About the service: Mill Hayes Residential Home is registered to accommodate up to seven people. At the time of this inspection the service was providing personal care to five people who have a learning disability.

People’s experience of using this service:

At our previous inspection in July 2017, the provider was in breach of the of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The operations manager told us that since our last inspection visit the home had been redecorated and repairs had been carried out. However, the home required further repairs due to damage caused by people who used the service.

During this inspection we found that the provider was in breach of regulation 12, Safe care and treatment and regulation 17, Good governance. The provider's governance was ineffective in assessing and monitoring the safety of the environment which placed people at risk of harm.

The provider had recently appointed a manager who told us they had applied to be registered with us. People were aware of who was running the home and there was a clear management structure in place. People were supported to maintain links with their local community.

The operations manager told us there were plans in place to improve the service delivery through further staff training and staff support.

People told us they felt safe living in the home. Risk assessments were in place to promote people’s independence and to reduce the risk of harm whilst doing so. People were supported by sufficient numbers of staff who had been recruited safely. People told us they received their medicines when needed. We observed that medicines were stored and recorded appropriately.

The hygiene standards within the home were good and we observed staff had access to personal protective equipment to reduce the risk of cross infection. Systems were in place to learn and make improvements when things went wrong.

People’s care and support needs were assessed before they moved into the home and people told us they were treated fairly by staff. The manager and operations manager told us that staff were provided with relevant training to ensure they had the appropriate skills to care for people. People had a choice of meals and had access to drinks at all times.

The provider worked in conjunction with other agencies to ensure people’s care and support needs were met. Staff supported people to access relevant healthcare services to ensure their physical and mental health.

Adaptations were in place to assist people with a reduced mobility. At the time of our inspection the provider was not offering a service to anyone with reduced mobility.

People told us that staff always asked for their consent before they assisted them. Various methods were used to support people to make decisions.

We observed that staff were attentive to people’s needs.

People were encouraged to be involved in decisions about their care and treatment. People told us that staff respected their right to privacy and dignity. Weekly discussions with people gave them the opportunity to be involved in planning their care.

People were supported by staff to access services within their community and to pursue their social interests. The provider had systems in place to receive and respond to complaints. At the time of our inspection the provider was not offering end of life care.

Rating at last inspection: The service was rated Requires Improvement at the last inspection in July 2017.

Why we inspected:

This was a routine inspection planned on when the service was last inspected in July 2017.

Enforcement:

Action we told the provider to take can be seen at the end of the full version of the report.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

This inspection was unannounced and took place on 13 and 26 July 2017. Mill Hayes Residential Home is registered to provide accommodation and personal care support for up to 16 people. People who used the service had physical health needs and/or were living with dementia. At the time of our inspection, 10 people were using the service.

There was a registered manager in post. 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.

At our last inspection took place on 16 June 2016, and at that time the service was rated as ‘Requires Improvement’ overall. At that visit, we found the provider was in breach of Regulations. We told them to make improvements to ensure they assessed the risk of, prevented, detected and controlled the spread of infections. We also told the provider to have an effective system in place to ensure the staffing levels reflected the support people needed. We told the provider to send us an action plan by 17 August 2016 stating how they would rectify these breaches in regulations. Even though they did not send us a formal action plan back, they did respond to the issues in the report in a letter.

At this inspection, we found that some improvements had been made, but further were needed. The environment had been updated in certain areas, however further were required. The provider did not always respond when they received feedback about improvements that were needed at the home. The provider is again rated as requires improvement with a breach of Regulations.

We saw that staffing levels had been considered, but the provider still determined the staffing levels on the number of people living in the home instead of on an assessment of people’s needs.

Staff gained people’s consent before they were supported. However, when people were unable to make decisions about their care, the provider had not formally assessed their capacity, and had not evidenced why certain decisions were in people’s best interests. We have recommended that the provider researches current guidance on best practice, to assess the capacity in relation to specific decisions for people living at the home.

People were not consistently enabled to participate in their interests or hobbies. We have recommended the provider considers further action to ensure that people who use the service receive care that reflects their personal preferences. People were involved in the planning and reviewing of their support, but some care records did not always reflect people’s needs consistently. We recommend the provider researches and considers nationally recognised guidance when designing and reviewing care, to ensure each person has a clear care plan.

Improvements had been made to monitor the quality of the service, but some of these systems were not effective. We have recommended the provider reviews the systems and processes in place to assess and monitor the quality of the service to ensure these are effective. Further work was needed to ensure the service was developed with the staff team. Staff felt supported, but did not have access to regular supervision sessions.

