This inspection was unannounced and took place on the 30 April 2018.

Millbrook Care Centre is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided and both were looked at during this inspection.

Millbrook Care Centre is a large detached property which provides accommodation for up to 46 older people. The accommodation is situated over two floors with lift access. At the time of this inspection there were 28 people living in the home.

We last carried out a comprehensive inspection of this service on 25 and 26 October 2016. At that inspection we found one breach of the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulations 2014. This was because medicines were not managed effectively.

We also found that improvements needed to be made to the quality assurance processes in place in the home and to how the provider notified CQC of important incidents.

Following the last inspection, we asked the provider to complete an action plan to tell us what they intended to do and by when to improve the key questions is the service safe and well led to at least good.

During this inspection we found the required improvements had been made.

Medicines were managed safely and people received their medicines as prescribed.

There was a robust system of quality assurance in place. Weekly, monthly and annual checks and audits were carried out by the registered manager and other managers of the service. These were used to assess, monitor and review the service.

The service had notified CQC of any accidents, deaths, serious incidents and safeguarding allegations as they are required to do.

The service had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 were positive about the registered manager and the way the home was organised and managed. Staff told us they enjoyed working at the home and felt supported.

Staff were aware of their responsibilities in protecting people from abuse and were able to demonstrate their understanding of the procedure to follow so that people were kept safe.

Individual and environmental risk assessments gave staff guidance on how to minimise and manage identified risks. Health and safety checks had been carried out and equipment was maintained and serviced appropriately.

The home was decorated and furnished to a high standard and was well maintained.

Recruitment procedures were in place which ensured staff were safely recruited. There were sufficient staff to meet people’s needs and staff received the training, support and supervisions they needed to carry out their roles effectively.

People had their nutritional needs met and had access to a range of health care professionals.

The requirements of the Mental Capacity Act 2005 were being met. 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 and their visitors spoke positively about the care and kindness shown by staff. One person said, “Staff are absolutely wonderful.” During the inspection we found that staff had a good understanding of people’s likes and preferences. Staff knew people well and understood individual’s care needs. Interactions were polite and friendly. Staff offered assistance in a sensitive and unhurried manner.

Care records contained risk assessments and care plans that were person centred, detailed and written using respectful terms. People told us they were

This inspection took place on 25 and 27 October 2016 and was unannounced. At a previous inspection, undertaken in May 2014 we found no breaches of legal requirements.

Millbrook Care Centre is a purpose built service that provides residential care and accommodation for older people. The home has 46 beds and is situated across three floors with lift access. The home also provides short stay care and end of life care where required.

The home had a registered manager in place and our records showed she had been formally registered with the Care Quality Commission (CQC) since July 2015. A registered manager is a person who has registered with the CQC 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 were safe living at the home and staff had a good understanding of safeguarding issues and how to recognise and report them. There was regular maintenance of the premises and fire risk and other safety checks were carried out on a frequent basis. Staff undertook fire drills to practice their response to such an emergency and people had emergency evacuation plans in place. Accidents and incidents were monitored and reviewed to identify any issues or concerns. A new falls team had recently been established to monitor and review the home’s response to falls.

Suitable recruitment procedures and checks were in place, to ensure staff had the right skills. All staff had been subject to a Disclosure and Barring Service check (DBS). We found some issues with the management of medicines at the home. Recording of when medicines were administered was not always complete and some people did not have “as required” care plans. Where people were dealing with their own medicines, these were not kept securely, as required by the provider’s own policy.

Staff told us they had access to a range of training and updating. The registered manager told us a new on-line system had been introduced and staff were being encouraged to fully complete all required training. Staff told us, and records confirmed they received annual appraisals and half yearly reviews. Staff were also subject to situational supervisions, if an incident or issue arose.

People told us, and our observations confirmed that the home was maintained in a clean and tidy manner.

People’s health and wellbeing was monitored and there was regular access to general practitioners, dentists, district nurses and other specialist health staff. We witnessed staff responding immediately and appropriately to health concerns.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS). DoLS are part of the Mental Capacity Act 2005 (MCA). These safeguards aim to make sure people are looked after in a way that does not inappropriately restrict their freedom. The registered manager confirmed that all people living at the home had capacity and no applications for DoLS had been made or granted. People were asked their consent on a day to day basis, some newer care records did not have explicit consent forms or care agreements in them, to say people had agreed to care delivery.

People were happy with the quality and range of meals and drinks provided at the home. They told us they could request alternative items and we saw this in practice. Special diets were catered for and kitchen staff had knowledge of people’s individual dietary requirements, likes and dislikes.

People told us they were happy with the care provided. We observed staff treated people patiently and with due care and consideration. Staff demonstrated a good understanding of people’s individual needs, preferences and personalities. People and relatives said they were always treated with respect and dignity.

Care plans were comprehensive, person centred and related appropriately to the individual needs of t

During our inspection we spoke with the manager and the care staff on duty. We also spoke with people living at Millbrook to gain their views and experiences of living in the home. We spent some time observing the interactions between staff and people living at Millbrook. We looked at a selection of records including care plan records and their quality auditing systems.

