This inspection took place on 9 and 11 October 2018 and both days of the inspection were unannounced. When we last inspected in July 2017, the service was rated Good.

Millennium Care – 1 Old Park Road is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The care home accommodates 10 people in a converted Victorian building across two floors. People had access to a large garden at the rear of the building.

Millennium Care – 1 Old Park Road had been built and registered before Registering the Right Support (RRS) had been published. The provider had not developed the service in response to the values that underpin RRS or changes in best practice guidance for providers of learning disability and autism services. These values and guidance includes advocating choice and promotion of independence and inclusion, so people using learning disability or autism services can live as ordinary a life as any other citizen. We found the service did not always conform to this guidance and values when supporting people.

There was a registered manager in place at the time of the inspection. However, they were not present in the home in the two months preceding the inspection. A deputy manager was overseeing the running of the service with support from senior management at provider level. 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 premises and equipment were not always maintained in a safe condition. Areas of the home were unclean. People were not adequately protected from the risk of infection as staff were not always adhering to basic infection control procedures.

People's health, safety and wellbeing was at risk because management at home level and above failed to adequately assess risk and provide sufficient guidance to staff on how to keep people safe from harm. We observed poor moving and handling practices during the inspection.

Medicines were not stored, documented and administered safely.

The provider did not always adhere to the Mental Capacity Act 2005. Where restrictive practices were in place, such as use of video monitoring and administering medicines covertly, documentation was not in place to ensure this was in the person’s best interests.

People were not consistently supported by staff in a respectful and kind manner. Care records contained insensitive terminology regarding people’s behaviours due to their learning disability or mental health condition.

People were not always receiving care in line with their needs and preferences. Although reviewed regularly, some care plans contained inaccurate or insufficient information. There was a lack of meaningful activities observed for people who remained at the service during the day.

People were not always supported to eat and drink. There was a lack of drinks at mealtimes and some people did not receive support to eat and drink in a timely manner.

There were not always enough staff deployed in the service to consistently meet people's needs. Care staff were deployed to non-care tasks such as cooking and cleaning. Staff were safely recruited.

Overall governance of the service was ineffective. Despite regular quality checks completed at both service and provider level, these had failed to identify the concerns identified on inspection. Where these checks had identified concerns with aspects of care delivery, sustained improvements had not been made.

Staff had received regular training, supervisions and an annual appraisal. However, we found that not all staff were competent in areas su

Millennium Care Limited – 1 Old Park Road is residential care home which provides care and support for up to ten people with learning disabilities. At the time of this inspection there were ten people using the service.

At the last inspection on 26 June 2015, the service was rated ‘Good’. At this inspection we found the service remained ‘Good’.

All staff had completed training in safeguarding adults and demonstrated an understanding of types of abuse to look out for and how to raise safeguarding concerns.

Detailed current risk assessments were in place for people using the service. Risk assessments in place were reviewed and updated regularly.

People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

There were systems in place to ensure medicines were handled and stored securely and administered to people safely and appropriately.

The home maintained adequate staffing levels to support people.

We saw friendly, caring and supportive interactions between staff and people and staff knew the needs and preferences of the people using the service. Care plans were person centred and reviewed regularly.

People had regular access to healthcare professionals such as doctors, dentists, chiropodists and opticians.

We saw evidence of a comprehensive staff induction and on-going training programme. Staff had regular supervisions and annual appraisals. Staff were safely recruited with necessary pre-employment checks carried out.

People were supported to engage in regular activities.

Quality assurance processes were in place to monitor the quality of care delivered.

Further information is in the detailed findings below.

This inspection took place on 26 June 2015 and was unannounced. When we last visited the home on 10 September 2013 we found the service met all the regulations we looked at.

Millenium Care Limited -1 Old Park provides accommodation, care and support for up to ten people with a learning disability or on the autistic spectrum. There were nine people using the service on the day of our inspection.

The home 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 provider is required to tell us when a formal decision, under the deprivation of liberty safeguards (DoLS), is made regarding whether people who used the service are able to consent to their care and support. The majority of people had a DoLS in place but the provider had not formally notified the Care Quality Commission of this.

Safeguarding adults from abuse procedures were available and staff understood how to safeguard the people they supported. Staff understood what to do if people could not make decisions about their care needs as assessments of people’s capacity had been carried out. Staff had received training on the Deprivation of Liberty Safeguards and the Mental Capacity Act 2005. These safeguards are there to make sure that people receiving support are looked after in a way that does not inappropriately restrict their freedom. Services should only deprive someone of their liberty when it is in the best interests of the person and there is no other way to look after them, and it should be done in a safe and correct way.

People received individualised support that met their needs. The provider had systems in place to ensure that people were protected from risks associated with their support, and care was planned and delivered in ways that enhanced people’s safety and welfare according to their needs and preferences.

People were involved in decisions about their care and how their needs would be met. People were supported to eat and drink according to their individual preferences. Staff treated people with kindness, compassion, dignity and respect.

Staff supported people to attend healthcare appointments and liaised with their GP and other healthcare professionals as required to meet people’s needs. Medicines were managed safely.

People told us they were happy with the care provided. Staff were appropriately trained and skilled to care for people. They understood their roles and responsibilities as well as the values of the home. Staff received supervision and an annual performance review. They confirmed they were supported by the registered manager and received advice where required.

The registered manager was accessible and approachable. People who used the service and staff felt able to speak with the registered manager and provided feedback on the service. People’s complaints had been responded to and action taken to resolve them.

Monthly audits were carried out across various aspects of the service, these included the administration of medication, care planning and training and development. Where these audits identified that improvements were needed action had been taken to improve the service for people.

The two people spoken with said they were involved and consulted about decisions affecting their care. People understood the care and treatment choices available to them. One person said, "the place is alright, I am happy here." We saw that staff understood people's needs. People were spoken with in an appropriate manner. One person said, "I am getting all the help I need."

We observed that staff spoke to people in a manner that showed respect. People were calm and relaxed in their interactions with staff. One person said they felt, "safe and secure here." People knew how to raise concerns about issues that affected their well-being. People said that staff knew how to meet their needs. We saw that staff understood people's needs and how to support them. One person said, "staff know how to help me."

We carried out this review as part of our routine schedule of planned reviews.

We reviewed all the information we hold about this provider, observed how people were being cared for, looked at records of people who use the services, talked to staff, reviewed information from stakeholders and talked to people who use the service.

We observed that people were involved and consulted about decisions affecting their care. Staff knew how to communicate with people and spoke with them in a manner that showed respect. People were treated well by staff. A relative said, There are always enough staff, the home is never short staffed, it has an excellent standard of care.

People get the care they need here. We saw that staff understood people's needs and knew how to support them. Staff were well supported with relevant training and supervision. Suggestions from visiting professionals, staff and people using the service were used as the basis to improve the care provided by the home on an ongoing basis.

We observed that people were involved and consulted about decisions affecting their care. Staff knew how to communicate with people and spoke to them in a manner that showed respect. People were treated well by staff. A relative said, "Staff understood what people need. People get the care they need here." Staff were able to explain the ways in which people communicated what they did or did not want to do. Staff spoke to people in a manner that showed respect. We saw that staff understood people’s needs and knew how to support them. People’s suggestions would be used as the basis to improve the care provided by the home.