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Inspection carried out on 4 June 2019

During a routine inspection

About the service:

Mill Green 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. Mill Green accommodates up to 15 people across one ground floor level.

What life is like for people using this service:

Staff were safely recruited. Where this was a part of their care plan, people's medicines were administered safely and in accordance with the prescribing instructions. However, risk management plans and the response to epileptic seizure required improvement to ensure people were always cared for in an effective and safe way.

The management team and staff placed people at the heart of their home. The provider and registered manager ensured their service was delivered according to their values. The home had a strong person centred and local community-based ethos. The staff team worked hard to promote people’s dignity and prevent people from becoming socially isolated within their home.

Respect and dignity were cornerstones of the values upheld by the staff and role modelled by the management team. Innovative approaches such as assisted access to electronic records and feedback tools, provided people and their relatives options in shaping a personalised service and making decisions.

People and their relatives were involved in choosing their care and support, from pre-admission to living in the home. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Staff were aware of how to report any concerns about neglect or abuse and were confident they would be addressed. They felt they were listened to and were part of an organisation that cared for them and their wellbeing, as well as the people they were supporting.

Regular audits were carried out; people were asked their views in person and via questionnaires. Changes were quickly made if issues were identified. The service learned from recorded incidents, concerns or accidents to help prevent a reoccurrence.

Rating at last inspection:

The last comprehensive inspection report for Mill Green was published in August 2016 and we gave an overall rating of Outstanding. At this inspection we found the service was Good. Safe has been rated as Requires Improvement and all other areas have been rated Good.

Why we inspected: This was a planned inspection based on the rating at the last inspection.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk.

Inspection carried out on 9 June 2016

During a routine inspection

The inspection took place on 9 and 10 June 2016 and was unannounced. The service was last inspected on 26 May 2014, when we found they were meeting the regulations.

The registered manager had been in post since the service was registered in January 2011. 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 provides accommodation and personal care for up to 15 younger adults, who may live with dementia, learning or physical disabilities or a life limiting condition. Fifteen people were living at the home at the time of our inspection.

People were at the heart of the service. Staff understood the importance of being partners-in-care with people who lived at the home. People were supported to maintain their preferred and familiar routines and habits, which made them content and relaxed. Staff took time to understand people’s histories and dreams and encouraged them to be ambitious in making decisions about their day-to-day lives.

Staff’s training, support and skills empowered them to respond to each individual’s unique practical and emotional needs. Staff were encouraged to reflect on their practice and were supported to develop specialist interests, to improve their understanding of how a physical condition affects a person’s emotional well-being. Staff made people feel valued and gave people control of their day-to-day lives, which increased people’s self-esteem.

People’s rights to choose how to live their lives, what to eat and when to eat, were staff’s highest priority. Risks to people’s nutrition were minimised because suitable, nutritious meals were available every day in accordance with people’s stated preferences. People were supported to eat out or buy meals, whenever they chose.

The group exercise sessions were effective and the positive impact on people’s moods was visible. People and staff shared the moment of fun together, which developed trust and positive relationships.

The provider’s policy of employing dedicated exercise and activity staff was adapted to enable staff to adopt the role of lifestyle coaches, which better met the varied and unique needs of people living at the home. People were supported to set up an individual exercise programme, which suited their preferred routines.

People planned their own care, with the support of their relatives and staff, to ensure their care plans matched their individual needs, abilities and preferences, from their personal perspective. Care staff showed insight and understanding in caring for people, because they understood people’s individual motivations and responses.

Staff were attentive to people’s appetites, moods and behaviours and knew them well enough to recognise the possible causes of ill health. Staff ensured people obtained advice and support from healthcare professionals to minimise the risks of poor health. The registered manager worked in partnership with experts in healthcare to ensure people had easy access to the best available advice and support.

Care co-ordinators were part of the duty management system, which meant there was a named manager available to respond to issues and to support staff, seven days a week. Staff were encouraged and supported to develop specialist interests that matched people’s needs.

People, their relatives and healthcare professionals were encouraged to share their opinions about the quality of the service, to ensure planned improvements focused on people’s experiences. The registered manager followed the provider’s principles in modelling and decorating the home according to people’s preferences and needs.

The registered manager understood their responsibility to comply with the requirements of the Mental Capacity Act

Inspection carried out on 25 June 2014

During a routine inspection

Prior to our visit we reviewed all the information we had received from the provider. During the inspection we spoke with a total of six people who used the service and asked them for their views. We spoke with two relatives of people who used the service. We also spoke with two care workers, one senior care worker, the housekeeper, the senior care manager and the area manager. We looked at some of the records held in the service including the care files for each person. We observed the support people who used the service received from staff and carried out a brief tour of the building.

The summary below describes what people who used the service, their relatives and the staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

We found that that people�s needs were assessed and care and support was planned and delivered in line with their individual care plans. These assessments and plans included any risks to the person and how these could be managed to keep the person safe. The provider employed sufficient staff to meet people�s needs.

There were arrangements in place to deal with foreseeable emergencies. We were told by staff members we spoke with that they were able to contact a manager when they needed to.

We found the home was clean and hygienic. People who used the service and relatives told us the home was clean and hygienic. There were arrangements in place to control the risk of infection.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. The provider had worked with the appropriate authorities to reassess whether any applications were necessary. No applications had been made by the provider.

