This inspection took place on 10 February 2015 and was unannounced. At the last inspection on 18 September 2014 we identified that the provider had breached six regulations. We found the provider had not ensured people's consent was always obtained, or acted in accordance with; the planning and delivery of care and treatment did not always ensure people's welfare and safety; people were not protected against identifiable risks of acquiring an infection and were not always protected from the risks of unsafe equipment. In addition the provider did not have effective arrangements to ensure that only suitable applicants were chosen to work in the home and their quality assurance systems were ineffective.
At this inspection we found improvements had been made in relation to the breaches identified previously. However, during this inspection we found breaches in relation to good governance and supporting staff.
Milverton Nursing Home provides accommodation and personal care with nursing for up to 30 older people some of whom have dementia. The home accepts a number of people who require end of life care, although this is not a specialism of the home. On the day of our visit there were 27 people living in the home.
The home had a 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.
There was no clear programme in place to ensure staff received a suitable induction to enable them to meet people’s needs. Staff were supported by the registered manager and received appropriate training to carry out their roles, except for induction training. Staff knew how to recognise if people were being abused and how to respond to keep them safe.
The registered manager understood their requirements under the Deprivation of Liberty Safeguards (DoLS). These safeguards are there to make sure that people in care homes and hospitals are looked after in a way that does not inappropriately restrict their freedom. Services should only deprive someone of their liberty when it is in the best interests of the person and there is no other way to look after them, and it should be done in a safe and correct way.
Where decisions needed to be made in people’s best interests, there was not always suitable guidance for staff to deal with these. For example the medicines policy did not cover covert medicines administration which meant there was no clear, consistent process for staff to refer to, to ensure medicines were only administered in this way when it was in people’s best interests.
The registered manager was gathering people’s views, or the views of their relatives, as to how they wanted their care to be delivered and what was important to them where possible. In this way staff would have the necessary information to refer to, to provide care in the ways people preferred.
Risks to people were well managed with care plans and risk assessments in place to minimise these. Staff understood people’s individual needs and preferences.
The premises and equipment were clean and safe, with regular health and safety checks carried out. Specialist equipment such as pressure relieving mattress’ and cushions and hoists were used appropriately.
Staff treated people with dignity and respect, kindness and compassion.
People’s health needs were met and people received the right support in relation to eating and drinking. Referrals to specialists were made when necessary. For example referrals were made to speech and language therapists when people had difficulties swallowing, and staff followed their advice.
There were enough staff to support people effectively, and recruitment procedures were thorough to help protect people from staff who were unsuitable.
The manager listened to suggestions to improve the service and acted upon them. People knew how to make complaints and were confident the registered manager would respond appropriately to any issues they raised.
The registered manager and staff were aware of their roles and responsibilities. The registered manager ensured a range of audits were carried out to check the quality of service, taking action where issues were identified. Regular meeting involving people using the service and their relatives took place so they could feedback on the quality of service.
Records in relation to staff supervision, wound management and Mental Capacity Act assessments were not always accurate or able to be located promptly when required.