This was an unannounced inspection which took place on 5 April 2017. The service was first inspected in January 2016 and breaches in regulation were found in relation to person-centred care, safe care and treatment, safeguarding service users from abuse and improper treatment, good governance and staffing. Requirement notices were issued and the provider submitted an action plan after the last inspection explaining how they would become compliant.

A focused inspection was conducted in October 2016 and we found improvements had been made to all breaches of regulation. This inspection was conducted to ensure these improvements had been sustained.

Milldene Nursing Home is a 13 bed home providing nursing and personal care to older people with mental health needs. There were 13 people living there at the time of inspection.

Staff knew how to keep people safe and minimise possible harm from occurring. The staff were confident they could raise any concerns about the quality of the service and these would be addressed to ensure people were protected from harm. People in the service felt safe and able to raise any concerns they might have.

Staffing was organised to ensure people received adequate support to meet their needs throughout the day and night. Recruitment records demonstrated there were systems in place to employ staff who were suitable to work with vulnerable people.

People’s medicines were managed by nursing staff who were trained and monitored to make sure people received their medicines safely. The medicines storage area was organised and effective ordering and supply procedures were in place with a local pharmacy. People could be supported to manage their own medicines if they wished.

Staff received support from senior staff to ensure they carried out their roles effectively through mentoring and support. Supervision and appraisal processes were in place to enable staff to receive feedback on their performance and identify further training needs.

People could make choices about their food and drinks and alternatives were offered if requested. People were given support to eat and drink if required.

Arrangements were in place to request external health and social care services to help keep people well. External professionals’ advice was sought when needed and incorporated into care plans.

Staff demonstrated they had an awareness and knowledge of the Mental Capacity Act 2005. The service had made applications for people who may be deprived of their liberty and there was a robust review and renewal process in place. People were supported to make decisions about their own care and treatment.

Staff provided care with kindness; we saw positive interaction between people and staff. People could make choices about how they wanted to be supported and staff listened to what they had to say.

People were treated with respect. Staff understood how to provide care in a dignified manner and respected people’s right to privacy and to make choices. The staff team knew the support needs of people well and took an interest in people and their families to provide individualised care.

People had their needs assessed and staff knew how to support people according to their preferences and choices. Care records showed that changes were made as people’s needs changed and in response to requests from people using the service, relatives and external professionals.

People were supported to enjoy activities or their own personal interests. People could raise any concerns or suggestions and felt confident these would be addressed promptly by the manager and senior staff.

The home had a registered manager who was visible, hands-on and knew the support needs of people well. There were systems in place to make sure the service learnt from events such as accidents and incidents, complaints and investigations. The provider had notified us of all incidents that occurred as required.

People and relatives views were sought by the service

We carried out an unannounced comprehensive inspection of this service on 23, 26 and 29 January 2016. Six breaches of regulations around statutory notifications, person centred care, managing risks to people, safeguarding people, audit and governance and staffing were found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet the legal requirements. We carried out this focused inspection on the 14 October 2016 to check that improvements had been made at the service. This report only covers our findings in relation to these requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Milldene Nursing home on our website at www.cqc.org.uk.

Milldene Nursing Home is a 13 bed home providing nursing and personal care to older people with mental health needs. There were 13 people living there at the time of the inspection.

A registered manager was in place who was in the process of de-registering and the acting manager was applying for registration. 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.

We found that the service had made significant improvements since our last inspection. The action plan submitted by the provider was almost complete.

The contingency plan for the service was now more robust and clear on what actions should be taken in an emergency.

The environment had been significantly improved and the manager was taking further steps to continue to improve the service.

Recruitment records were now in place for all newly appointed and existing staff. File audits had been carried out and any issues had been addressed.

All staff now had access to the provider’s training and had completed updated training where required. New staff had completed induction and were signed off by the manager as being competent, following the provider’s procedure.

Supervisions and appraisals for all staff were now occurring regularly and further training and support was put in place for staff where required.

The care plans and other provider documentation were now being used consistently. Care plans were more detailed, person centred and subject to a more thorough review process. Where people’s support needs had changed care plans were adapted quickly to reflect this. External professional advice was promptly incorporated into revised care plans.

The manager now had dedicated time to manage and capacity to monitor the quality of the service and make changes. The service now had a full staffing complement and access to its’ own bank staff

Issues raised at the last inspection had been addressed. The manager carried out regular learning and review after incidents affecting people took place. This was to avoid repeat incidents and improve the quality and safety of the service.

This was an unannounced inspection which took place over three days on 23, 26 and 29 January 2016. This is the services first inspection since a change of provider and registration in July 2015.

Milldene Nursing Home is a 13 bed home providing nursing and personal care to older people with mental health needs. There were 12 people living there at the time of inspection, one further person was in hospital at the time of our inspection.

There was a registered manager who had been in post since July 2015. 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 service also had a home manager who had day to day responsibility for running the service and staff supervision.

The service did not always raise all safeguarding alerts externally with the local authority or CQC. Improvements were being made to the environment and there was a schedule in place for these to be completed. Emergency plans were not in place for possible evacuation or critical events in the service.

Accidents and incidents which occurred in the home had not been reviewed and acted upon to reduce the likelihood of these occurring again. The process for recording and managing these was inconsistent.

Records about staff recruitment were not consistent; there were gaps in records that should have been identified as part of the recruitment process.

People’s medicines were managed safely by nursing staff who knew people’s needs well and were aware of possible side effects. There was effective joint working with local GP’s to promote good health.

People told us they liked the staff team and they were always available to meet their needs. People and relatives felt the staff team knew how to look after people.

Staff were not receiving regular supervisions and appraisals of their performance. Staff training was not up to date and steps had only recently been taken to address this.

The Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards (DoLS). DoLS are part of the Mental Capacity Act 2005. These safeguards aim to make sure people are looked after in a way that does not inappropriately restrict their freedom. We saw that no one was subject to DoLS, but staff we spoke with were not aware of the process to identify people subject to a DoL. The provider did not have a policy and guidance on DoLS in place.

People told us they felt the staff team were caring and supported them. We observed positive interactions between people and staff. We saw in care records how people’s independence and right to make choices had been considered.

People’s care plans and records remained unchanged for a number of years. Reviews were limited and care plans had not changed over time. The provider had not transferred care plans to their own documentation and staff were using the previous provider’s documentation and systems.

Complaints had not always been acted upon correctly. Records did show that the registered manager took action to resolve the issues raised by people using the service, but a recent complaint remained unresolved.

The service had failed to notify the Care Quality Commission of a significant incident and staff failed to raise a safeguarding alert with the local authority.

The registered manager held multiple roles within the organisation and much of the day to day responsibility was delegated to a home manager. Quality system checks and audits in the home were not consistent and there was a lack of critical review of the service by the registered manager and home manager. The home manager did not have the dedicated time to carry out their management duties or have full access to the provider’s resources.