This inspection took place on 10 and 11 January 2017 and was unannounced. The Mill House Care Home offers accommodation for up to 31 people with dementia and physical health care needs. There were 31 people living at the home at the time of our inspection. People had their own rooms and the use of a number of comfortable communal areas, dining areas and lounges, a sensory zone, nail bar and hairdressing salon and garden areas.

We had the opportunity to talk with four people who lived at the home on the day of the inspection. We spoke with 7 relatives and a friend of a person who lived at the home. Not everyone was able to communicate directly with us, so we used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

A manager was in post at the time of our inspection. They were in the process of applying to become a registered manager. 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 registered manager and senior staff team supported care staff to provide safe and compassionate care. Risks to people’s safety were recognised and staff took action so people were able to do things they enjoyed in a safe way. There were enough staff available to support people in the ways they wanted. Staff knew what actions to take, if they had any concerns for people’s safety or well-being and were able to obtain advice from the manager, provider or external organisations if required. People were supported to take their medicines so they would remain well.

Staff had the skills required to support people so they would enjoy a good quality of life. People’s right to make decisions and their freedom was protected and staff worked with other organisations to make this happen. Staff supported people to enjoy a range of food and drinks safely, so they would remain well. People were supported to see their preferred health professionals and staff promptly sought emergency health assistance when required.

People had developed strong relationships and bonds with staff, who supported people with compassion and respect. People enjoyed being with the staff who cared for them and were given reassurance by staff when wanted this. Staff knew how to support people so they were able to make choices about what daily care they wanted. People’s need for independence and to maintain their preferred lifestyles were taken into account by staff when they cared for them.

People benefited from living in a home where staff understood their individual preferences and unique needs. The whole staff team were committed to making sure people received the right care for them as individuals. Staff recognised when people’s needs changed and took action so people continued to enjoy life and receive care in the best way for them. Where people were not able to decide on all aspects of their care themselves, staff worked with their relatives, so people wishes and preferences were embedded into the way their care was planned and reviewed. People and their relatives knew how to raise any complaints they had and were confident staff would take action if this happened.

There was clear and open communication between the provider, manager and staff, so staff knew what was expected of them. The provider, manager and senior staff based their approach to care on nationally recognised best practice. The manager and senior staff reflected on the care they provided, so they could be assured people received the care they needed and improvements were driven through. The manager and senior staff worked with the local community to promote people's understanding of the needs of people with dementia.

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service.

The inspection was unannounced, which meant that nobody knew we were visiting. We last inspected The Mill House, 25 November 2013 and found the service to not be in breach of any regulations.

The Mill House provides accommodation and personal care for a maximum of 31 people some of whom may have dementia related illnesses. At the time of our inspection there was a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

People told us that all the staff were caring and that staff were respectful and talked to them calmly. We observed many situations were care staff spoke kindly to people and maintained their dignity when providing assistance. People told us they were supported to remain independent and received assistance when they needed it.

People told us they found the provider and registered manager approachable and told us they would raise any complaints or concerns should they need to. All the people we spoke with told us that they had never needed to complain or had anything to complain about. Through regular meetings and using an ‘open door’ policy we found that the provider and registered manager promoted a positive culture, in which they invited people to talk with them about any concerns they may have. We found that when staff had raised concerns to the provider, the provider had acted promptly and appropriately.

Our findings from our inspection confirmed that the provider was not in breach of any regulations. We found that people were kept safe by trained staff who knew how to protect people. We found that people were cared for in a supportive way that did not restrict their freedom. The provider of Mill House had carefully planned and designed the home and garden to ensure it was safe for people who had poor mobility or for those that lived with dementia. Adaptations to the garden ensured it was safe for people to use in a safe way. There were sufficient staff to meet people’s needs.

There was a long standing experienced team of staff that knew people well. Staff knew people’s likes and dislikes and respected their wishes. People we spoke with were complimentary about the food and their dining experience. Relatives spoke about the good support people were offered with maintaining their nutrition where there were concerns. We observed people receiving regular fluids and staff supported those who needed assistance. 

