About the service: Millbrow Nursing Home provides nursing care and accommodation for up to 44 older people. On the day of the inspection 42 people were living at the service. Accommodation is provided on two floors, with lounges and dining rooms available on both floors. A passenger lift and stairwell provide access to the first floor. There is also a small car park at the front of the building. Assisted bathing facilities are provided on both floors. Staff are on duty twenty-four hours a day to provide nursing care and support for the people who live at the service.

People’s experience of using the service:

People who used the service were happy about the service being delivered to them. We received mixed comments about the food and people were unsure of the choices of food available.

Staff had followed the Code of Practice in relation to the Mental Capacity Act 2005 (MCA). However, Statutory notifications regarding authorisations of DoLs were not always submitted to the Care Quality Commission (CQC) as required by law. The registered manager has submitted all required notifications following the inspection.

We identified a breach of regulation relating to staff supervision and appraisals. Staff noted improvements to the service since the registered manager commenced in post. They felt supported and listened to.

Health and safety needed regular oversight and support to consistently manage safe systems at the service. We noted some areas of repair were needed within the building and a lack of evidence of environmental risk assessments and quality assurance checks in the management of health and safety within the building.

Improvements were needed so that medication administration records (MARs) were appropriately completed. We identified a breach of Regulation regarding safe care and treatment and management of medications and health and safety.

Staffing was supported by agency staff at a rate of 75%. Agency staff were regularly used for vacancies and sickness. This created a risk to the stability of the workforce and inconsistency of care delivery. We identified a breach of Regulation relating to the safe management of staffing within the service.

Quality assurance processes had not identified issues highlighted during this inspection. We identified a breach of regulation relating to good governance as we did not see sufficiently established and effective quality assurance systems in place.

Staff were knowledgeable of local safeguarding procedures. The service had learnt from recent safeguarding incidents that had serious outcomes to the care people had received at the service.

Updated care plans described the support people needed. People were referred to appropriate health and social care professionals when necessary to ensure they received treatment and support for their specific needs.

Information and arrangements were in place for the staff team to respond to concerns and complaints.

We noted some personal records openly on display in the nurse’s office. This highlighted potential concerns about people being able to access personal information.

We have made a recommendation that the service review storage of confidential information.

We recommend the service review the dining experience and look at trialling various initiatives to help improve this aspect of support for people.

We recommend the service review and make improvements to the environment to meet the needs of people who were living with cognitive impairments and dementia

Rating at last inspection: This was the first comprehensive inspection since the service registered with CQC in February 2018. This comprehensive inspection took place on the 4 and 13 February 2019 and was unannounced.

Why we inspected: This inspection was a planned comprehensive inspection. We had received information of concern prior to the inspection from two safeguarding incidents that had been reviewed by Halton local authority and were substantiated.

Enforcement: