Millbeck is a residential care home for up to 30 people. Millbeck provides care and accommodation to older people, including those living with a dementia. Accommodation is on two floors with a passenger lift providing access.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Staff knew how to keep people safe and prevent harm from occurring. Staff had completed training in safeguarding vulnerable adults and understood their responsibilities to report any concerns. Thorough recruitment and selection procedures ensured suitable staff were employed. Risk assessments relating to people's individual care needs and the environment were reviewed regularly. Medicines were managed safely and administered by staff trained for this role.

Staff received appropriate training and support. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. People were supported to have enough to eat and drink and had access to healthcare professionals as and when this was needed.

Staff provided care and support with kindness and compassion. There were positive interactions between people and staff. People could make choices about how they wanted to be supported and staff treated them with dignity and respect. People's independence was promoted and encouraged. There was a welcoming and homely atmosphere at the service.

People received support which was person-centred and responsive to their needs. Detailed care plans were in place which guided staff how people wished to be supported with daily living. People were involved in writing and reviewing their care plans and in decisions about their care. There was a varied programme of activities and entertainment available to prevent people being bored or socially isolated.

People spoke positively about the newly appointed manager and the wider management team. There was an effective quality assurance system in place to encourage feedback, ensure the quality of the service and drive improvement.

Further information is in the detailed findings below.

This inspection took place on 31 May 2016. The inspection was unannounced which meant the staff and registered provider did not know we would be visiting.

Millbeck is a purpose built care home for up to 30 older people operated by Anchor Trust. The home is located in the centre of Norton, in close proximity to shops, public transport and other amenities. Bedrooms are located on the ground and first floor and all have en-suite facilities.

The service had 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 was on maternity leave at the time of inspection. A regional support manager was supporting the deputy manager during the registered manager’s absence.

Staff we spoke with knew how to administer medicines safely and the records we saw showed that medicines were being administered and checked regularly.

However improvements were needed in guidance for medicines prescribed ‘when required’, topical medicines administration and handwritten medication administration records (MAR). We have recommended that the registered provider makes improvements to ensure the safe management of medicines.

Accidents and incidents were monitored each month to see if any trends were identified.

Policies were in place to ensure people’s rights under the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards were protected. Where appropriate, the service worked collaboratively with other professionals to act in the best interests of people who could not make decisions for themselves. At the time of inspection there was one person subject to a DoLS authorisation. We saw evidence of consent within care files.

People were supported to maintain their health through access to food and drinks. Appropriate tools were used to monitor people’s weight and nutritional health. People spoke positively about the food provided.

There was evidence of activities provision and people who used the service were happy with what was available.

Staff we spoke with understood the principles and processes of safeguarding. Staff knew how to identify abuse and act to report it to the appropriate authority. Staff said they would be confident to whistle blow [raise concerns about the service, staff practices or provider] if the need ever arose.

The registered provider followed safe processes to help ensure staff were suitable to work with people living in the service. There were sufficient staff to provide the support needed and staff knew people’s needs well. Staff had regular supervisions and appraisals to monitor their performance. Staff received regular training in the areas needed to support people effectively.

People and their relatives spoke positively about the care they received. Throughout the inspection we saw people being treated with dignity and respect. Staff were seen to be very respectful of people and supported people in a dignified and discreet manner.

No one at the service was using an advocate at the time of the inspection. Information on advocacy was available. Procedures were in place to provide people with end of life care.

We found care plans to be person centred. Person centred planning [PCP] provides a way of helping a person plan all aspects of their life and support, focusing on what’s important to the person.

The service worked with various healthcare and social care agencies and sought professional advice, to ensure that the individual needs of the people were being met.

The service had an up to date complaints policy. Complaints were properly recorded and fully investigated. However outcomes did not always include the complainants response.

The registered provider carried out regula

One inspector carried out this follow-up inspection. During the inspection, we spoke with two people, three staff, the manager and regional manager. We looked at four sets of care records.