We found that the service was responsive towards peoples health needs. People told us they took part in activities that they enjoyed and that they were personalised to their choice.

We found the registered manager had systems in place to ensure that the quality of the care was monitored.  Checks were carried out and completed monthly. Where there were any actions following these audits they were followed up and improvements had been made.

On the day of our inspection there were 30 people living at The Mill House. We spoke with five members of staff, four people who used the service and four relatives. We looked at policies and processes, seven care records and five staff records to gain an insight into the care provided.

We saw that people and their relatives were involved in decisions about the care provided and details of their needs and interests were included in their care records.

Care plans and risk assessments were in place and were updated regularly to ensure people received the care they needed. There were a variety of activities designed to meet people's needs and maintain their independence. People told us they liked living at The Mill House. One person told us, “I’m alright here.”

People’s safety was protected because there were systems in place to report safeguarding concerns and staff received relevant training. People told us they were satisfied with the care provided and said they felt safe. A relative we spoke with told us, “I can’t fault it. I’m happy they are here.”

Relatives we spoke with said the staff were excellent. Staff we spoke with said they loved working at The Mill House. Staff said they were supported with relevant training to care for the people who used the service.

People experienced good quality care and effective systems for monitoring were in place. There was evidence that people and their relatives knew how to complain if things were not right.

During our inspection we spoke with three people who used the service and two relatives. We observed how staff interacted with people to support them in making decisions about their lifestyles. We saw that staff respected the decisions that people made. We spoke with a relative who said, "I can't fault the place or the people who work here."

The three care files that we reviewed indicated that arrangements had been made to support people in receiving their health and care needs. We saw recordings that confirmed that staff had actively promoted people's health and well-being. From the discussions held with staff we found that people were well supported in leading a varied lifestyle that suited their individual preferences. People were encouraged and supported to do things for themselves and were given choices. One person told us, "It's very nice here and food's good, I like it."

We found that systems were in place to keep people safe. Staff had received training in safeguarding people and knew how to respond to concerns.

We found that there were enough staff allocated to work for each shift so that people's care needs were met. There were systems in place for staff to attend appropriate training courses. We spoke with the registered manager, the care manager and two senior care workers. We received positive feedback about the day to day running of the home.

People told us they knew how to make a complaint but that they had not needed to.

We spoke with people who live at The Mill House, who told us that they were happy at the home and that the staff looked after them well. We also spoke with visitors at the home during our visit. Everyone we spoke with had positive things to say about the home and the staff. Comments included "wonderful", "the home has life in it", "like living in a hotel", "nothing is too much trouble, can’t rate it high enough" and "I am so glad I found The Mill House".

We observed interactions between staff members and people living at The Mill House. Staff were seen to be respectful and kind. The Mill House has been made as homely and friendly as possible. One relative said everything was "excellent, more like a family than a care home". Visitors we spoke with made reference to the pleasant atmosphere within the home.

The home was seen to be clean in the areas we looked. In order to aid people’s orientation the service had painted toilet doors red. The walls in communal areas such as lounges and corridors had photographic displays, pictures of events such as the World Cup in 1966 and of film stars. Other displays were more tactile for people to touch.

Care plans and risk assessments were in place. These were person-centred and identified individual care needs. Some areas were not covered and some assessments and plans were not fully up to date. Care workers did however have a good understanding of people’s needs.

The majority of staff had received training to ensure they had knowledge about their responsibilities regarding safeguarding people against abuse. The registered manager had in the past informed the Care Quality Commission of any concerns or allegations made within the home and took appropriate action to ensure people were kept safe. These actions had included notifying the local authority under multi agency safeguarding procedures and the Independent Safeguarding Authority.

Although The Mill House had systems in place to ensure the safe administration of medication we found failings and occasions when errors had occurred.