This inspection was unannounced and took place on the 05 and 07 December 2018.

Millway House is a ‘care home’ and is registered to accommodate up to 57 people. 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. At the time of the inspection 44 people were accommodated at the home.

The registered manager left shortly before the inspection and there was a new manager in post who wasn’t yet registered but an application for this was in the process. 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 peoples safety was compromised in some areas. Risks associated with people’s care had not always been identified and assessments made to reduce these risks for people. These included those associated with behaviours which may be challenging or distressing for people.

Environmental risks were not always managed effectively.

Staff felt supported through training. However, staff did not receive regular supervision to discuss areas of development and to enable them to carry out their roles effectively.

Relevant recruitment checks were conducted before staff started working at the service to make sure staff were of good character and had the necessary skills. However, there were unexplained gaps in some staff employment histories.

Staff understood safeguarding procedures to keep people safe. There were enough staff to keep people safe.

Staff had an understanding of the Mental Capacity Act (MCA) and were clear that people had the right to make their own choices. Staff sought consent from people before providing care and support. The ability of people to make decisions was assessed in line with legal requirements to ensure their rights were protected and their liberty was not restricted unlawfully. However, some decisions needed to be explored more for people who required bedrails.

Medicines administration records (MARs) confirmed people had received their medicines as prescribed.

People received varied meals including a choice of fresh food and drinks. Staff were aware of people’s likes and dislikes and went out of their way to provide people with what they wanted.

People were cared for with kindness, compassion and sensitivity. Care plans provided information about how people wished to receive care and support. This helped ensure people received personalised care in a way that met their individual needs.

People were supported and encouraged to make choices and had access to a range of activities.

A complaints procedure was in place.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have taken at the back of the full version of the report.

The inspection took place on 20 and 21 September 2016 and was unannounced.

There was 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.

People were supported by staff that had the skills and knowledge to meet their assessed needs.

Information regarding diagnosed conditions was documented in people’s files.

Staff received a thorough induction before they started work.

The provider had employed skilled staff and took steps to make sure care was personalised.

Recruitment practices were safe and relevant checks had been completed before staff commenced work.

Staff worked within good practice guidelines to ensure people’s care, treatment and support promoted good quality of life.

The provider had appropriate arrangements in place to assess people’s capacity to make decisions about their care and treatment. Staff were knowledgeable about the requirements of the Mental Capacity Act 2005. Fifteen people were subject to DoLS at the time of our inspection and the registered manager was in the process of making more referrals to the local authority for DoLS assessments.

People had access to a wide range of social activities.

People who required assistance to eat and drink were supported effectively. Appropriate assessments had been conducted for people who had difficulty in swallowing their food. Interactions between staff and people during meals times were respectful and dignified.

Multi-disciplinary teams including mental health workers and occupational health were involved in reviewing and updating people’s risk management plans.

Medicines were managed safely. Any changes to people’s medicines were prescribed by the service’s GP and psychiatrist. People were involved before any intervention or changes to their care and treatment were carried out.

Records showed people’s hobbies and interests were documented and staff accurately described people’s preferred routines.

The provider actively sought, encouraged and supported people’s involvement in the improvement of the service. People’s care and welfare was monitored regularly to make sure their needs were met within a safe environment.

The provider had systems in place to regularly assess and monitor the quality of the service provided.

People told us the staff were friendly and management were always visible and approachable. Staff were encouraged to contribute to the improvement of the service.

Staff told us they would report any concerns to their manager and said the management and leadership of the service very good and very supportive.

We previously inspected Milway House on 10 December 2013 and found the service did not have suitable arrangements in place to monitor the competency of care and nursing staff. We judged the service was non compliant and told the provider they required improvement.

At this follow up inspection we looked training records to answer the question:

Is the service effective?

We found the provider had made the necessary improvements and we made the judgement the provider had achieved compliance. Training records accurately reflected learning and development for care and nursing staff. Systems were in place to appropriately supervise the competence of nursing staff.

At the time of our inspection the provider did not have a registered manager in post. The current manager was in the process of registering with The Care Quality Commission.

We found that before people received any care or support they were asked for their consent and the provider acted in accordance with their wishes. We saw that staff asked permission from people before providing any help or support.

During our visit we spoke with nine people and four visiting relatives. Everybody we spoke with was complimentary about the care and support they or their family member received. One person told us: “We are all well looked after here the food is very good too. I really enjoy the activities they are good and jolly”.

Daily records showed that staff provided care and support in line with the guidance in people’s care plans. Staff we spoke with demonstrated their knowledge of the care and support plans and people’s individual needs.

We looked at all areas of the home and how the infection control systems were working. The home appeared clean and there were no unpleasant odours. One person said: “The carers are very good they wear aprons and always wash their hands before they start my care”.

Individual training records showed there were shortfalls in the on-going training of the registered nurses employed by the service. This meant that nurses had not received recent training including good practice guidelines to equip them for the role of leading people’s care.

At this inspection we looked at the quality assurance systems used to monitor aspects of the home. The provider had appropriate systems in place for gathering, recording and evaluating information about the quality and safety of care the service provided.

People told us they were involved in how their care was planned and delivered.

“People have a choice and we will support them with their choices,” the manager of the home told us.

People were confident that any concerns raised would be dealt with promptly and effectively. One person who used the service told us: "If I had a problem with staff I would go to the chief nurse and they would sort it out very quickly."

We found the home to be well maintained, clean, warm and comfortable.

People’s needs were assessed and care and treatment was planned and delivered in line with their individual care plans.

We found that the provider had arrangements in place to deal with foreseeable emergencies.

People who use the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. The provider responded appropriately to any allegation of abuse.

Staff received appropriate professional development. The provider was able to access training relevant to their staff's needs.

There was evidence that learning from incidents / investigations took place and appropriate changes were implemented. The provider took account of complaints and comments to improve the service.

People told us they were involved in how their care was planned and delivered.

People told us they felt safe living at Millway House and had opportunities to participate in meaningful activities if they wanted to.

People said the home was well maintained, clean, warm and comfortable. People told us the ongoing work to refurbish the original part of the home had not interrupted their daily living.

People were confident that any concerns raised would be dealt with promptly and effectively.

People told us they were involved in how their care was planned and delivered.

People told us they felt safe living at Millway House and had opportunities to participate in meaningful activities if they wanted to.

People said the home was well maintained, clean, warm and comfortable. People told us the ongoing work to refurbish the original part of the home had not interrupted their daily living.

People were confident that any concerns raised would be dealt with promptly and effectively.