We carried out an unannounced comprehensive inspection on 24 and 25 April 2018.

Dalesview Partnership Limited - Old Mill House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Old Mill House is registered to provide accommodation and personal care for up to six people with learning disabilities. There were five people living in the service on the day of our inspection.

At the last inspection on 19 October 2015, the service was rated 'Good' although improvements were required around the making of safeguarding referrals and the administration of medicines. At this inspection on 24 April 2018 we found the service had made improvements around the issues seen at the last inspection. However other safety issues were noted relating to the absence of window restrictors to prevent people falling and uncovered heat sources to prevent people burning themselves. This has led to a breach of the regulations and the service is now rated as 'Requires improvement'. You can see what action we have asked the service to take around this breach of regulation at the back of this report.

The service was managed by a registered manager who was registered on 18 January 2014. 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.

Recruitment checks took place before staff started work but some issues were seen and additional checks were required during the inspection to ensure that some staff had been safely recruited.

People received their medicine as prescribed by healthcare professionals. Medicines were stored securely to ensure they were safe. There were risk assessments which identified risks to people and management plans had been put in place to ensure people's health and well-being were maintained.

People were protected from the risks of abuse and improper treatment. Staff had received training on safeguarding and they were knowledgeable on the procedure to follow if they had any concerns. There were sufficient staff available to safely meet people's needs.

The registered manager and staff had a good understanding of the Mental Capacity Act (MCA) 2005. 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.

A person's relative told us staff were kind and caring. We observed that staff treated people with respect and promoted their dignity.

People were supported to communicate their views about the choices available in relation to what food and drink they preferred and participation in activities.

People's nutritional needs were met. People told us they enjoyed the choice of food that was available to them. People had access to food and drinks throughout the day.

Systems were in place to help ensure the safety and cleanliness of the environment. People who used the service were encouraged to participate in cleaning the home.

Staff were trained on various areas to ensure they had the relevant skills, knowledge and experience to provide good care to the people they looked after. Staff received regular support and supervision to help them carry out their duties effectively.

Staff we spoke with told us they enjoyed working in the service and felt valued by both colleagues and the manager. Staff felt able to raise any issues of concern or make suggestions to improve the service in supervision and staff meetings.

The service liaised with various health and social care professionals to meet the needs of people.

People had

Old Mill House is a small care home registered to provide care and accommodation for up to six young adults who have a learning disability. The home is situated on a main road in Chorley, close to a variety of facilities and amenities. Care is provided on a 24 hour basis, including waking watch care throughout the night.

The last inspection of the service took place on 30 July 2013. During this inspection the service was found to be compliant with all the regulations assessed.

This inspection took place on 19 October 2015 and was unannounced.

We were assisted throughout the inspection by the long term 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’s medicines were managed in a generally safe manner. There were clear procedures in place as well as individual care plans, in relation to the support people required to take their medicines. However, we found a discrepancy with one person’s recently prescribed medicines, which indicated there had been an error. The registered manager investigated this immediately.

Staff were aware of their responsibility to protect people in their care from all forms of abuse. Staff were confident to report any safeguarding concerns and confident the registered manager would deal with them appropriately. However, we did become aware of one incident, which should have been referred to the local authority safeguarding team but was not. However, the incident had been dealt with appropriately by staff and the registered manager agreed to review the procedures and reporting criteria.

We found that care workers were aware of any risks to the safety and wellbeing of people who used the service and knew how to support them in a safe manner.

People’s care was planned in accordance with their individual needs and wishes and their views about their care and the general running of the service were encouraged.

People were supported to access community helath care when they neeed it. The staff team at the service worked positively with community professionals to ensure people’s needs were met.

Due regard was given to the needs and rights of people who were not able to consent to all aspects of their care. The service worked in accordance with the Mental Capacity Act 2005 and associated Deprivation of Libery Safeguards.

People were supported to engage in varied activities of their own choosing, both at home and out in the community.

Staff were carefully recruited to help ensure they had the necessary skills and knowledge and were of suitable character. Staffing levels were flexible and planned in accordance with the needs of people who used the service.

Staff were provided with a good level of training and support to assist them in carrying out their roles effectively.

People were enabled to raise concerns or express their views and opinions.

There were effective systems in place to regularly assess the quality and safety of the service provided. Both the registered manager and provider monitored all aspects of the service and took appropriate action when they identified areas for improvement.

During our visit we were able to meet all the residents of the home. Whilst we didn’t receive any comments from people, we observed them to be happy and relaxed in their surroundings. The expert by experience accompanied some residents on a trip and reported, ’The staff treated the residents with respect and dignity and everybody enjoyed their time out,’ and 'staff and residents appeared to get along very well, the residents have lived there for a long time and appear very settled and comfortable in the home.’

We noted that Old Mill House provided comfortable and homely accommodation. The expert by experience commented that the home was clean and well furnished, but felt some communal areas would benefit from an update. The expert by experience also reported, ‘We saw that there was a nice garden area with flowers and vegetables in it and at least one resident helped in the garden.’

We saw that there was information posted about the home for the benefit of residents, which included pictorial menus, activity timetables and a pictorial staff rota. There was also easy read information available regarding how to make a complaint and how to raise concerns about abuse.

Standards relating to people's care and welfare, management of health needs and medication were assessed. We also looked at arrangements for recruiting and training staff. Finally, we assessed processes for monitoring the quality of services provided. The service was compliant in all the areas we inspected.

We met the residents at the home when we carried out our site visit. People were not able to give us their specific views on the standard of service provided or their experiences of living at the home. However, we saw that residents appeared happy and relaxed in their surroundings and clearly got along well with their support staff.

We spoke with several relatives of people who live at the home. People gave us very positive feedback about their opinion on standards within the home and expressed satisfaction with all aspects of the service. Comments included;

‘’That home is fantastic. We are so happy with it.’’

‘’I can’t say anything that would make it any better. It’s brilliant in every way.’’

‘’They couldn’t do any better for (name removed). I hope she never has to move anywhere else.’’