Is the service effective?

People we spoke with told us their needs were met. A person told us, �The care we get is good�. We saw people being cared for and supported in accordance with their plans. It was clear from what we saw and from speaking with staff they understood people's care and support needs and that they knew them well

Staff had received training to meet the needs of the people living at the home. Care staff we spoke with told us they had received the training they needed to provide care and support to people.

We saw in care plans that risk assessments had been completed that promoted people's independence. We saw in care plans that where people undertook aspects of their care independently this was clearly stated. One person who used the service told us, �Well, it is important to do as much as you can yourself�.

Is the service caring?

People told us staff were kind and met their needs. A person who used the service said, "Staff are good". Another person we spoke with told us, "The staff are kind and caring".

We saw staff talking with people in a kind, considerate and respectful manner. We saw staff took care to ensure people had enough to eat and drink.

Care staff we spoke with told us they felt people were well cared for. Relatives we spoke with told us they were happy with the care their relative received.

Is the service responsive?

We found that each person's needs were regularly reviewed and care plans were updated if needed. Records showed that people were supported in line with their plans.

People had access to activities and had been supported to maintain relationships with their friends and relatives. However, a person who used the service and two relatives told us they would like to see more activities taking place outside of the home.

We found the provider had made changes to improve the service as a result of investigations into complaints and accidents.

Is the service well-led?

We found the provider had systems in place to seek the views of people and that these were acted on. People who lived at the home told us they would feel able to raise any concerns they had with the provider and were confident their concerns would be dealt with.

The provider carried out quality checks and we found that the health and safety of people who used the service, staff and others was monitored.

We were told by people who used the service, relatives and care staff that they found the manager of the home was approachable and listened to their views.

Inspection carried out on 25 April 2013

During a routine inspection

Many of the people who lived at the home were not able to talk about their care and support because of their complex needs. We observed that care staff talked to people reassuringly while they assisted them. Care staff explained that they monitored people�s needs by watching their facial expressions and body language, if they were not able to communicate verbally.

In the three care plans we looked at, we found people or their relatives had agreed how people should be cared for and supported. The care plans considered people�s dependencies, abilities and preferences for care. People were involved in discussions about their ongoing care and support. When people declined to be supported with particular aspects of their care, this was recorded.

The provider�s system for managing medicines included individual medicine cabinets for each person, training for staff and regular checks of medicines and of staff�s competence. Staff recorded when medicines were administered or declined.

The provider checked that staff were suitable to work with vulnerable people before they started working at the service. Care staff we spoke with told us that their induction process included reading care plans, shadowing experienced staff and being trained to care and support people safely.

We found that people's and staff records were kept securely and updated regularly. The provider�s policy for record keeping specified how long records should be kept before they were destroyed.

Inspection carried out on 2 May 2012

During a routine inspection

We carried out this review to check on the care and welfare of people using this service. We talked with four people who lived at the home and four care staff employed by the service about the quality of care. They all told us the service was very good. One person who lived at the home said, �I don�t think anything could be improved. All the staff are nice and I am getting used to the other residents�.

We found that many people had lived at the home for a long time and knew the other people and staff very well. We saw that people's own rooms were decorated and arranged in a style that they had chosen. People we talked with seemed pleased to show us their rooms and to explain the importance of their possessions.

We saw that people had a written care plan. People told us they or their relatives had been involved in agreeing what to include in their care plans. One person said to us, "They know the care I need and are always able to support me". Staff we talked with were knowledgeable about people's individual needs and described how they supported them. This meant that people were involved in agreeing the care they received.

We saw that care plans were detailed and risks to people's health and wellbeing had been considered and were regularly reviewed. We saw that when people's needs changed their care plans were updated and staff were told about the changes. People we talked with said they have regular meetings with the care manager to talk about their support needs. One person said, "The support is ok, things are generally alright". This meant that people�s needs were monitored and care plans were adapted to meet changing needs.

We found that staff were effectively trained and supported to meet people�s needs. We saw that the registered manager kept a record of training to make sure that staff maintained their competence and developed their skills. Staff told us that they met regularly with their line manager to discuss their practice and development of their skills.

Staff explained how they ensured people�s dignity, privacy and safety while carrying out care tasks. We saw that staff knocked at people's doors and waited to be invited into people's rooms. One person told us they had slept in much later than they thought they would as staff always allowed them to wake up naturally and never came in to wake them before they were ready.

We found that the quality of care was monitored by senior staff throughout the day and by the care manager on a daily basis. We saw the daily handover book was detailed and allowed the care manager to monitor when doctors or nurses had been asked to visit people and any changes to people�s medication or support needs. We found that the registered manager monitored accidents and incidents and took actions to reduce the risk of a re-occurrence.

We found that the provider made regular checks on the home, the staff, care records and the quality of care. People we talked with told us that they have conversations with the service manager. We saw that some people had responded to the provider's annual survey and that the provider had analysed the results. We found that the provider had responded to the things people said in the survey and had taken action to improve people's level of satisfaction. This meant that the provider took account of people's views about the quality of the service.

Reports under our old system of regulation (including those from before CQC was created)