Mill View

Mill View is a residential care home providing personal and nursing care. The home accommodates up to 70 people in a purpose built two storey building. On the day of this inspection there were 35 people living at the home. People living at the home had a range of needs including nursing needs, mental health needs and some people were living with dementia.

People’s experience of using this service and what we found

Leadership was not consistent and people, their relatives and staff were not fully engaged and supported by the registered manager. Some people told us they felt isolated in the home and relatives described a lack of effective communication with the registered manager. Staff did not always feel well supported because the registered manager was not always visible and accessible to staff.

There were enough staff to provide care safely, but the deployment of staff did not always support person centred care. Staff described having little time to spend with people. The registered manager said they were developing plans to address these issues.

People and their relatives spoke positively about the care they were receiving at Mill View. One person said, “I feel very safe here, all the staff are kind and caring and I am always treated with the upmost respect.” Relatives said people were well cared for by kind staff who were knowledgeable about their needs. One relative told us, “The staff really care about the residents here.”

There were safe systems in place to assess, monitor and manage risks to people. Lessons were learned when things went wrong, and comprehensive risk assessments and care plans supported staff to care for people safely. Some people needed support with eating and drinking. Staff were knowledgeable about their needs and there were safe systems in place to ensure people were supported in the way that met their individual needs.

Staff had received training relevant to their roles, including in how to safeguard people from abuse. People were supported to access health care services when they needed to.

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.

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

Rating at last inspection

The last rating for this service was good (published 19 March 2020).

Why we inspected

We undertook this focussed inspection to check that the provider continued to manage risks associated with eating and drinking. We undertook a focused inspection to review the key questions of safe, effective and well-led only. We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe and effective section of this focussed report.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection. The overall rating for the service has remained good. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvements. Please see the well led section of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Mill View on our website at www.cqc.org.uk.

Follow up

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

People’s experience of using this service and what we found

There had been improvements in the service since the last inspection. People were being effectively supported to have enough to eat and drink. Systems to manage risks associated with choking had been reviewed and these positive changes had been sustained and were embedded within staff practice.

There had been improvements in the deployment of suitable staff. One person told us, “I think above all it’s the carers that make this a good home. They put the people they are looking after first. The management are good, but the carers are excellent.”

Management systems were used effectively to identify shortfalls in quality and to drive improvements. There were robust governance systems in place and the registered manager had oversight of the quality of the service. People, relatives and staff spoke highly of the registered manager and described them as being approachable and accessible. People, relatives and staff, were included in developments at the home and their views and suggestions were welcomed. One person said, “I can’t think of anything they need to improve on.”

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 received the training and support they needed to provide effective care. People’s needs were assessed regularly, and care plans were comprehensive. Staff considered people’s diverse needs, their preferences and choices. People were treated with dignity and respect and they were supported to be as independent as possible. Staff were kind and caring in their approach and knew people well. One person told us, “The staff are always kind. They never appear stressed and they really put themselves out to make things nice.”

Staff understood their responsibilities for safeguarding people. Risks were assessed and managed effectively and there enough staff to keep people safe. People were receiving their medicines safely and there were effective infection control systems in place. When things went wrong, lessons were learned. Analysis of incidents identified patterns and trends and informed the development plan for the service.

People were receiving a personalised service and staff knew people well. Activities were relevant to people’s needs and interests. People were supported to plan for end of life care. Staff were responsive when people’s needs changed.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 6 February 2019) and there was a breach of regulation. The provider completed an action plan after the last inspection to show what they would do, and by when, to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

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

The team inspected the service against three of the five questions we ask about services: is the service safe, effective and well-led? This report only covers our findings in relation to those key questions. No risks, concerns or significant improvement were identified in the remaining key questions through our ongoing monitoring or during our inspection activity so we did not inspect them.

The ratings from the previous comprehensive inspection for these key questions were included in calculating the overall rating in this inspection. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Mill View on our website at www.cqc.org.uk At the previous inspection on 28 February 2017 we rated Mill View as Good. At this inspection we identified areas in need of improvement and this meant that the overall rating of the home has changed to Requires Improvement.

