This unannounced inspection took place on 15 December 2016. At our last inspection visit in October 2015 we found the provider was meeting the regulations. Mill House is a care home which provides accommodation and personal care for up to 24 people. At the time of our inspection 21 people lived at the home.

The home had 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.

People told us they felt safe in the home. Staff we spoke with were aware of their responsibilities to keep people safe and report any allegations of abuse. People’s individual risks were assessed. There were sufficient numbers of staff to meet people’s needs. People received their medicines as prescribed and systems were in place to store and dispose of medicines safely. The provider had processes in place to ensure staff were recruited safely and that they had the training and skills to meet people’s needs. Staff obtained consent before they provided care. Staff understood people’s decisions when supporting people and worked to ensure people’s best interests were met. People enjoyed their food and had choices regarding their meals. People were supported to access health care professionals to meet their health needs.

People said staff were kind and caring and treated them with dignity and respect. People felt involved in their day to day choices and were supported by staff to maintain their independence. People and their relatives were involved in developing their care plans and people received care that met their needs. People told us they were happy living at the home and took part in a number of different activities. People and relatives knew how to raise any concerns and were confident any issues would be addressed.

People and staff told us the registered manager was approachable and supportive. Staff understood their roles and responsibilities. People and their relatives were encouraged to share their opinions about the quality of the service received. Effective audit systems were in place to assess and monitor the quality of service provided.

At the time of our inspection the provider did not have a registered manager in post.

We spoke with six people who lived at the home and two visiting relatives. We observed how care was provided to people and looked at five people’s care records. We spoke with four staff, the acting manager and the provider. We also looked at other records relating to the management of the home.

People told us they were asked for their consent in respect of daily routines. We saw that staff gained consent from people who were not able to express their views through observation of their reactions. One person told us, “Staff are very good, they do ask permission”.

People and a visitor we spoke with expressed satisfaction with the care and support that staff provided to people. We saw people were provided with care and support as set out in their care plans. One person told us that, “Staff are okay, they are very helpful”.

People told us they had a choice of meals and were happy with the meals that they had. We saw that people who were more dependent were supported to ensure they had sufficient nutrition and hydration.

Staff told us that they were well supported by the provider and received sufficient training to ensure they were able to care for people safely and to an appropriate standard.

We saw the provider had effective systems to assess and monitor the quality of service.

We spoke with three people that lived at the home, one visitor, three staff and the acting manager during our inspection.

We saw staff engaged positively with people and took steps to promote people’s privacy and dignity. We saw that staff knocked bedroom doors before entering people’s rooms, spoke to people respectfully and routinely offered them choices. People also told us how staff enabled them to retain their independence where possible.

People told us that they were happy with the care and support they received saying, “It’s alright” at the home and, “Staff are very good really”. A visitor told us that they had,”Every confidence” with the service.

We saw that people’s needs were assessed and their care was planned and delivered in line with their care plans. We found that people had regular access to health professionals for advice and treatment.

People felt able to share their views and raise any comments with the home. We saw that the manager responded appropriately to comments or concerns that people made to them. There were also systems in place to identify, assess and manage risks to the health, safety and welfare of people who use the service and others. This included making sure there was sufficient and safe equipment available that was needed to ensure people’s needs were met safely.

People told us at the time of our last review of compliance that the home is always clean and there are never any smells. They also told us that their beds are changed on a regular basis. One person commented on having watched cleaners do their job, and was satisfied with the way this was done. One person living at the home has participated in infection control training with the staff, their certificate displayed on a wall in the home.

People we spoke during the course of our last review of compliance told us that they were happy with their bedrooms, one saying that the availability of ensuite facilities was a benefit. One person told us that they liked sitting in the garden which they could access when wished. We were also told that people are able to bring their own furniture in and personalise their rooms should they wish.

People told us that they are confident in the homes current manager. Other professionals have told us that the service has improved since the current acting manager has been at the home, this meaning outcomes for people living there have improved.

A relative of a person living at the home told us that “it’s a very good home” and that the manager was “brilliant”.

Our inspection took place on 1 and 2 October 2015 and was unannounced. We last inspected the service on 28 September 2013. We did not ask the provider to make any improvements at this inspection.

Mill House provides personal care and accommodation for up to 24 older people, some who may live with dementia. There were 22 people living at the service when we carried out our inspection.

The service had a registered manager at the time of our inspection. 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 told us that they felt safe and they were treated well by staff. The registered manager and staff had a good understanding of how to keep people safe and escalate any concerns appropriately. People said they had to wait for assistance at night on occasions and staff did not always have time to support them with their pastimes and stimulation. People told us they were given their medicines when needed.

People told us, and we saw care and support was provided in a way that showed staff were kind and considerate. Staff were knowledgeable about people’s care and support needs, and were supported with appropriate training. People were supported to make their own decisions and choices by staff who understood and promoted people’s rights and worked in their best interests. People’s healthcare needs were promoted and regular appointments with healthcare professionals were maintained.

People told us they enjoyed the food and drink they were provided with and this was provided when requested and in sufficient quantities. We saw staff provided appropriate assistance to people that needed help to eat and drink and there were systems in place to ensure people at risk of weight loss were monitored, although we saw the availability of staffing did impact on staff ability to consistently provide people support with their meals when needed.

People told us the staff were kind to them. We saw people had developed positive working relationships with the staff who supported them. People told us that they were well cared for and staff understood what was important to them. Staff demonstrated a good knowledge of what was important for people and what was recorded in their care records. The confidentially of people’s information was compromised when staff shared information about people.

People's needs were assessed and their support plans provided staff with guidance about how they wanted their individual needs met. People participated in a range of activities and pastimes that reflected their individual interests and preferences, although staff did not always have time to support people with these pastimes.. People knew who to speak with if they had any concerns and were confident these would be addressed.

The provider assessed and monitored the quality of the service. There were systems in place to gain people’s views on the service. There were also systems in place to monitor the quality of the service such as a range of management audits. People and staff told us they found the registered manager and other senior staff approachable and we saw the registered manager was visible within the service. Staff felt well supported and were aware of the provider’s values and vision in striving to provide good quality care. The provider had not always formalised their plans for improvement of the service in a way that could be easily shared with stakeholders.