In our scheduled inspections we always set out to answer our five questions: is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led? However, we were not able to answer all these questions during this follow-up inspection because we were only looking at records. This is because we had identified non-compliance with records at our last inspection in April 2014. This meant that records were not accurate and up to date. We went back to check that the home had taken action to ensure that records were fit for purpose and were now accurate and up to date.

The summary is based on our observations during the inspection, speaking with people using the service, and the staff supporting them and from looking at records

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

We found that people’s care records contained the information they needed and this information was accurate and up to date. New records for laundry and domestic staff had been introduced; however we could not be sure about the effectiveness of these records.

Records of night checks showed that some checks did not occur at the intervals specified in their care records.

Some records which had been unavailable during the last inspection had been located and stored appropriately.

Is the service responsive?

The home responded quickly to the areas of non-compliance identified with records during the last inspection. The home promptly sent us an action plan which set out the action which they were going to take.

We found that the home had made significant improvements to the quality of record keeping. We saw that a small amount of work was needed in some areas but overall the standard of record keeping had significantly improved.

People were involved in decisions about their care and support. We observed people being given choice throughout our inspection and staff sought people’s permission before care and support was given.

We saw that not all staff were trained in Mental Capacity Assessment and Deprivation of Liberties Safeguards. Some staff we spoke with lacked knowledgeable in these areas and were unsure of the procedures that they needed to follow should someone be unable to make a decision or consent to care and treatment. We asked the manager to take immediate action and ensure that all staff were up to date with training in these areas.

Care plans and risk assessments were in place for people. They were individualised and detailed the care and support which people needed.

We saw that staff made appropriate referrals to other professionals when needed. Staff were very knowledgeable about people’s care and support needs and were responsive to them. People were treated with kindness and respect by all staff.

We saw that the home had not had an activities co-ordinator for some time and this position was in the process of being advertised. During our inspection we saw that most people spent time in their rooms. We saw people attending the hair salon during our inspection but we did not see any specific activities taking place. People told us that there were very little activities taking place.

Millbeck was clean, hygienic and well maintained. There were good processes in place to ensure the infection prevention and control of the home.

The service had a registered manager in place. We saw that there was a good staff team in place at Millbeck and staff told us they were supported by their manager. People and relatives we spoke with told us they felt able to talk to the manager and staff about any concerns which they had.

We saw gaps in the recording of information which breached the Health and Social Care Act 2008 and associated regulations.

Is the service safe?

People had been cared for in an environment that was safe, clean and hygienic. Staff were very knowledgeable about the procedures they needed to follow for infection prevention and control.

Staff were attentive to people’s needs and carried out safe practices when providing care and support. People we spoke with confirmed they felt safe living at Millbeck.

We found gaps in the recording of information in people’s records, in audits and in kitchen cleaning schedules and safety checks. We found some records were unavailable during inspection. Records did not contain all the information required by the Health and Social Care Act. This meant the provider could not demonstrate that people were protected from the risks of unsafe or inappropriate care because records were incomplete. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care home. While no applications had needed to be submitted, proper policies and procedures were in place. Not all staff had been trained to understand where an application should be made, and how to submit one, however we could see that staff were in the process of undertaking this training.

Is the service effective?

People were treated with dignity and respect when staff were providing them with care and support. It was clear from our observations and from speaking with people that staff had a good understanding of people’s care and support needs and that they knew them well. We saw that health professionals were involved in people’s care when needed.

All people living at the home had the capacity to make their own decisions. We saw staff sought people’s permission before any care tasks were carried out. We observed people being given choice about when and where to access support and what to eat for lunch.

Not all staff were up to date with their training on the Mental Capacity Act and lacked knowledge in this area when we spoke with them. We could see that half of the team had undertaken this training and the remaining team members were in the process of accessing this training.

Is the service caring?

People were supported by kind and attentive staff. We saw that staff showed patience and gave encouragement when supporting people. Staff were friendly and responsive to people’s needs. We saw staff interacting with people when providing care and support and helping to increase their independence.

Is the service responsive?

People’s needs had been assessed before they moved into the home. This information was contained within people’s care records and helped to ensure care plans were specific to individual needs.