Mill View 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 View accommodates up to 70 people in one purpose built two storey building. On the day of this focussed inspection there were 62 people living at the home. People living at the home had a range of needs including nursing needs, mental health needs and some people were living with dementia.

The home had a registered manager who was present during the focussed inspection. 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.

Some people were not receiving the support they needed to eat their food. Staff were not deployed effectively to support people in a timely way at lunch time and staff were not always aware of people’s needs. This was identified as a breach of the regulations.

Risks to people had been assessed. However, care plans did not always give staff clear guidance in how to manage some risks and some staff were not all accessing care plans. This meant that people were at risk of not receiving the care they needed. This was an area of practice that needed to improve.

Quality assurance systems were not always effective in identifying shortfalls. Analysis of incidents had led to positive changes in supporting people at meal times. However, these changes were not yet fully embedded and sustained in all areas of the home. This was an area of practice that needed to improve.

People told us they felt safe at the home. People were receiving their medicines safely and staff were knowledgeable about infection control. There were enough staff on duty and recruitment procedures were robust. However the deployment of staff was not always effective, for example at meal times.

People had confidence in the staff skills. One person said, “They are very good here. The staff know how to care for people well.” Staff had received the training and support they needed. One staff member told us, “We have training all the time. The dementia training was very powerful.” Staff described effective team work and there were systems in place to support communication between staff. People’s needs and preferences were assessed in a holistic way. Staff understood their responsibilities with regard to seeking consent for care and treatment.

There was a clear management structure and the registered manager provided visible leadership. There were positive links with the local community. People, relatives and staff were engaged with developments at the home.

You can see what action we told the provider to take at the back of the full version of the report.

The service had a new manager in post who was about to apply to become the 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.

At the last inspection in September 2016 we identified continued breaches of the regulations in two areas. We took enforcement action against the provider. We issued one warning notice in relation to good governance and asked the provider to make further improvements to arrangements for supporting people with food and hydration. We undertook a comprehensive inspection on 28 February 2017 to check whether the required actions had been taken to address the breaches we previously identified. This report covers our findings in relation to these requirements.

Improvements to the governance of the service had been sustained and embedded and this meant that the breach of regulations had been addressed.

Systems for monitoring care provision had become embedded in practice. This meant that risks to people were being effectively managed in a sustained in a consistent way across the service. Clear management and consistent monitoring had led to improvements in the quality of record keeping. This meant that staff had accurate information to support them in providing personalised care to people. People and relatives told us that they had noticed improvements since the last inspection in September 2016. One person said, “I think they have improved quite a bit in the running of this place. All in all, I would say it’s a good place to be.” A relative told us, “It hasn’t been good here but I’d say it is getting better.”

People were being supported to have enough to eat and drink. “Hydration stations” had been introduced around the home to encourage people to help themselves to drinks and snacks. Staff were focussed on ensuring that people were offered regular fluids and snacks. People’s records were being completed accurately and confirmed that they were consistently meeting fluid targets. People told us that they had plenty to eat and drink and our observations confirmed that people were receiving the support they needed. One person told us, “We have lots to drink, if we want, we ask them and they make it straight away.” A relative said, “Staffing levels at meal times are much better and people get the help they need.” The provider had followed their action plan and was now meeting the requirements of the regulations.

People told us they felt safe at Mill View, one person said, “It’s nice here there are lot of people around if you need something, you just need to call out.” A relative told us, “Staffing levels have really improved over the last six months or so, I complained about staffing levels previously but it is much better now.” Our observations confirmed that people were not having to wait for their care needs to be met. Staff were consistently responding to call bells within two minutes and there were enough staff to support people at meal times. Risks to people were identified and care plans detailed how to support them to reduce the risks. People’s medicines were stored administered and managed safely and people told us they received their medicines when they needed them.