People were protected from harm by staff who understood how to recognise signs of abuse and how to report concerns. Risks to people were assessed, monitored and reviewed. Medicines were managed safely and the provider had safe recruitment processes in place. Staff received an induction and training to give them the knowledge and skills they needed to carry out their roles. People were supported to maintain a balanced diet and have access to health care services.

People’s privacy was respected and their dignity promoted. They felt that the staff were caring in their approach. Staff encouraged people to be

This inspection took place on 16 July 2016. At our last inspection on 30 June 2014 the provider was meeting the regulations we inspected. Mill Hayes Residential Home provides accommodation and personal care for up to sixteen people. This includes care for people with dementia care needs and physical care needs.

There was a registered manager in post. 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 environment was not well maintained to ensure people were safe and not at risk of cross infection. The provider had not listened to people’s concerns about the need for refurbishment. People’s level of dependency on staff had not been taken into account when staffing was planned. People spent long periods of time without any interaction from staff and there were limited opportunities for them to take part in activities which might interest them. Staff were kind but they did not protect people’s dignity. Some people’s care plans were not accurate and had not been reviewed. The audit programme had not been completed and did not identify risks to people.

There were arrangements in place to recruit staff who were suitable to work with people in a caring environment. Staff understood their responsibility to protect people from avoidable harm and potential abuse and knew how to report concerns. Staff received training to improve their knowledge and skills to care for people effectively. People’s medicines were managed to ensure they received their prescribed treatments safely. The opinions and support of health care professionals was sought to maintain people’s physical, mental and psychological health. People were given a choice of food and drinks which met their needs and preferences.

You can see what action we told the provider to take at the back of the full version of the report.

The inspection was carried out by a CQC inspector. We spoke with five people who used the service, three relatives, three staff members and the registered manager. We also reviewed records relating to the management of the home which included three care records, daily care records, staff training records, minutes of staff and residents meetings and quality monitoring reports. We used the information to answer the five questions we always ask:

Is the service safe?

People told us they felt safe. Robust safeguarding procedures were in place. Staff had all had training in safeguarding and were aware of how to report any concerns about abuse to managers.

Staff training was up to date. Staff told us the training was "excellent" and they were encouraged to obtain national qualifications. They told us they felt confident in meeting people's needs. Staff had the training and skills to support people in providing safe, effective care.

We monitor the operation of the Deprivation of Liberty Safeguards (DoLS) that apply to hospitals and care homes. Staff had been trained to know when an application should be made. Correct procedures were in place but no applications had needed to be submitted since our last inspection. No one was subject to DoLS at the time of our inspection.

Is the service effective?

People told us that they were happy with the care they received and felt their needs had been met. It was clear from what we saw and from speaking with staff that they understood people's care and support needs. People were treated with dignity and respect. A person told us, "If I want anything, I only have to ask and I have it." A visitor we spoke with previously had two relatives who lived at Mill Hayes but had continued to visit a person they had met on previous visits. The visitor told us, "It is an excellent home. Nothing is too much trouble for staff. I found that any niggles were dealt with immediately by staff. People are happy here."

We looked at the provision of food and hydration for people who used the service. Referrals had been made to health care professionals where there had been concerns about weight loss or poor eating. Care plans contained information and instructions from professionals to meet people's dietary needs and reduce the risks of dehydration and malnutrition. The instructions had been followed. Several people told us they enjoyed the food.

Is the service caring?

Staff were able to describe the good practices they used to ensure that people's privacy and dignity were respected. We observed that staff engaged well with people. Everyone received the same caring response from care staff and were included in the conversations taking place.

A person who used the service told us, "I need a lot of care. Staff are very good to me. They always explain what they are proposing to do, like when they use the hoist. It makes me feel safe. I have no complaints." A relative told us, "They are wonderful staff and it is home from home."

Staff were able to tell us in detail about people's needs and how they supported them. This matched the information we had seen in care records. We saw that care staff showed patience and gave encouragement when supporting people.

Is the service responsive?

People and their relatives were aware how to make a complaint. A relative told us they would feel confident if they needed to make a complaint and that staff were approachable. No complaints had been received by the service since our last inspection. We saw that a complaint made in the previous year had been dealt with swiftly and appropriately in line with the home's policy and procedures for complaints. The person making the complaint had clearly been satisfied with the outcome.

We saw from reviews of people's care needs that plans of care had been adapted when there had been a change in the person's need or wishes.

Is the service well-led?

