About the service: The Millings is a residential care home providing personal care and accommodation to 34 people aged 65 and over at the time of the inspection.

People’s experience of using this service: People living at The Millings were consulted with and included in the delivery of care that was provided by a team who had built upon the already outstanding work they did.

Everyone we spoke to including people, family members and staff said they would rate the home as “exceptional” and “outstanding.” One family member said, “There are no improvements needed, they are incredibly responsive and I really admire the patience of staff.”

The atmosphere of the service was exceptionally welcoming and homely. Staff told us throughout the inspection that they were working in people’s home and needed to be respectful of that. People commented that The Millings was “My home, I love it here and would highly recommend it.” External healthcare professionals also commented on the exceptionally friendly yet professional atmosphere.

Outstanding practice had been developed and improved upon to provide people with care that was truly compassionate, caring and inclusive. People were recognised as unique individuals with strengths who could make a contribution to society. There was a culture of people being equal partners in their care whose individuality and diversity was acknowledged, respected and celebrated.

Partnership working was exceptional and led to improved quality of life of people. Work had been completed with Bradford University to introduce a falls huddle which had resulted in a 45% reduction in falls. A system called Immedicare was used for online consultations with healthcare professionals. People were fully included in the consultation and the healthcare professional was able to see the person and any injury they may have. This had also resulted in a reduction in the number of calls for ambulances and also the number of calls to GP surgeries.

Leadership was exceptional and staff at all levels were dedicated and motivated to provide truly personalised care, which the provider described as relationship focused care. There was a focus on getting to know the person so care and support could be tailored to the person, maintaining their individuality and uniqueness.

People were matched with staff based on interests and hobbies. People had two ‘care partners’ who were the key staff members involved in people’s support. They developed strong and meaningful relationships with people to make sure people received care and support in a way they wanted.

Staff supported people to maintain their independence and continue their interests and hobbies whilst developing new interests and maximising social inclusion. A ‘Bees Knees’ project had been introduced so people had photographs on display which made them feel like the bees knees. These photographs were used to prompt conversation and staff said they acted as, “a reminder of who people were as individuals and what they had achieved in their lives.”

Community involvement was exceptional. People were active members of the local community and were involved in community events from organising a Jo Cox memorial event, to the Tour de Yorkshire cycling event to hosting speakers, including the author of ‘The Shepherdess.’ Relationships had been developed with care homes in the south of the country and also in France so people were able to share experiences. Technology was used to maintain relationships so people could speak over video calls or instant messaging services.

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.

Staff development was exceptional and there was a focus on training staff to value the importance of building open, honest and inclusive relationships with people. Free To Be Training run by the Lesbian, Gay, Bisexual and

The inspection was carried out on 22 and 24 August 2016 and was unannounced. At the last inspection carried out on 11 September 2014 the provider was meeting all the regulations that were assessed.

At the time of our inspection the service was providing support to 35 older people.

There was a registered manager in place. 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 independence was actively encouraged through a range of imaginative, person-centred approaches to activity-planning. The service provided innovative support to people to enable them to live fulfilled and meaningful lives. Links had been made with local services such as schools and Durham University to ensure people were offered very person centred opportunities not just to undertake activities they enjoyed but also to learn new skills. The activity staff worked as a team to ensure their individual skills such as creative writing, gardening and exercise were utilised so their job satisfaction and motivation were visible to see. Staff were skilled at ensuring people were safe whilst encouraging them to stretch their potential and achieve as much independence as possible.

The registered manager and staff team demonstrated commitment to providing the best possible care and opportunities for people. The close links with the local community meant the service provided support to local schools, churches and community groups via sharing their facilities and we saw people either independently or with support could access the community freely.

We saw people were actively involved in all aspects of the service from meeting with the cooks regularly to recruiting staff and assisting the writing of the home’s brochure. People told us, “You can be involved as much as you want in how things are done.”

The registered provider demonstrated how they had sustained outstanding practice, development and improvement at the service. The leadership sought out creative ways to provide a personalised service and had achieved good results through close working with other agencies. The staff team were highly motivated and were actively involved in and contributed to continuous improvements in care and running of the service.

There was enough staff to meet people’s needs and to ensure they were able to access activities and be part of their local community. The provider operated safe and robust recruitment and selection procedures which people were involved in where possible.

Staff protected people’s privacy and dignity. All interactions between staff and people were caring and respectful, with staff being patient, kind and compassionate. Staff supported people with patience and an unhurried approach to ensure they promoted active involvement in their care and do as much as possible for themselves.

Thorough investigations had been carried out in response to safeguarding incidents and these had also been appropriately reported to CQC by the provider. Learning from incidents was evident in adjustments to procedures such as how medication was managed, to ensure people were protected from harm. Comprehensive audits were carried out by the management team to ensure the appropriate improvements took place within the home.

Records and conversation with the registered manager, people and relatives showed that people were listened to and complaints or concerns were taken seriously and responded to appropriately.

The registered manager ensured that staff had a full understanding of people’s support needs and had the skills and knowledge to meet them. Training records were up to date and staff received regular supervisions and appraisals. Staff were clear about their roles and responsibilities

Our inspection team was made up of one inspector. During the inspection we asked five questions; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?

On the day of the inspection we talked with eight people about their experience of care at The Millings. We spoke with the relatives of two people. We talked with ten staff and looked at records. We also spoke with a district nurse who visited the home frequently. Below is a summary of what we found. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People were treated with respect and dignity by the staff and people we spoke with told us that they felt safe. Staff had received training in safeguarding and understood how to safeguard the people they supported. Systems were in place to make sure that managers and staff learnt from events such as accidents and incidents. This reduced the risk to people and helped the service to continually improve.