Staff had the training and support they needed to carry out their roles and responsibilities. People told us they had confidence in the staff. One person said, “I am confident that they (staff), are well equipped to care for everyone.” Staff understood their responsibilities with regard to the Mental Capacity Act 2005 and were consistently working in line with the legislation and guidance. People were supported to access health care services and told us that staff were proactive in seeking advice. A relative said, “Staff are very quick to contact the doctor if they are concerned.”

People and their relatives told us they had developed positive relationships with the staff. Their comments included, “They are extremely kind, very, very kind,” and, “The staff are wonderful. I can’t fault the staff they are very caring.” Staff knew people well and spoke about them with warmth and affection. One staff member said, “We have such lovely residents, they are our main focus.” People were able to express their views about their care. Staff were proactive in offering people choices and supporting them to remain as independent as possible. People were treated with respect and their dignity and privacy was protected. One person said, “The staff are very respectful.”

People received care that was responsive to their needs. Care plans were personalised and updated regularly. This provided staff with the information they needed to deliver care that was appropriate for people’s specific needs. A relative told us, “They (staff) have been fantastic in responding to the changes in (person’s name)’s health.” Care records included details of people’s life history, interests and hobbies. Staff used this information to encourage people to follow their interest. One person told us, “They have a choir here and they sometimes arrange to go out, it’s nice to get out. I have recently taken up painting lessons; there is a lady who comes in on a Wednesday morning.”

People and relatives knew how to make a complaint and told us that they were confident that any concerns they raised would be acted upon. There was management oversight of complaints and incidents and accidents. Analysis of these events was undertaken to identify any patterns and to improve the quality of the service.

People, their relatives and staff spoke highly of the management of the home. Most people we spoke with were aware that there was a new manager. One person said, “The manager is very good, very approachable and very accessible.” A relative said, “They seem very effective, things are dealt with quickly.” A staff member told us, “It feels different here now, calmer, more organised. The new manager has made the difference. Staff are a lot happier, the staff meetings are more positive. It’s nice to come to work again.”

There was an open culture where issues could be discussed freely. People and their relatives told us they were able to discuss any concerns at regular meetings and records confirmed this. People and staff told us that staff morale had improved. One staff member said, “Staff work well together now, there is good communication, we have regular meetings and the manager listens to our issues.”

Mill View is a purpose built home providing residential and nursing care for up to 70 people including people who live with dementia, mental health conditions and have general nursing needs. The service provides both long term and respite placements and at the time of the inspection there were 67 people living at the home. Some people were independent but others were living with dementia and had a mixture of dependency levels and needs. Many of the people had difficulties in communicating their needs. This meant that they were vulnerable as they were unable to raise concerns or make basic decisions about their care and welfare needs.

The service had a newly registered manager in post. 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 previous inspection of 23 February 2016 identified a number of continued breaches of the regulations, with regard to inadequate staffing levels, failures in meeting people’s nutrition and hydration needs, poor record keeping, and ineffective quality monitoring systems. We also found a number of areas of practice that needed to improve, including protecting people’s dignity and supporting people to follow their interests. The provider produced an action plan in June 2016 to tell us what they would do to meet the legal requirements.

We undertook a comprehensive inspection on 15 and 20 September 2016 to check whether the required actions had been taken to address the breaches previously identified. Improvements had been made in some areas. However we found continuing breaches in relation to nutrition and hydration and good governance.

We continued to have concerns that records were not always complete and accurate and governance systems and processes were not always robust and effective. There had been improvements in the personalisation of care plans. However this had not been fully embedded and some records were not complete and accurate. It remained that not everyone’s care plan was focussed on their individual needs for example one person’s care plans did not reflect the support that they required to eat even though the care plan had been reviewed. The registered manager had put a number of systems in place to improve monitoring of service delivery such as introducing hydration calendars to ensure people were receiving adequate fluids and introducing mechanisms to check that recording was maintained. However, these systems were not yet all embedded and were not always effective in driving service improvement.

