s nutritional needs were being assessed and met. Where concerns were identified about a person’s food intake appropriate referrals had been made for specialist advice and support. However, improvements were needed in people’s mealtime experience.

People received care that was personalised to them and met their needs and wishes. The atmosphere in the service was friendly and welcoming. Staff respected people’s privacy and dignity and interacted with people in a caring and compassionate manner. However, improvements were needed in the way that staff recorded issues with people’s anxiety and distress.

Processes were in place that encouraged feedback from people who used the service, relatives, and visiting professionals. Systems were in place to monitor the quality and safety of the service provided. However improvements were needed to drive the service forward.

Procedures and processes were in place which safeguarded people from the potential risk of abuse. Staff understood the various types of abuse and knew who to report any concerns to. Appropriate recruitment checks on staff were carried out.

There were procedures and processes in place to ensure the safety of the people who used the service. These included checks on the environment and risk assessments which identified how the risks to people were minimised.

Staff listened to people and acted on what they said. Staff understood how to minimise risks and provide people with safe care. Appropriate arrangements were in place to provide people with their medicines safely.

People were encouraged to attend appointments with other healthcare professionals to maintain their health and well-being.

People voiced their opinions and had their care needs provided for in the way they wanted. Where they lacked capacity, appropriate actions had been taken to ensure decisions were made in the person’s best interests. The service was up to date with recent changes to the law regarding the Deprivation of Liberty Safeguards (DoLS) and at the time of the inspection they were working with the local authority to make sure people’s legal rights were protected.

People were supported by the manager and staff to make decisions about how they led their lives and wanted to be supported. People were encouraged to pursue their hobbies and interests and participated in a variety of personalised meaningful activities.

There was a complaints procedure in place and people knew how to make a complaint if they were unhappy with the service.

There was an open and transparent culture in the service. Staff were aware of the values of the service and understood their roles and responsibilities.

An adult social care inspector carried out this inspection. The inspector spoke with five people who used the service, two visiting relatives, the acting manager and three care staff. We reviewed the care plans for five people, and the supervision records for four staff.

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

Is the service safe?

Care staff were trained to carry out their duties safely and efficiently. They told us that they received a range of frequently refreshed training. This included training in safeguarding vulnerable adults, which they stated gave them confidence that they would spot the signs of potential abuse and know what action to take.

People who used the service confirmed that they felt safe, for example when care staff assisted them in moving around the service. People's care plans identified and assessed risks in their daily lives, for example difficulty in maintaining a healthy weight. This helped staff to be aware of the care and assistance people needed to keep them safe and healthy.

Arrangements were in place to deal with foreseeable emergencies such as fire. Processes and actions to reduce risks, such as from substances hazardous to health, were regularly audited.

Policies and guidance informed staff of the requirements of the Mental Capacity Act 2005 (MCA) and we saw that the service was provided in accordance with the Deprivation of Liberty Safeguards.

Is the service effective?

People received the care and support they required to maintain their health and well-being.

We saw that people’s welfare was protected whilst their independence and community involvement was supported.

Is the service caring?

People were pleased with the service and felt that they received good care. One person described the quality of the service as, “120% - we are all well looked after.”

People's care was planned and delivered in accordance with their needs and preferences. We saw that staff treated people with care and respect. Care staff described how they sought people’s consent before providing care, and this was confirmed by people who used the service.

Is the service responsive?

We found that the service was responsive to people's wishes. Care plans were agreed with the people who used the service and were reviewed and adjusted in response to any changes in their needs. Feedback was encouraged and acted on.

Is the service well led?

The provider had effective systems in place to check and monitor the quality of the service.

We saw that training was in place, and refreshed, to ensure that staff were equipped with the skills and knowledge needed to be able to carry out their duties.

However, the provider's approach to formal appraisal of staff was not robust and some staff told us that they did not feel that opportunities for professional development were readily available.

Information we received on our, ‘share your experience’ website page, raised concerns that the budget to purchase equipment used by staff to ensure safe infection control procedures were followed, had been reduced. We were told this had resulted in the service running low and/or out of stock. Therefore the focus of this inspection was to check that there were sufficient equipment (disposable gloves, aprons, specialist laundry bags, and paper hand towels) for staff use.

When we inspected, we identified that although there had been a shortfall, which had resulted in supplies running low, or out of stock, the situation had now been addressed. Staff told us the cause for the shortfall was not budget related. We were told the problem had occurred during a changeover of suppliers.

We spoke with three people in the privacy of their bedrooms. They told us that staff kept their bedrooms and en-suites clean and tidy. One person told us, “They (staff) keep it alright.” All three people spoke positively about the staff and the care they received. One person told us, “Staff are kind to me.” Another person described staff as, “Very good,” whilst the third person remarked, “Staff are good to me, can’t grumble.”

The first registered manager named in this report was not in post and not managing the regulatory activity at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time.

During our inspection we spoke with four people in the privacy of their bedrooms to gain their views about the level of care and support they received. All were positive about the staff and the quality of care they received. One person told us, “Everyone is so kind and helpful.” Another person said, “I would say the standard of care is brilliant.”

We also spent time with people living with dementia observing the lunch time routines. We saw that staff were attentive and supported people in a respectful and kind manner to eat their meal.

People told us they were offered a varied choice of nutritious meals and plenty of drinks. One person told us, “Rice pudding is to die for, in fact all the food is lovely, pastry melts in your mouth and cakes are so light.”

We asked people if they would recommend Mills Meadow to others, they told us they would. One person remarked, “Oh yes it’s a lovely place, jolly well is.”

People told us if they had any concerns, that they felt comfortable to tell staff. One person told us, “Can’t complain at the moment. If I had a complaint I would soon tell them (staff), but touch wood I haven’t needed to.”

The first registered manager named in this report was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time.