Milford House Care Home

Updated 18 May 2019

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This was a comprehensive, unannounced inspection, which took place on 30 August 2018. The inspection team consisted of two inspectors and an expert by experience. An expert by experience is someone who has personal experience of using or caring for someone who uses this type of care service.

Before our inspection the provider sent us their completed Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and any improvements they plan to make. We spoke with local authority care commissioners for people’s care at the service. We also looked at all the key information we held about the service. This included written notifications about changes, events or incidents that providers must tell us about.

We spoke with nine people, seven relatives, one nurse, five care staff including one senior; three catering and two domestic staff. We also spoke with the registered manager, two senior external managers for the provider and two community professionals involved with people’s care at the service. We looked at six people’s care records and other records relating to the management of the service. This included staffing, medicines and complaints records and records relating to the provider checks of the quality and safety of the service. We did this to gain a representation of views about people’s care and to check that standards of care were being met.

Updated 18 May 2019

Milford House is a ‘care home.’ People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Nursing and personal care is provided for up to 65 adults in two adapted buildings, known as The Coach House and Milford House.

At our last inspection in August 2017, we rated the service as Requires Improvement because people were not always provided with safe or effective care. This was because they were not always protected from the risk of avoidable harm and people’s care records were not always accurately maintained to account for people’s care. We did not ask the provider for an improvement plan as there were no regulatory breaches. At this inspection we found the provider had made improvements to the standard of Good. There were 52 people accommodated, who were predominantly older adults, including some people living with dementia or a physical disability.

There was a registered manager at the time of our 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 of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Improvements were made to ensure people received safe care and effective care. People were protected from the risk of harm or abuse by staff who understood and followed relevant guidance to ensure this.

Known potential risks to people’s safety associated with their health conditions, care equipment and environment, were assessed before people received care, monitored and regularly reviewed. People’s medicines were safely managed.

Staff understood and consistently followed the provider’s operational care policies for risk management, care and medicines’ systems; which helped to ensure people’s care was consistently safe and effective.

People received holistically assessed, interagency agreed care. A range of health improvement initiatives were in progress utilising evidence based techniques. This, together with partnership working and the provider's introduction of relevant care technology systems, helped to ensure people received timely, informed and effective care.

Staff were effectively trained, supported and deployed. People were supported to have maximum choice and control of their lives and to help recruit new staff. Staff were skilled, knowledgeable and experienced and they supported people in the in the least restrictive way possible.

There was a strong emphasis on the importance of eating and drinking well for people at the service. Creative methods were used to help promote and ensure this. People were supported to maintain and improve their health and nutrition in consultation with external health professionals when needed.

Environmental upgrading and refurbishment was completed in consultation with people who used the service. This was done in a way that took account of their related needs, choices and independence.

People received care from kind, caring and compassionate staff, who ensured people’s dignity and rights in their care. Staff consulted with people and their representatives and followed what was important to people for their individual care, preferred daily living routines and lifestyle preferences.

People receive individualised care, that was usually timely, agreed and regularly reviewed with them, or their representatives when required. Staff understood and followed their roles and responsibilities for people’s care and knew how to communicate with people in the way they understood.

The provider had developed accessible information systems and ways to communicate with people, relatives and staff at the service; which helped accurately inform people’s care provision.

People were regularly supported to engage and participate in a comprehensive range occupational, social and leisure activities of their choice, which they enjoyed. This was provided in a way that helped to meet their individual preferences, diverse needs and inclusion in home and community life. Work was in progress to further enhance the care experience of people living with dementia.

People and relatives were supported and knew how to raise any concerns or to make a complaint about care or service provision, if they needed to. The provider regularly sought and obtained feedback from people, relatives and external professionals to help inform or improve the quality of people’s care and service provision. The provider used findings from this to make improvements when needed.

Staff were trained and informed to follow nationally recognised care principles for people’s end of life care when needed. This helped to ensure people would receive informed, co-ordinated and personalised end of life care and experience a comfortable and dignified death.

The service was well managed and led. The provider operated effective systems to ensure the quality, safety and effectiveness of people’s care and to ensure service improvements when needed. Staff understood their role and responsibilities for people's care and were recognised for their hard work and contributions to the service, through the provider's award scheme. The provider had notified us of important events when they happened at the service and visibly displayed their most recent inspection ratings in accordance with legal requirements.

Further information is in the detailed findings below.