This inspection took place on 11 and 14 September 2018 and was unannounced.

At our last inspection on 27 July 2016 we had rated the service 'Requires Improvement' and identified a breach relating to staff training and the safety of the premises.

Following the last inspection, we asked the provider to complete an action plan. We needed the provider to inform us on how they intended to improve

Mill House is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The CQC regulates both the premises and the care provided, and both were looked at during this inspection. The home provides nursing and personal care for up to 43 people. Accommodation is provided on three floors in single rooms with lift access between the floors. There are communal areas on the ground floor, including a lounge and a dining room. There were 28 people using the service at the time of the inspection.

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.

Medicines management was not always safe which meant people were at risk of not receiving their medicines when they needed them. We saw that one person was left without medicines because the re-ordering systems were not robust enough. Not all medicines administered covertly were consulted with a pharmacist. We raised these issues with the registered manager and saw evidence they made necessary improvements on the second day of the inspection.

We found that not all people living at Mill House had personal emergency evacuation plans (PEEPs) in place. We brought it to the attention of the registered manager who provided us with

evidence these were in place on the second day of the inspection.

The provider had appropriate staff recruitment procedures however, these were not followed; not all employment checks were completed before staff started working with people.

The principles of the Mental Capacity Act 2005 were not being applied in respect of best interest decisions to provide care or use restrictive practices.

People gave mixed feedback about the quality of meals served to them.

During the inspection we found there was a lack of communication between regular and agency staff. The agency staff not always received appropriate briefing and some of them were unaware of people’s needs.

There was a complaints policy in place. However, the complaints policy required people to raise their concerns in writing which would not always be possible due to people’s health conditions. Complaints raised verbally were not always recorded and it was not clear what action was taken to in response to them.

There was one person receiving palliative care from the service, however, there was no end-of-life care plan for this person. The registered manager ensured there was an end-of-life care plan for this person on the second day of the inspection

There were gaps in the records. Quality assurance systems were in place but had failed to identify the issues which we found at the inspection.

People told us they felt safe and staff were aware of their responsibility to keep people safe. Risks to people's safety were appropriately assessed and managed. Staff knew what action to take if they were concerned that someone was being abused or mistreated.

Staff received on-going training. Staff told us they felt supported by the management and received supervisions and appraisals, which helped to identify their training and development needs.

Staff made referrals to and sought support from a range of health care professionals in a timely way.

People had positive relationships with staff and were treated in a cari

This inspection took place on 27 July 2017 and was unannounced.

Mill House is a care home registered to provide care for up to 43 people. At the time of our visit there were 33 elderly people living at the service, all of whom required nursing and personal care. The accommodation was arranged on two levels of the service’s building.

There was a registered manager in post, who was a regional support manager with the provider. The service was being managed on a day to day basis by a new manager who had been in post since February 2017 and was supported by the registered manager. The new manager was planning to apply to become the 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.

Staff were clear about the action they would take to keep people safe from abuse. People and staff were confident they could raise any concerns and these would be dealt with properly.

The provider had a ‘traffic light system’ in place to alert and guide staff. However, that system was not always used effectively. Most of the risks to people's health were identified and plans were in place to manage the risks. These had been kept under review and were relevant to the care being provided.

Medicines were administered in line with recognised good practice, which significantly reduced the risk of people being subject to unsafe medicines administration. Staff received regular medication training. However, staff members did not undergo competency checks to evidence they were safe to administer medicines. Other training of staff, for example fire safety training, was not always up-to-date. As a result, it could not be ensured whether staff had the relevant skills and knowledge to meet people’s needs. Staff had not been receiving regular supervision to support their practice and development. The manager had identified this already and had a plan in place to ensure staff would receive supervision going forwards

People were not always protected from the risk of fire as the testing of fire equipment had not always been carried out in accordance with the provider’s policy.

A quality assurance system was in place but it was not always effective as it had failed to highlight and address the issues identified at our inspection.

We found recruitment procedures were safe with appropriate checks undertaken before new staff members commenced their employment. Staff told us their recruitment had been thorough and professional.

The principles of the Mental Capacity Act 2005 (MCA) were understood and were being followed. Mental capacity assessments and best interest decisions were recorded in relation to applications for Deprivation of Liberty Safeguards (DoLS), and the use of bed rails and wheelchair lap belts for people who lacked capacity.

People were supported to maintain a healthy diet and referrals had been made to relevant healthcare professionals. Records confirmed people were seen by doctors, dieticians and care home support service.

There was a calm, warm and friendly atmosphere at the service. People told us staff were kind and caring, which we also observed on the day of inspection.

Staff ensured people were treated respectfully and with dignity at all times. People felt involved and able to make decisions regarding their care.

Staff used the care plans to guide them when providing person-centred care. Most of the care plans contained information about people’s past history, the places where they had lived and what interested them.

The service had a complaints procedure which was made available to people they supported. People told us they knew how to make a complaint if they had any concerns.

The manager was approachable and ensured they listened an