People were cared for in a service that was safe, clean and hygienic. Risk assessments were in place in individual support plans in relation to activities of daily living. Staff personnel records contained all the information required which meant that the provider could demonstrate that the staff employed to work in the home were suitable and had the skills and experience needed to support the people living at The Millings. Staffing levels were appropriate to meet the needs of the service and were reviewed and adjusted to address any changing needs.

Is the service effective?

People told us that they were happy with the care they received and felt that their needs had been met. It was clear from what we saw and from speaking with staff that they understood people's care and support needs and they knew them well. Staff had received training to meet the needs of the people living in the home. People's health and care needs were assessed with them and they were involved in writing their plans of care. Relatives we spoke with were able to describe specific benefits to the health and wellbeing of their relatives and the impact that this had had on their daily life. One relative told us. "You know [the person] is in safe hands. If you can't be happy here, you can't be happy anywhere."

Is the service caring?

People were supported by kind and attentive staff. We saw that staff were patient and gave encouragement when supporting people. People told us they were able to do things at their own pace and were supported to be as independent as possible. Where shortfalls or concerns were raised, these were addressed. People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with their wishes.

Is the service responsive?

People were regularly involved in a range of activities inside and outside the home. The home supported people to take part in activities within the local community which included attending University of the Third Age (U3A) sessions, visiting local places of interest and shopping. People knew how to make a complaint if they were unhappy and all the people we spoke with told us that they felt that they could talk with any of the staff if they had a concern or were worried about anything.

Is the service well-led?

The service worked well with other agencies and services to ensure that people received their care in a joined up way. The service had a quality assurance system which included planned audits. People who lived in the service, staff and relatives were asked for their views. Any identified shortfalls were addressed promptly and as a result the service was constantly improving. When we spoke with a visiting district nurse, they told us that they believed that the service was well run and was a positive place for people to live. They told us, "They seem to want to do the best for the residents, there's a nice atmosphere and the staff are always friendly." Staff told us that they felt well supported by the manager.

We carried out this visit to check that improvements had been made to the management and administration of medication following our last vist. We found that the provider and manager had sought appropriate professional advice and had implemented a range of improvements at the home. Safe systems were now in place for the management and administration of medication at The Millings.

During our visit we spoke with six people who use the service and three relatives. We also spoke with the manager, deputy manager, senior care, chef and other staff working in the home.

People spoke highly of the home and told us they were well care for. Comments made by people who lived there and their relatives included “I find them very helpful”, “Very willing” and “She’s wonderfully looked after.”

People’s nutritional needs were assessed and monitored, with a choice of regular meals, snacks and drinks being provided. People enjoyed positive dining experiences, with individual needs provided for. Comments included “We have meetings with the cook”, “They know what we can and can’t eat” and “The food is generally very good.”

Arrangements were in place to obtain, store and administer medications. However, improvements were needed to ensure that people were protected from the risks associated with inaccurate or unclear medication administration records.

People who lived at the home spoke highly of the staff, telling us that they were professional and caring. Comments included “They are all so kind, all the staff, not just the care staff.” Staff records confirmed that new staff went through a thorough recruitment process.

People who lived at the home told us that they would feel able to raise any issues or concerns with management. A complaints procedure was in place and records showed that comments and concerns were listened to and resolved appropriately.

When we inspected the home we spoke with people who used the service, staff and visitors. People told us they were extremely happy living at the home. People looked very well cared for. One person said "It is delightful, the staff, my room, the manager. It is all lovely". People using the service were calm and relaxed, and engaged in a number of tasks and activities during our visit. Staff interacted with people in a friendly manner and we saw relaxed conversations between staff and people living at the home. Visitors to the home were positive about the care and support their relatives were receiving. One visitor said “The care is very good. The staff have a way of knowing what the right thing to do is. The atmosphere is always friendly and people are always dressed and groomed beautifully”.

There were lots of events and activities organised for people either at the home or within the wider community. Staff told us they felt settled and happy in their jobs and were well supported by their manager. People told us they felt safe living at the home and would raise any concerns they had with any of the staff and they would be dealt with. The home had in place a quality monitoring system that asked people who lived at the home for their views on the service provided. This helped to ensure that the provider was listening to the people who used the service and tailoring the service to meet the expectations of the people using it.

People told us that they were well looked after and that they were happy with the care they received. People made comments such as and "It is like living in a hotel with care" and "The best step I ever took, I am very happy here and I have no complaints"

People were also positive about the staff who looked after them. People made comments such as 'excellent' 'marvellous' 'very good'

People we spoke with also made positive comments about the quality of the food at the home and the choices available. For example, one person told us "meals are wonderful"

People said they would either speak to the manager if they did have a concern or a complaint.

We also talked with several relatives who were visiting the home. They all spoke highly about The Millings. One relative said "The Millings is brilliant. I felt that I got my mum back. The care is excellent. Staff are very caring and they go that extra mile"

Other relatives made comments such as: "I think the staff at The Millings are top notch. Very, very kind, plenty of patience. Care here is spot on I have no complaints" and another relative told us "The home is always immaculate and the quality of the furnishings etc is extremely good. I cannot praise it too highly. The way the staff care is remarkable and hugely appreciated"

One visitor to the home told us "I find it absolutely fabulous. The level of care seems to me to be outstanding. I have never yet heard a complaint. What I like about it is the sense of freedom for the residents and the way they look after each other. The residents here retain their dignity"

We also spoke with a health care professional who spoke highly about the home. They told us "Care is very good they know the patients and they care for them well"

We spoke with the Local Authority Contracts Officer who informed us that they did not have any concerns about this service.