We considered the evidence collected under the outcomes we reviewed and addressed the following questions: Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?

Below is a summary of what we found. Please read the full report for the evidence supporting our summary.

Is the service safe?

People we spoke with told us that they were treated well by staff and they felt safe in their environment. There were systems in place to support staff and provide them with guidance on how to support people safely. Member of staff we spoke with told us they received 'excellent' support from the manager and that she was available at all times to address any issues of concerns they might have. There was evidence to demonstrate that staff had received training relevant to their role and that ongoing mandatory training was available.

We saw documentation to demonstrate that staff received regular supervision and that they attended team meetings. These provided a forum for people to raise concerns, discuss good practice issues and learn from events such as accidents, incidents and complaints and concerns. This way of working helped to reduce the risks to people and helped the service to continually improve.

Is the service caring?

People we spoke with spoke highly about the care and support they received from staff. They told us that staff listened to them and worked well with them. One person said, "Nothing is too much trouble for the staff, they help you as much as they can and they understand that I want to be as independent as possible".

During our observations we saw staff providing care and support in a kind and sensitive way. Staff treated people with respect and we noted that there was good communications between staff and people living in the home.

Is the service effective?

People we spoke with and some of their relatives who were visiting told us that they were fully involved in the planning of the care they received. People living in the home told us that staff listened to them about how they wanted to be supported and took the necessary action, such as call out medical practitioners if this became necessary.

People we spoke with told us they were involved in attending resident and family meetings where they could express their views. We were told that the manager and the staff team were pro-active in responding to their suggestions, ideas and concerns.

We saw documentation and information on the individual care plan files to demonstrate that the service worked well with other professional agencies to make sure that people received care and attention from the relevant healthcare professionals.

Is the service responsive?

We saw that people's needs were assessed prior to moving into the home so that the manager could be sure that the staff team could meet the individual assessed needs of people. This meant that people moving into Millbrook could be confident that the staff had the right skills and experience to provide care to them in a safe way.

We saw that care plans were regularly reviewed and where there were any changes in healthcare needs there were documented. We saw that people in the home had access to healthcare professionals and the service sought medical intervention in a timely way if this was necessary.

Is the service well- led?

The manager had been in post since the opening of the home and had established a strong staff team. All the staff we spoke with spoke highly of the manager and told us that she was very supportive and that they could approach her at any time with issues of concern or for requests for training. They confirmed that they were in receipt of regular staff supervisions and appraisals and that they regularly attended staff meetings.

There were robust systems in place for the day to day management and monitoring of day to day care practices in the home, such and medication audits, care plans audits. The manager told us that all complaints were taken seriously and reported using the organisations auditing and monitoring systems. This meant that the service used all information to develop the service and improve care practice whenever possible.

The service had an annual feedback survey questionnaire which was sent out to people living in the home and their relatives. This meant that people had the opportunity to affect the running of the home and influence practice.

The people who used the service were being supported and enabled to make informed choices about their care and treatment.

We saw that comprehensive assessments were carried out prior to admission and on admission to Millbrook Care Centre.

We observed during our inspection that people were treated kindly and with patience.

People we spoke with told us that they liked the staff and confirmed that they were available when they asked for support.

We looked at the care records for four people living at Millbrook. We found that people's needs were assessed and care and treatment was planned and delivered in line with their individual care plan in a way that took into account their individual needs and wishes. There were systems in place to ensure that people's needs were regularly monitored and reviewed.

People told us they liked the food and were offered choices. We saw that people were

provided with the appropriate support and encouragement they needed to meet their

nutritional needs.

There were effective systems in place to reduce the risk and spread of infection.

A robust staff recruitment process was in place, which helped to ensure that people were supported by staff members who were suitable for their required roles. From the staff records we looked at we were able to see that the staff currently working for the home had been appointed correctly.

There were 40 people living at Millbrook Care Centre at the time of our inspection. At the time of the visit there was a strict infection control regime being followed however we were able to speak with two people who used the service and two relatives of other people who used the service. They told us they were happy with the service they received. Comments included,

“I don’t want to leave, I like it here”.

“They have a laugh with mum”.

“I’m really pleased, it always seems really clean”.

We looked at the comments and compliments received from people who used the service and their relatives. These included,

“Keep up the good work”.

“We could not have had a kinder group of carers”.

We found that people who used the service had care plans and a range of risk assessments in place. This meant Millbrook Care Centre provided people with safe and appropriate care and support that met their needs. Care and support was person centred and people’s views were taken into account in the way the service was provided and delivered. There were effective systems in place to regularly assess and monitor the quality of the service provided.

The provider had taken appropriate steps to identify and prevent abuse from occurring. We saw there were sufficient numbers of suitably trained and qualified staff to support the health and welfare needs of people who used the service. There were appropriate systems in place for the management of medicines.