Archived: Milton House Nursing and Residential Home

Milton House Nursing and Residential Home 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.

The care provider, Mrs Carol Shutt and Mr Winston Shutt are registered to provide accommodation for up to 22 persons who require nursing and/or personal care in one adapted building. At the time of our inspection there were 20 people using the service.

There was a 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.

There was a range of systems and procedures in place to monitor the quality and effectiveness of the service. However, audits were not always completed on a regular basis in line with the providers own guidance. The audit systems had not identified some areas for improvement. We saw evidence of action plans being implemented to address any issues found. We made a recommendation around managerial tasks to be completed.

We saw the service was clean and had appropriate infection control processes in place.

Each person we spoke with told us they felt safe. They expressed no concerns about their safety and they were complimentary about the level of care provided. The service had appropriate safeguarding policies and procedures in place, with detailed instructions on how to report any safeguarding concerns to the local authority. Staff were all trained in safeguarding vulnerable adults and had a good knowledge of how to identify and report any safeguarding or whistleblowing concerns.

We saw the home had adequate systems in place for the safe administration and recording of medicines.

All staff demonstrated a good knowledge and understanding of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS), which is used when someone needs to be deprived of their liberty in their best interest. We checked whether the service was working within the principles of the MCA. We found that the provider had followed the requirements in DoLS authorisations and related assessments and decisions had been appropriately taken.

Staff had been recruited in a safe way. Systems and processes showed staff had their backgrounds checked before employment. We made a recommendation about the recordings of interviews.

Staff spoke positively about the training available. We saw all the staff had completed an induction programme and on-going training was provided to ensure skills and knowledge were up to date.

Staff confirmed they received supervision with their line manager, which along with the completion of team meetings, meant they were supported in their roles. Records we saw backed up what staff had told us.

Observations of meal times showed these to be a positive experience, with people being supported to eat where they chose. Nutritional assessments were in place and special dietary needs catered for.

Throughout the inspection we observed positive and appropriate interactions between the staff and people who used the service. Staff were seen to be caring and treated people with kindness, dignity and respect. Both people who used the service and their relatives were complimentary about the quality of the staff and the standard of care received.

Care files contained completed pre-admission assessments and accurate and detailed information about the people who used the service and how they wished to be cared for. Each file contained detailed care plans and risk assessments, along with a range of personalised information which helped ensure their needs were being met and care they received was person centred.

Everyone we spoke to was positive about the variety and frequency of activities available. We saw the activity schedule catered for all interests and abilities and included involvement from external agencies.

Milton House is registered to provide personal and nursing care for up to twenty-two older people. The main part of the house is over 200 years old and this provides the lounges and a small number of bedrooms. There is additional purpose built accommodation providing further bedrooms, dining room and a conservatory lounge. Many areas of the home have views of the surrounding countryside and the river, which runs alongside the property. It is a short drive away from the village centre.

The home had a registered manager in post, as required. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

A system of audits and quality assurance checks were in place. However, these did not always identify areas where improvements were needed, such as when to implement the use of food and fluid monitoring for people at risk of being under nourished. We made a recommendation about this.

People who used the service were not protected against the risks associated with the appropriate administration, use and management of medicines. We identified deficiencies with a significant number of medicine administration records and the way medicines were being managed.

People were supported to maintain good health. Care plans identified people’s daily and nightly care needs and information was personalised.

People usually consented to care and support from care workers by verbally agreeing to it. Records included provision for people or their representative to sign their agreement to the care and support they received. Records concerned with people, care workers and the running of the home were maintained and kept securely.

Care workers and nurses received support in their role from the registered provider, registered manager and senior staff team. There was a process for completing and recording supervisions and annual appraisals and we saw this was being reviewed and updated.

Systems and processes were in place that ensured sufficient numbers of suitably trained and competent care workers, including nurses, were on duty to meet and respond to people’s needs. Pre-employment checks on employees were completed that helped to minimise the risk of unsuitable people from working with adults who may be at risk.

Care workers confirmed they received induction training when they were new in post and told us that they were happy with the training provided for them. Training for care workers and nurses was organised by the registered manager and a training programme was in place.

We found that people were protected from the risk of avoidable harm or abuse because the registered provider had effective systems in place to manage any safeguarding issues. Care workers and nurses received training on safeguarding adults from abuse and understood their responsibilities in respect of protecting people from the risk of harm.

The registered provider had systems and processes to record and learn from accidents and incidents that identified trends and helped prevent re-occurrence. Systems and processes were in place that helped identify risks associated with the home environment and when providing care and support for people.

Care workers and nurses had received training and understood the requirements of The Mental Capacity Act 2005 and the registered provider and registered manager were following this legislation.

People were supported with a choice of food at meal times and any special food requirements were accommodated. Snacks and hot and cold drinks were available for people throughout the day and this was confirmed to us by people we spoke with.

All staff demonstrated a clear understanding of people’s individual needs and preferences. They were caring and treated everyone with dignity and respect. We saw staff clearly communicated with the people they were providing care and support to and gave people the opportunity to comment and agree before providing that support. Staff took a pride in their work and told us they were proud to work at the home.

A programme of activities was on offer to meet both people’s individual requests and as a group. People spoke with enthusiasm about what they did with their spare time and it was clear that people could opt in or out of any of the activities as they wished.

People told us they felt well supported and were able to raise any issues with the management team, including the registered provider. We observed a warm and friendly atmosphere throughout the visit. We received very positive comments from everyone we spoke with about the service.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to safe care and treatment. You can see what action we have asked the registered provider to take at the back of this report.

We walked around the home and found it was kept very clean and well maintained.

We looked at the medication and found that medication was stored and disposed of safely. We observed staff administering medication and confirmed that it was given in the correct way.

We talked to people about staffing levels. People felt that there were enough staff in the home and that they were supported in the right way to protect their dignity and help with their independence. Some commented that the staff worked very hard but always seemed to have time to sit and have a chat.

We looked at how records were kept accurate and up to date. We felt that this needed to improve. We found that the care plans and medication records were not always accurate or up to date. This was important to ensure that people had the right support and their health and care needs were not omitted or overlooked. Staff training and supervision records were also not in place. This meant that important staff training and development may be overlooked. We also found saw that individual care and staff records were easily accessible in the dining room. This means people's confidential information was not held securely.

They also confirmed they were happy with the care and support they received from the home. People said 'The staff go out of their way to make you comfortable.' And 'I have been here many years and the care has always been so very good. I believe I am very fortunate to live here.'

The staff told us that they had regular training and support from the management team at the home. Staff comments included, 'We have a lot of support from the manager and the owner. I feel I can take anything to them.' And 'I have confidence that the manager will sort any problems out.'

We found that people had good information and support to make decisions about their care or air their views about the home. We also found that good systems were in place to support people living at the home and the staff to raise concerns or complaints.