Milverton Nursing Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question requires improvement. At this assessment the rating has improved to good. This meant people were safe and protected from avoidable harm.

The provider was previously in breach of the legal regulation in relation to safe care and treatment. Improvements were found at this assessment, and the provider was no longer in breach of this regulation.

This service scored 69 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

Systems were in place to identify, investigate and learn from incidents and feedback. For example, safeguarding concerns were investigated and resulted in action with lessons shared with staff. Staff and leaders described ongoing improvements, and one staff member reflected that “there has been a lot of positive change… we are still in the process of improvement”. Governance systems, audits and service improvement plans were used to review incidents and drive improvements and ensure learning was consistently embedded.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

New pre-admission assessments templates had been introduced that were comprehensive and were used to inform care planning. These gave staff a clearer review of people’s needs and how to support them to meet those needs prior to a person moving in. Assessments were reviewed and care was adapted as staff got to know people better. Staff worked with healthcare professionals such as GPs and specialist healthcare providers to enable a smooth transition and clear pathways to access care and support.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect.

The service had systems in place to safeguard people from abuse and improper treatment. Safeguarding concerns were identified, investigated and acted upon, including referral to external agencies and the Disclosure and Barring Service where required. Policies were in place and staff understood how to raise concerns. People and relatives felt safe, with one person stating, “Here I feel safe… when I use [the call bell] the staff come along quickly.”

People can only be deprived of their liberty to receive care and treatment with appropriate legal authority. Incare homes, thiscan be donethrough a procedurecalled the Deprivation of Liberty Safeguards (DoLS),whichispart of the Mental Capacity Act 2005(MCA).We checked whether the service was working within the principles of the MCAand how they managed DoLS within the service. We found that appropriate procedures were in place in order to keep people safe.

The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

People were involved in managing risks. Care planning and risk assessments had been moved over to a new electronic system and these were being used to provide personalised information about risks to people’s safety and how these should be managed. Staff demonstrated awareness of people’s individual needs, preferences and communication requirements, and efforts were made to involve people in decisions where possible, including adapting communication methods such as using written prompts. Records showed risks such as falls, nutrition and skin integrity were assessed and monitored.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

The provider maintained a safe and clean environment for people. Observations confirmed the home was clean, well-maintained and free from odours, with appropriate safety measures such as accessible call bells, fire safety equipment and maintained equipment. Environmental risks were identified and addressed promptly, including rectifying an unrestricted window during the inspection.

On the whole, the provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs. However, we found the provider had not always stayed up to date with training required mandatory by the government.

Staff received a full induction to the service and were required to complete their mandatory training prior to delivering care. In addition, staff were required to complete regular refresher training and undertake competency checks to ensure they retained their knowledge and skills. At the time of our site visit staff had not completed training on learning disabilities and autism as required mandatory for all social care providers. The registered manager arranged for this to be completed shortly after our visit. The registered manager already had a meeting booked in with the training provider to discuss how systems could be improved to enable clearer oversight of training compliance as they were aware that this was an area requiring improvement.

The management structure had been reviewed, and new roles had been implemented to improve leadership within the care team. The staff rota had also been revised with new start times for the nursing team, so the nursing and care team started and finished their shift at the same time. This improved handover of information and communication. There had been some staff turnover since our last assessment, and safe recruitment practices were in place to ensure suitable staff were employed. Some relatives we spoke with were still getting used to the new staffing structure and this impacted on their view of staff visibility. However, people felt call bells were answered promptly and staff were available to help them when they needed support. We observed staff being present and responsive to people’s needs throughout our site visit.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

The home was observed to be clean, and staff followed infection control practices such as the use of personal protective equipment. Regular audits were undertaken and did not identify concerns. People and relatives consistently reported high standards of cleanliness. A relative said, “It’s always clean… bedlinen and towels are changed regularly.” One person told us, “It is spotless… they wear gloves and aprons for personal care.” Infection prevention and control policies and procedures were in place and understood by staff.

The provider made sure that medicines were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened.

Improvements had been made with medicines management, including enhanced storage, monitoring and auditing processes, and the use of an electronic medicines system. However, stock discrepancies were identified during the assessment, where recorded quantities did not match actual stock levels. The provider had recognised these issues and planned further improvements, including strengthened oversight and daily checks. We saw evidence that these improvements had been implemented in the days following our assessment to further improve the safety of medicines management.

Improvements had been made to ensure appropriate protocols were in place to instruct staff about when to administer ‘when required’ medicines and how to administer medicines that had been prescribed to be given covertly.