Staff were clear about their roles and responsibilities. They said they felt supported by managers. A staff member told us they felt that they were listened to and could approach managers at any time. A staff member gave us an example of contacting the manager on-call after hours and told us they had received a helpful response. This helped to ensure that people received a good quality service at all times.

We saw that the views of people who used the service, their relatives and staff had been sought as a means of improving the service.

Staff had a good understanding of the home's whistleblowing policy. They told us that if they witnessed poor practice they would report their concerns.

The provider visited during our unannounced inspection and confirmed they visited at least once each week. It was clear that people using the service and staff had regular contact with the provider.

We found that the provider had systems in place to gain consent for care and treatment from people who used the service or their relatives. People told us that they were given choices in their care and staff listened to them. We spoke with staff who told us they respected people’s wishes and had some understanding of the Mental Capacity Act 2005.

People who used the service and their relatives told us that they were happy with the care provided. One person we spoke with told us, “I like it here, I like everything”. Another person told us, “Its good care in here, the staff are right with you”. A relative told us, “I am very happy with the care my relative receives. The staff understand how to help X with their needs”.

We saw that systems were in place to ensure that medicines were administered and managed appropriately.

The provider had a recruitment policy in place and checks had been carried out to ensure that staff were suitable to provide support to people who used the service.

We found that the provider had a system in place to handle complaints and these were acted on in line with their policy and procedures. People told us that they knew how to raise their concerns if they needed to.

When we inspected the home on 21 May 2012 we observed staff using unsafe moving and handling techniques in respect of a person who used the service. We told the home that they needed to make improvements with manual handling of people in order to become compliant in this outcome.

We carried out an unannounced inspection to the home to check that the service had now complied. The manager explained how a manual handling assessment had been undertaken by an occupational therapist in respect of this person. They also told us that the recommended equipment had been used to move the person more safely at that time. They told us that this was no longer applicable because the needs of this person had changed.

The manager and deputy manager told us that all staff had been retrained in manual handling since our last visit. We saw records of staff training to confirm this. This meant that all staff delivering care have the knowledge about safe handling techniques and how to apply these. The manager was a manual handling trainer and regularly observed and supervised the staff. This helps to ensure that people using the service are handled more safely and according to their assessed needs.

We saw that staffing arrangements had been improved to help meet the needs of people who use the service.

We saw where people's social and therapeutic needs were now met on a more individual basis.

You can see our judgements on the front page of this report.

We carried out this inspection as part of our schedule of inspections. We wanted to see what life was like for the people who lived in the home. We also wanted to see whether the service had made any improvements since we last visited.

During our visit to the service we spoke with two care staff, the manager, the deputy manager and one of the providers. We also spoke with a total of six people who lived in the home and three visitors.

The visit was unannounced. This means that the service did not know that we were coming.

People were complimentary about the staff who looked after them and said that they were “kind” and looked after them well.

A visitor told us, “This place is absolutely great” and the staff were “worth their weight in gold”.

Staff knew how people liked to be supported and were attentive to people’s needs. The atmosphere in the home was friendly and informal.

We looked at the care plans of two people and observed how their particular needs were being met by the staff. One of these people needed total assistance with transferring and moving. We were concerned to observe staff carrying out manual handling of this person in an unsafe way. The provider will need to consider making manual handling safer for this person and for the staff carrying out this task.

Since our last visit the service had made some improvements to outcome four. Care plans were more detailed and more up to date. Reviews had been done which helped to ensure that care was applicable and appropriate for the person’s needs.

There were some activities taking place but this was mainly reliant on visits from outside entertainers. The provider might like to consider assessing each person and introducing suitable activities in order to meet their social and therapeutic needs.

Some of the environment was quite dark and in need of redecoration. Some of the furnishings were also in need of repair and/or replacement. The provider might like to consider updating the environment in order to make this more stimulating for the people who live there.

We carried out this inspection visit to assess whether the service (care home) was compliant with outcome four of the essential standards of quality and safety. This outcome falls under the regulations of the Health and Social Care Act 2008. Outcome four looks at the care and welfare of people who use the service.

Prior to our visit we had not received any concerns about this service and we carried out this inspection as part of our schedule of inspections. Our visit was unannounced so the service did not know we were coming.

When we arrived staff were welcoming and helpful. The registered manager was on duty and assisted us throughout our visit.

We were introduced to people who live in the home. We were also introduced to some visitors and the staff who work for the service.

Without exception, all of the people who live in the home and all the visitors we met with were very complimentary about the care and services provided. People told us that they felt very well cared for and that the staff were “excellent”.

Visitors told us that they were sure that their relatives were well looked after and that they “could not fault the place”.