There had been improvements to the meal time experience. However, it remained that not all people were always given the support they needed to eat and drink. The risks of dehydration and malnutrition were not always effectively monitored. We observed one person at risk of malnutrition who was not offered the support they needed to eat their meal. Records showed that they were losing weight. People told us that they didn’t receive a hot drink, or anything to eat following the evening meal until breakfast the next morning. One person said, “Between 5:00pm and 9:30am we get nothing offered to us.” One relative said, “My relative has type two diabetes and I think they should have something in the night between 5:00pm and 9:00am, he has been quite poorly in the mornings. Recording of people’s food and fluid intake was inconsistent and contained gaps and inaccuracies, a member of staff told us “It depends who is on duty.” This meant that the registered manager could not be assured that people were always receiving the food and fluids that they needed.

Although there was a wide range of organised activities available at the home, some people remained at risk of becoming isolated and lacked opportunities for social interaction and stimulation. People told us that this was because only the activities co-ordinators had time to spend with people. We made a recommendation to the provider regarding seeking advice on how to support people’s need for social interaction and occupation. Our observations were that staff were sometimes too busy to provide more than a task focussed approach. This meant that although people were getting the care they needed their social needs were not always able to be met. We made a recommendation to the provider about meeting people’s needs for social engagement and occupation.

Risks to people were identified and assessed to keep people safe. Staff were effectively managing risks associated with people’s nursing needs. However, manual handling guidelines were not always followed and this put people and staff at potential risk of injury. The registered manager had recognised this issue and had put training in place to ensure that staff had the necessary skills to help people to move safely.

At the last inspection we found that people’s dignity was not always respected. At this inspection staff were protecting people’s dignity. People told us that they had developed positive relationships with staff and that they were treated with respect. One person said “They are really caring and they always treat me with kindness and respect, and they always knock on my door before they go into my room and they always close the door when there doing anything for me.”

Staff recruitment was ongoing, but the registered manager told us that they had employed seven new staff members since the last inspection, and more were due to start during the next month. Staffing levels had improved and feedback also confirmed this. One staff member said, “The new staffing levels have made a big difference, we can cover all areas of the floor now.” People told us that staff were well trained and knew how to care for them. One person said, “I think they have a lot of training and they are very good.” There was a robust induction process in place and recruitment procedures were safe and ensured that staff were suitable to work with people.

People received their medicines safely and had access to health care services for ongoing support. A visiting health care professional told us that staff listened to and acted upon the advice they gave them.

The registered manager was committed to improving the standard of care and had made a number of improvements at the service. People and staff spoke highly of the registered manager.

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

Mill View is a purpose built home providing residential and nursing care for up to 70 people, including people who live with dementia, mental health conditions and have general nursing needs. The service provides both long term and respite places and at the time of the inspection there were 62 people living at Mill View.

The service should have a registered manager however currently the person in charge is not registered. 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 previous inspection carried out on 29 November 2014 and 2 December 2014 identified a number of breaches of the regulations with regard to inadequate levels of staffing, poor record keeping, failures in meeting nutrition and hydration needs, lack of staff training and support and ineffective quality monitoring systems. The provider produced an action plan in April 2015 to tell us what they would do to meet the legal requirements.

We undertook a comprehensive inspection in February 2016 to check whether the required actions had been taken to address the breaches previously identified. This report covers our findings in relation to these requirements. Improvements had been made in some areas, however we found continuing breaches of regulation relating to staffing levels, nutrition and hydration, and good governance. Further areas for improvement were identified in relation to maintaining people’s dignity, providing person centred care and ensuring people were supported to follow their interests.

It remained that there was not always sufficient staff to keep people safe and meet their needs. People, relatives and staff told us that there was not time to do more than provide basic care and our observations confirmed this. One person told us “The staff do their best but they are so busy, they are rushed off their feet most of the time.” The provider had an active recruitment programme however their updated action plan confirmed 'We have been unable to significantly reduce the use of agency staff due to the high number of vacancies.' We saw that people were left unattended for what appeared to be long periods of time, people had to wait to have their care needs met and staff were often too busy to spend time talking to people other than when directly providing care.