We saw that people and their relatives were involved in monthly reviews about the care and support which they received. Records confirmed people’s preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people’s wishes.

The home was working alongside other health professionals to meet people’s needs. Staff were attentive to people’s needs and followed programmes of support put in place by health professionals.

Is the service well-led?

Staff had a good understanding of the ethos of the home and quality assurance processes were in place. Staff were clear about their roles and responsibilities and we saw them working as a team throughout our visit.

We looked at the records and spoke with people and their relatives. They confirmed that staff acted quickly when people’s needs changed. We saw that staff followed programmes of support which were put in place by other health professionals.

People and relatives we spoke with confirmed that they could approach the manager and staff to discuss any concerns which they had. We saw meetings were in place for people living at the home and their relatives and staff. This ensured that people were involved in and kept up to date with changes affecting them.

What people told us.

We spoke with seven people who lived at the home and two relatives who were visiting on the day of our inspection. We also spoke with a health professional who was visiting one person on the day. People who lived at the home were able to express their views and told us they were happy with the care and support which they received.

Three people we spoke with told us, “We like living here. We are well looked after and can’t complain.” Two people told us, “Staff are very good.”

We heard mixed reviews about the food which was provided. Two people told us, “The foods ok, some things could be better,” and “The food is passable.” Two other people we spoke with told us, “The food is good,” and “The food is lovely; I can ask for other things if I want.”

One person told us about their care needs and how staff really understood how to look after them. They told us, “Staff are always careful with me.” A health professional we spoke with confirmed this to be the case and told us, “The staff are really helpful and follow the programme of support which I have put in place. They are always willing to assist.”

Everyone we spoke with confirmed that their rooms were clean and tidy.

During our inspection we saw people visiting the hair salon. People we spoke with told us they looked forward to having their hair done. Some people we spoke with told us they accessed the local community. One person told us, “There is not much to do here.”

We spoke with three people who used the service. They told us they were treated well and the staff were good. One person said, “Staff check I’m alright, I get meals and baths, if I ask for anything they see to me.” Another person said, “I get fed and watered and they do things for me that I can’t do.”

We found that people were treated with dignity and respect. We saw there was a friendly and relaxed atmosphere between people living and working at the home. We observed staff interacting well with people and supporting them which had a positive impact on their wellbeing.

We found the premises that people, staff and visitors used were safe and suitable and that people were supported by suitably qualified, skilled and experienced staff.

We found there were effective systems to regularly assess and monitor the quality of service that people received.

We spoke with four people living at Millbeck and one relative. All of the people told us they were satisfied with the level of care and support that they received.

People said, "I am well cared for here and think we are very lucky."

A relative spoken with said they were kept well informed of any changes to their family member. They said, "There is good communication, I am kept well informed of everything and feel that I have been fully consulted."

A friend of a person living at Millbeck said, “I believe she is being very well cared for and the staff are all pleasant and welcoming.”

We spent some time walking around the home, observing interactions between people living at the service and staff. We saw that people were treated kindly and with respect.

We spoke to people about life within Millbeck. They confirmed they were able to make decisions about their daily lives and that they were treated with respect. One person said, "Definitely treated with dignity and respect, I have a keyworker and they do my baths and showers".

People told us that they were provided with the care and support they needed. They said, "The staff are very good and I get the care that I need". A relative said they were kept well informed and they were confident that they were doing all they could for their loved one.

People told us they felt safe living at Millbeck. One person said, "Yes, I feel safe, if I was unhappy I would speak to the team leaders". A relative confirmed they had received a service user’s guide that they were aware of the complaints procedure and that if they had any concerns they could speak to any of the staff about it.

One person spoken to expressed some concern in respect of staffing. They said that they did not know how long they would have to wait when using the call buzzer but said, "not the only pebble on the beach".

Other people spoken to said they went long periods of time without seeing any staff. One person said, "I have seen my keyworker very little this year".

A relative also express some concern. They said, "I think there is a problem with staffing, there used to be loads of staff. The keyworker used to spend a lot of time and the one to one time is no longer happening"