This comprehensive inspection was carried out on the 14 and 15 March 2017. The inspection was unannounced.

Milbanke Home for Older People is a residential home operated by Lancashire County Council. The home is located close to the centre of Kirkham. Accommodation is provided for up to 45 elderly people who require personal care, dementia care or are living with mental health needs. The home is split into four courts. There is a passenger lift to gain access to both floors. There are accessible gardens for people to use and car parking is available at the home.

There was a manager in place who was registered with the Care Quality Commission. 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 last inspected Milbanke Home for Older People March 2015. We identified no breaches in the regulations we looked at.

During this inspection carried out in March 2017 we found the registered provider was working in line with the principles of the Mental Capacity Act 2005. Appropriate applications to deprive people of their liberty were made to the local authorities as required. We observed care and support being provided in a safe way. Documentation recorded the care and support people required to maintain their safety.

Staff were able to explain the actions to take if they were concerned someone was at risk of harm or abuse. People who lived at the home told us they felt safe. One person told us, “Oh I’m safe. Everyone looks after me so well.” During the inspection visit we identified an occurrence which required reporting the Lancashire Safeguarding Authorities. We have made a recommendation regarding this.

Documentation we viewed evidenced people were involved in the planning of their care and people we spoke with confirmed this. People told us they were supported to see health professionals if the need arose and we found this was recorded in care documentation.

We looked at the auditing systems to identify shortfalls at the home and drive improvement. We found that when accidents or incidents occurred, the registered manager reviewed these. Staff spoken with were able to explain the steps taken to minimise the risk of reoccurrence. There were audit systems to identify if improvements were required at Milbanke Home for Older People.

We found medicines were managed safely. We observed medicines being administered and saw this was carried out safely. Staff told us they received training to enable them to administer medicines correctly and we saw documentation which evidenced this.

We reviewed staff files and found there were processes that ensured staff were suitably recruited. Staff we spoke with confirmed checks had been carried out prior to starting work at the home.

Staff told us they met with their line manager on an individual basis to discuss their performance. Staff with were complimentary of the training provided and told us further training was being arranged to ensure their skills remained up to date. Staff spoke positively of the registered manager. We found staff meetings took place to enable information to be shared and guidance sought if this was required.

We discussed staffing with people who lived at the home. People told us they considered there were enough staff to support them. Relatives and staff we spoke with raised no concerns regarding the staffing provision at the home.

People who lived at Milbanke Home for Older People told us they considered staff were caring. One person told us, “Everyone here is nice, so nice.” We observed people being supported with kindness and compassion.

During the inspection we saw activities were available for people to participate in if they wished to do so. We observed people joi

We inspected this service on 20 March 2015. The inspection was unannounced, which meant the provider did not know we would be visiting the service.

We last inspected this service 23 August 2013, when we judged the service to be meeting all the requirements of the regulations we inspected against.

Milbanke Home for Older People is a residential care home service provided by Lancashire County Council. The home offers 24 hour care and support for up to 44 people. The home is divided into four ‘courts’, two of which provide care for people who are living with dementia. Each court has an open plan lounge and dining area, equipped with a homely kitchen. At the time of our inspection, the home was caring for 41 people.

The home had a registered manager, who registered with the commission on 04 February 2011. At the time of our inspection the registered manager was absent and the home was being run by a registered manager from another Lancashire County Council service. The service had notified us about this appropriately.

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, their relatives and staff all told us there were no concerns about the safety of the service. Risks to people were assessed and guidance was available for staff about how to deliver safe care to people.

Staffing levels were regularly assessed and a sufficient number of staff were deployed to ensure people received the support they needed. The provider followed robust recruitment procedures to help ensure sure only suitable staff were employed at the home.

People’s medicines were managed safely and appropriately.

People were supported by staff who had the skills and knowledge to undertake their role effectively. Staff were able to access training on an ongoing basis.

People told us and records confirmed that people were able to access healthcare services when they needed them. People’s general health was monitored appropriately.

Concerns were raised about the quality of food provided for people. We discussed this with the manager who assured us they were already taking action to remedy this. We received documentation from them, which showed they were doing so.

The service did not routinely record people’s consent to care and treatment. We have made a recommendation about this.

People we spoke with told us they were treated with kindness and respect. They spoke positively about the care and support they received.

People were supported to express their views and be actively involved in making decisions about their care and support. Care plans were person centred and reflected people’s wishes.

People who used the service had varying levels of independence and staff respected this.

People told us they were able to choose what staff supported them with, how they spent their time, and what activities they participated in. People told us that staff took time to get to know them so that they could provide activities which they enjoyed.

The service had not received any complaints in the last 12 months prior to our inspection. A suitable complaints policy had been implemented by the provider and was made available to people who used the service and their relatives.

Regular audits and checks were carried out by the management, including visits by the business manager, which were designed to assess, monitor and improve the quality of the service provided.

Regular meetings took place where people could discuss the running of the service, raise concerns and make suggestions for improvements.

People we spoke with, their relatives and staff all spoke positively about how the service was managed and about the management team. There was an open and inclusive culture within the service.

We spent time in each of the units at the home. We saw that staff were very pleasant in their manner and communicated well with those living at the home. The atmosphere was relaxed and friendly.

People using the service told us; “I am settled here. The staff are very good.” And “Staff will get a doctor if I am ill.”

We received much positive feedback from relatives. We were told; “We can see a marked difference in her. She now seems to have a purpose.” And from another relative, “We are very pleased with Milbanke.”

We ate lunch with some people living at the home. We saw that staff supported people to choose their meal and provided assistance to those who needed support to eat. The majority of people we spoke with were happy with the meals provided at the home.

The home was well maintained. We saw that people were able to personalise their bedroom, with their own furniture, pictures and ornaments. The people we spoke with were happy with the accommodation.

Staff were recruited effectively and received appropriate training and support. This helped to ensure care was delivered safely and to an appropriate standard. People living at the home told us; “The staff are all helpful. We have a laugh and a joke together.” And “They are all lovely.”

Relatives told us; “The management of the home is very good.” And “I’ve never had any cause for concern.”

There were effective systems in place to gain feedback about and monitor the quality of the service.

We found that the home had recently been upgraded and redecorated to provide homely accommodation for people who used the service. We were told there were plans to improve the gardens to provide independent access for people with dementia. People who lived at the home said, "My room is very good indeed. I have all I need in there and like to watch films", "My room is very nice. I help to keep it nice and clean" and "The room is nice. I have some of my own things to make sure that it is like home".

People who used the service told us, "I am happy here. I like to read to keep me occupied", "I am happy here and satisfied with the care that I get" and "I am very happy here. I cannot thank the staff enough". People said they were well looked after and happy with their care.

Staff training and robust policies and procedures for the protection of vulnerable adults helped keep people safe.

People told us that food was good to help meet their nutritional needs.

Plans of care had been developed with people who used the service to ensure their wishes were taken into account.

Staff told us they were well trained and supported to help them care for the people who lived at Milbanke.