People were still not always given sufficient support to eat and drink and risks of dehydration and malnutrition were not being appropriately monitored and managed. A visiting relative told us “No one’s been in to see if they’ve had a drink.” We saw that people who had been assessed as being at risk of dehydration were not having fluids offered consistently and records showed that their fluid intake was unacceptably low. People were not always given sufficient support to eat. One person had lost a significant amount of weight and their care plan contained contradictory information regarding the support they needed with eating. This indicated that monitoring and management of risks associated with people’s food and fluid intake was not robust and some people remained at risk of receiving poor nutrition and hydration.

People’s care records were not always personalised and some did not give an accurate reflection of people’s needs. One person said “I’m treated the same as the other people but my condition is different, sometimes the staff don’t understand my behaviour.” Although some care plans were detailed others contained very little information about people’s life history and it was not possible to ‘see the person’ in the documentation in order to promote personalised care. Information specific to the person was sometimes missing or incomplete and this meant that people did not always receive support that was personalised and responsive to their needs and people were not always supported to follow their interests or to use local facilities. Relatives had concerns that people’s dignity was not always supported for example with regard to maintaining people’s privacy when supporting their continence and people’s culture and beliefs were not always respected. The provider and person in charge had systems in place for monitoring quality and standards of service but these were not always effective. This meant that gaps in service delivery had not always been identified, for example with regard to gaps in people’s records.

Some areas of practice had improved including support and training for staff and this was improving standards of care in some areas. For example staff had received training specific to their roles such as pressure damage awareness training and we saw good practice relating to this. Staff had a good understanding of the Mental Capacity Act and applied sound principles in seeking peoples' consent to care and treatment and in making best interest decisions where necessary. The person in charge had ensured the service was proactive in seeking authorisations for Deprivation of Liberty Safeguards. Staff demonstrated a good understanding of how to safeguard people and understood their responsibilities to report abuse.

Risks to people’s safety were assessed and monitored. People’s medicines were stored, managed and administered safely and people were supported to access health care services. One person told us, “If I am in pain I just ask for my tablets and they bring them there’s no problem,” and a relative said “If there’s anything wrong they call in the GP.”

The provider followed safe procedures for the recruitment of staff and people spoke highly of the caring nature of staff, comments included “They are really kind and do their best for me,” and “The staff are all friendly and caring,” and a relative told us “I had a member of staff nearly in tears because they weren’t able to give people more time.” We saw numerous positive interactions between staff and people that demonstrated a caring approach. People were supported to express their views and be actively involved in making decisions about their care as well as the running of the home. We observed the residents meeting and found that this was conducted in an inclusive manner with suitable adjustments made for people who were living with dementia and for people who had sensory needs.

The person in charge was committed to learning from people’s experiences and encouraged people and relatives to give feedback and complain. People told us they knew how to complain and felt comfortable to do so. Relatives confirmed that the person in charge was approachable and took their concerns seriously. However a number of relatives said that their most pressing concern was with regard to staffing levels and they did not believe that the Provider was doing enough to address this issue.

People relatives and staff spoke highly of the person in charge. People said “She’s a very nice person,” and “She is approachable, she’s often walking around talking to people, asking them how they are.” Staff told us that they considered the culture at the home to be fair and open and said that they had confidence in the person in charge. We saw that the person in charge was working hard to make improvements and had made some progress but that some improvements had yet to be implemented and embedded.

This summary is based on our observations during the inspection, discussions with 12 people, six relatives, the manager, the clinical lead, two nurses, one team leader, two carers and the activities coordinator. We also reviewed records relating to the management of the service and four people's care and health records. As some people could not talk with us about their experiences of living at the service we spent time observing how they were cared for and treated by staff. We observed interactions between staff and people who lived at the service for four hours during the morning and lunchtime period.

If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

People had care plans that were detailed and provided up-to-date information about their care needs. The selection of care plans that we looked at demonstrated that people or their representatives had been consulted and that their personal needs and preferences were reflected.

The service had appropriate systems in place to manage medicines. Medicine was stored, administered, recorded and disposed of in a safe way.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. Since our last visit one application had been made. The manager demonstrated knowledge of their responsibilities in respect of this.

