The inspection took place on 7 and, 15 September 2017. The inspection was unannounced this meant that the provider didn’t know we would be visiting.

Our inspection was carried out because of concerns we had due to the notifications we received from the service. Notifications are reports of changes, events or incidents the provider is legally required to let us know about. The inspection was prompted in part by notification of an incident that involved the people who used the service. This incident is subject to a criminal investigation and as a result this inspection did not examine the circumstances of the incident.

At our last inspection in May 2017 we found the service was meeting all of our fundamental standards and was rated as ‘good’ and following this focussed inspection the service remains good overall.

We found during this inspection that notifications of significant events were not always submitted as required to the CQC from the manager and we are taking action outside of this inspection.

At the time of our inspection the service had registered manager in place. 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.

The people using the service told us they felt safe.

Staff understood the procedure they needed to follow if they suspected abuse might be taking place.

Risks to people were identified and plans were in place to manage the risk and minimise them occurring. Care plans contained risk assessments. These identified risks and described the measures and interventions to be taken to ensure people were protected from the risk of harm.

We saw where accidents had occurred these were reviewed and risk assessments were updated to prevent future occurrences.

Staff training records, showed staff were supported and able to maintain and develop their skills through training and development opportunities and these included training to ensure people’s safety.

Regular staff communications and team meetings were in place for staff to attend that were valued.

The inspection took place on 16 May 2017 and was unannounced. This meant the provider or staff did not know about our inspection visit.

We previously inspected Miltoun House in March 2015, at which time the service was in breach of Regulation 17 (Good governance) due to risk assessments not being recorded, and Regulation 12 (Safe care and Treatment) because the fire risk assessment had not been reviewed since January 2013. This meant they were requires improvement in safe but had an overall rating as good.

Following our last inspection the registered provider sent us information, in the form of an action plan, which detailed the action they would take to make improvements at the service.

At this inspection we found the recording of risk assessments had improved and the fire risk assessment had been reviewed in January 2016, September 2016 and again in May 2017.Action had been taken to ensure all of the previous breaches of regulation were addressed

Miltoun House is located in Guisborough and provides services to people with mental health conditions. The service can accommodate up to eighteen people. All rooms are single occupancy and have en suite facilities. It is situated close to the centre of Guisborough and has easy access to shops, local amenities and public transport. There were 16 people using the service at the time of our inspection.

The service had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like directors, 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 were sufficient numbers of staff on duty in order to keep people safe, meet their needs and ensure the premises were well maintained.

The storage, administration and disposal of medicines were safe. The service had recently introduced an electronic medicines administration system and we found this to be working well, with no errors identified.

Safeguarding principles were well embedded and staff displayed a good understanding of what to do should they have any concerns.

There were effective pre-employment checks in place to reduce the risk of employing an unsuitable member of staff. People who used the service were involved in the interview process.

There was prompt and regular liaison with GPs, nurses and specialists to ensure people received the treatment they needed.

Staff completed a range of training, such as safeguarding, health and safety and first aid. Staff had a good knowledge of people’s likes, dislikes and life histories.

Staff had built positive, trusting relationships with the people they supported. Staff were supported through regular supervision and appraisal, as well as confirming the registered manger was supportive and willing to talk at any time.

People enjoyed the food they had and confirmed they had an input into the menus. People had access to their own kitchen to make drinks, snacks throughout the day. We saw fruit was freely available.

People were supported to access activities of their choice.

People were supported to have maximum 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

The atmosphere at the home was relaxed and welcoming. We saw numerous instances of caring and supportive interactions during our inspection.

Staff, people who used the service and a relative we spoke with was positive about the registered manager’s impact on the service. We found the culture to be one where people received a good standard of care in a setting they found homely, safe and secure and were happy to live in.

We inspected Miltoun House on 31 March 2015. This was unannounced which meant that the staff and provider did not know that we would be visiting.

Miltoun House is located in Guisborough and provides services to people with mental health conditions. The service can accommodate up to eighteen people. All rooms are single occupancy and have en suite facilities. It is situated close to the centre of Guisborough and has easy access to shops, local amenities and public transport. The service provider is the long standing Miltoun House Group, which became a limited company and re-registered as Marran Ltd on 31 December 2014.

The service has a registered manager, who has been registered with us in respect of the service’s new registration since 08 January 2015. Prior to this they were registered as manager for the service’s previous registration. 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.

We observed that some windows on the first floor of the home had not been restricted to ensure the safety of people who used the service. We asked the registered manager to check all of the windows on the first and second floor to ensure that they were all restricted to 100mm or less. The registered manager told us that this would be done as a matter of priority and in the interim windows would be locked. We were contacted after the inspection to be informed that restrictors had been fitted to all windows on the first and second floor of the service.

The service’s fire risk assessment had not been reviewed since 2011. We did not see any formal risk assessments documented in the individual care files we looked at, although some care plans did comment briefly on relevant risks. The registered manager assured us that people were safe. However there was a potential risk of people not being kept safe because the provider had not identified, assessed and managed risks relating to the health, welfare and safety of people who used the service.

There were systems and processes in place to protect people from the risk of harm. Staff were aware of different types of abuse, what constituted poor practice and action to take if abuse was suspected. Appropriate checks of the building and maintenance systems were undertaken to ensure health and safety.

Staff told us that they felt supported. There was a regular programme of staff supervision and appraisal in place. Records of supervision were detailed and showed the registered manager worked with staff to identify their personal and professional development.

Staff had been trained and had the skills and knowledge to provide support to the people they cared for. There was enough staff on duty to provide support and ensure that their needs were met. Staff were aware of the requirements of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards which meant they were working within the law to support people who may lack capacity to make their own decisions.

We found that safe recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work. This included obtaining references from previous employers to show staff employed were safe to work with vulnerable people.

Appropriate systems were in place for the management of medicines so that people received their medicines safely. However risk assessments were not in place for those people who were administering their own medication.

There were positive interactions between people and staff. We saw that staff treated people with dignity and respect. Staff were attentive, caring and gave encouragement to people.

People’s nutritional needs were met, with people being involved in decisions about meals. People who used the service told us that they got enough to eat and drink and that staff asked what people wanted. Staff told us that they closely monitored people and would contact the dietician if needed. However, staff did not complete nutritional assessment documentation.

People were supported to maintain good health and had access to healthcare professionals and services. People told us that they were supported and encouraged to have regular health checks and if needed were accompanied by staff to hospital appointments.

Assessments were undertaken to identify people’s health and support needs. Person centred plans were developed with people who used the service to identify how they wished to be supported.

People’s independence was encouraged. People were encouraged to pursue their hobbies and leisure interests. Staff encouraged people to participate in the local community to prevent social isolation.

The provider had a system in place for responding to people’s concerns and complaints. People told us they knew how to complain and felt confident that staff would respond and take action to support them.

There were systems in place to monitor and improve the quality of the service provided. Staff told us that the service had an open, inclusive and positive culture.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of the report.