People were involved in decisions about their care and support. We observed people being given choice throughout our inspection and staff sought people's permission before care and support was given.We saw that not all staff were trained in Mental Capacity Assessment and Deprivation of Liberties Safeguards. Some staff we spoke with lacked knowledgeable in these areas and were unsure of the procedures that they needed to follow should someone be unable to make a decision or consent to care and treatment. We asked the manager to take immediate action and ensure that all staff were up to date with training in these areas.
Care plans and risk assessments were in place for people. They were individualised and detailed the care and support which people needed.
We saw that staff made appropriate referrals to other professionals when needed. Staff were very knowledgeable about people's care and support needs and were responsive to them. People were treated with kindness and respect by all staff.
We saw that the home had not had an activities co-ordinator for some time and this position was in the process of being advertised. During our inspection we saw that most people spent time in their rooms. We saw people attending the hair salon during our inspection but we did not see any specific activities taking place. People told us that there were very little activities taking place.
Millbeck was clean, hygienic and well maintained. There were good processes in place to ensure the infection prevention and control of the home.
The service had a registered manager in place. We saw that there was a good staff team in place at Millbeck and staff told us they were supported by their manager. People and relatives we spoke with told us they felt able to talk to the manager and staff about any concerns which they had.
We saw gaps in the recording of information which breached the Health and Social Care Act 2008 and associated regulations.
Is the service safe?
People had been cared for in an environment that was safe, clean and hygienic. Staff were very knowledgeable about the procedures they needed to follow for infection prevention and control.
Staff were attentive to people's needs and carried out safe practices when providing care and support. People we spoke with confirmed they felt safe living at Millbeck.
We found gaps in the recording of information in people's records, in audits and in kitchen cleaning schedules and safety checks. We found some records were unavailable during inspection. Records did not contain all the information required by the Health and Social Care Act. This meant the provider could not demonstrate that people were protected from the risks of unsafe or inappropriate care because records were incomplete. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.
CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care home. While no applications had needed to be submitted, proper policies and procedures were in place. Not all staff had been trained to understand where an application should be made, and how to submit one, however we could see that staff were in the process of undertaking this training.
Is the service effective?
People were treated with dignity and respect when staff were providing them with care and support. It was clear from our observations and from speaking with people that staff had a good understanding of people's care and support needs and that they knew them well. We saw that health professionals were involved in people's care when needed.
All people living at the home had the capacity to make their own decisions. We saw staff sought people's permission before any care tasks were carried out. We observed people being given choice about when and where to access support and what to eat for lunch.
Not all staff were up to date with their training on the Mental Capacity Act and lacked knowledge in this area when we spoke with them. We could see that half of the team had undertaken this training and the remaining team members were in the process of accessing this training.
Is the service caring?
People were supported by kind and attentive staff. We saw that staff showed patience and gave encouragement when supporting people. Staff were friendly and responsive to people's needs. We saw staff interacting with people when providing care and support and helping to increase their independence.
Is the service responsive?
People's needs had been assessed before they moved into the home. This information was contained within people's care records and helped to ensure care plans were specific to individual needs.
We saw that people and their relatives were involved in monthly reviews about the care and support which they received. Records confirmed people's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.
The home was working alongside other health professionals to meet people's needs. Staff were attentive to people's needs and followed programmes of support put in place by health professionals.
Is the service well-led?
Staff had a good understanding of the ethos of the home and quality assurance processes were in place. Staff were clear about their roles and responsibilities and we saw them working as a team throughout our visit.
We looked at the records and spoke with people and their relatives. They confirmed that staff acted quickly when people's needs changed. We saw that staff followed programmes of support which were put in place by other health professionals.
People and relatives we spoke with confirmed that they could approach the manager and staff to discuss any concerns which they had. We saw meetings were in place for people living at the home and their relatives and staff. This ensured that people were involved in and kept up to date with changes affecting them.
What people told us.
We spoke with seven people who lived at the home and two relatives who were visiting on the day of our inspection. We also spoke with a health professional who was visiting one person on the day. People who lived at the home were able to express their views and told us they were happy with the care and support which they received.
Three people we spoke with told us, 'We like living here. We are well looked after and can't complain.' Two people told us, 'Staff are very good.'
We heard mixed reviews about the food which was provided. Two people told us, 'The foods ok, some things could be better,' and 'The food is passable.' Two other people we spoke with told us, 'The food is good,' and 'The food is lovely; I can ask for other things if I want.'
One person told us about their care needs and how staff really understood how to look after them. They told us, 'Staff are always careful with me.' A health professional we spoke with confirmed this to be the case and told us, 'The staff are really helpful and follow the programme of support which I have put in place. They are always willing to assist.'
Everyone we spoke with confirmed that their rooms were clean and tidy.
During our inspection we saw people visiting the hair salon. People we spoke with told us they looked forward to having their hair done. Some people we spoke with told us they accessed the local community. One person told us, 'There is not much to do here.'