Is the service effective?

We found that people's care plans were detailed and that they had been reviewed on at least a monthly basis. This ensured that the care provided was in line with their individual needs and preferences. One relative told us, 'I was party to her care plan at the start and reviews are done every three months and I believe that's changing to monthly'.

As many of the people living at the service were unable to speak directly of their experience, we spent time observing the care and support that they received. Staff demonstrated skill and experience when supporting people. One person that we spoke with told us, 'It's a nice place to be in if you've got to be in a home'. A relative said, 'I've seen no better care'.

Staff had received training to meet the needs of people living at the service. Staff that we spoke with told us that they felt supported and were able to deliver good care. One said, 'We support and work well together, it flows quite easily'.

People's rights with regard to consent were being promoted by the service and staff understood how people's capacity should be considered.

At our last visit we found that the layout and the use of key pads restricted people's movements and freedom. At this visit we found that the codes were displayed by the doors. This meant that people who were able and safe to move around the service independently were free to do so. One person said, 'I can navigate about alright'.

Is the service caring?

People were supported by kind and attentive staff. We saw that staff were patient and gave encouragement when supporting people. We spoke with 12 people. They were all satisfied with the care that they received. They told us they were able to do things at their own pace and were not rushed. Our observations confirmed this. One person told us, 'This is our home and it feels like it' and said, 'They can't do enough for everyone'. Another told us, 'I would give this home a glowing reference'. A relative shared, 'There's a lot of compassion here, it's evident in all the staff'.

Is the service responsive?

People told us that they were able to raise suggestions or concerns and that they were consulted about changes in the service. Relatives told us that they were kept informed and updated if there were any issues or concerns regarding the health of their family member. One relative said, 'They always telephone me when X (their relative) is not well'. We found that the service listened and responded to questions and feedback received from people, their representatives and from staff. One relative told us, 'The staff are very sensitive to residents' and relatives' needs'.

Is the service well-led?

Since our last visit a new manager was in post. Prior to their appointment the post was vacant for five months. The new manager was taking action to monitor and assess the quality of the service. Where necessary, action plans were in place or being drawn up that detailed steps to address any identified shortfalls. This meant that systems were in place that ensured that the quality of service was regularly monitored and assessed. One member of staff said, 'It's (the service) structured and organised'.

Systems were in place to make sure that the manager and staff learnt from events such as accidents and incidents. This reduced the risks to people and helped the service to continually improve.

We received consistent positive feedback from people about their experiences and life at Mill View. They told us about the kindness and friendliness of staff and how well cared for they felt. People told us: 'I can't tell you how good it is here, It's like living at home' and 'I only have to ask and I get help' . A relative told us: 'We visited so many homes to look around, we were given paper work about Mill View and as soon as we met the staff we knew that this was the place for mum as she would be safe and well cared for here' .

We saw many examples of staff supporting people in a sensitive respectful manner. People told us how staff spoke to them with respect and treated them with dignity. People told us they felt staff knew 'What they were doing' and that they had the skills to meet their needs. A person told us 'Whenever we have to use the call bell day or night they always come as quick as they can, I don't recall ever having to wait any length of time'.

We saw how people's medical needs were supported. A person told us: 'The Dr visits once a week but if needed in the meantime they are very quick to let him know I need him'. A relative told us 'Since mum has been back here she has improved considerably they are just so good with her and so caring'.

The meal time was relaxed and we observed people being supported to eat their meals in a dignified and timely manner. People described their meal 'Nice' 'Plenty of it' and 'The food is always very good'.

People consistently told us that they felt safe living at Mill View. A relative told us how they had peace of mind as they had much confidence in the staff that their relative was safe from harm and abuse.

A relative told us 'It does not matter what time of day I visit it's always clean and tidy, this then gives me confidence that mum is being looked after'.

People were not able to access freely the facilities within the service as their movement was restricted through the use of key pads on all doors and lifts from each of the units. There was no documentation to suggest that all people who lived at the service were at risk and therefore required their movements to be restricted in this manner.