• Care Home
  • Care home

Archived: Pilgrim Homes - Milward House

Overall: Good read more about inspection ratings

6 Madeira Park, Tunbridge Wells, Kent, TN2 5SZ 0300 303 1460

Provided and run by:
Pilgrim Homes

Important: The provider of this service changed. See new profile

All Inspections

15 November 2016

During a routine inspection

We inspected Milward House on 15 and 16 November 2016. The inspection was unannounced. Milward House is a residential care home registered to provide accommodation and personal care for a maximum of 28 people. The home specialises in providing care to older people with a strong Christian faith. At the time of our visit there were 19 people living in the home. The home is located in Tunbridge Wells and is arranged over three floors.

At the time of our inspection there was a registered manager at the home. 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.

At our last inspection on 16 and 23 February 2015, we found five breaches of the Health and social Care Act 2008 (Regulated Activities). These breaches were in relation to unsafe care due to poor moving and handling procedures, staff not following cleaning procedures to reduce the risk of infection, people not being secure in the premises and staff not being trained in safeguarding, staff members not receiving sufficient training, the registered provider had not offered meaningful activities for people living with dementia and that care plans were not individualised. The provider sent us an action plan stating that they had addressed the concerns raised.

At this inspection, we found that the provider had taken action on all these areas and was fully meeting the regulations where breaches were found.

The registered provider had systems in place to protect people against abuse and harm. The registered provider had effective policies and procedures that gave staff guidance on how to report abuse. The registered manager had robust systems in place to record and investigate any concerns.

Risks to people's safety had been assessed and actions taken to protect people from the risk of harm. The environment was clean and appropriate measures had been taken to reduce the risk of infection. Medicines were managed safely and people had access to their medicines when they needed them.

Staff were well trained with the right skills and knowledge to provide people with the care and assistance they needed. Staff met together regularly and felt supported by the manager. Staff were able to meet their line manager on a one to one basis regularly. There were sufficient staff to provide care to people throughout the day and night. When staff were recruited they were subject to checks to ensure they were safe to work in the care sector.

Where people did not have the capacity to understand or consent to a decision the provider had followed the requirements of the Mental Capacity Act (2005). An appropriate assessment of people's ability to make decisions for themselves had been completed. Where people's liberty may be restricted to keep them safe, the provider had followed the requirements of the Deprivation of Liberty Safeguards (DoLS) to ensure the person's rights were protected.

People had enough to eat and drink, and received support from staff where a need had been identified. People's special dietary needs were clearly documented and staff ensured these needs were met.

The environment was designed and adapted to meet the needs of people who are living with dementia, through sympathetic re-decoration and usage of the building.

The staff were kind and caring and treated people with dignity and respect. Good interactions between people and their support staff were seen throughout the day of our inspection. Staff knew the people they cared for well and treated them with kindness, compassion, dignity and respect.

People could have visitors from family and friends whenever they wanted. People spoke positively about the care and support they received from staff members.

People received a person centred service that enabled them to live active and meaningful lives in the way they wanted. People had freedom of choice at the service. People could decorate their rooms to their own tastes and choose if they wished to participate in any activity. Staff respected people's decisions.

People felt well cared for and were supported with a variety of activities. However, activities were not always structured meaning that people could potentially become under stimulated. We have made a recommendation about this in our report.

Support plans ensured people received the support they needed in the way they wanted. Peoples health needs were well managed by staff so that they received the treatment and medicines they needed to ensure they remained healthy. Staff responded effectively to people's needs and people were treated with respect.

Staff interacted with people very positively and people responded well to staff. The culture of the service was open and person focused. The registered manager provided clear leadership to the staff team and was an active presence in the home.

Audits to monitor the quality of service were effective and embedded. They identified actions to improve the service and these had been carried out.

16 & 23 February 2015

During a routine inspection

This inspection took place on 16 and 23 February 2015 and was unannounced.

Pilgrim Homes - Milward House is a care home providing accommodation with nursing and personal care for up to twenty eight older people who are practicing Christians, some of whom were living with dementia. The service is located in Tunbridge Wells, approximately half a mile from the town centre. The service was provided in a large detached property with accommodation on two floors in the main building. There was independent living accommodation attached to the property. This part of the service does not require registration with the Care Quality Commission. People had a variety of complex needs including dementia, mental and physical health needs and mobility difficulties. The last inspection was carried out on 2 February 2014 when we found the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 were met.

During this inspection we found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, which correspond to the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 which cam into force on 1 April 2015. People were not safeguarded against abuse. Some staff were not adequately trained to meet people’s needs. People did not receive personalised care in accordance with their wishes and choices.

There was a registered manager at the service. 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.

People gave us complimentary comments about the service they received. People felt safe and well looked after. Our own observations and the records we looked at did not consistently match the positive descriptions people and relatives had given us.

We observed unsafe practice which placed people at risk of harm because staff did not follow correct procedures. The provider had not taken adequate steps to make sure that people were safeguarded from abuse and protect them from risk of harm. People from the independent living units and anyone visiting them had unrestricted access in and out of the service through connecting doors on upper floors which were not locked. There were no assessments of the risks this presented to the people living at the service or evidence of consultation with them about this arrangement. Management and quality assurance systems were not consistently effective in recognising shortfalls so that necessary improvements were made for people to receive a good service.

People’s care plans did not provide staff with the information they needed to provide a personalised service. People’s choices were not respected in relation to receiving personal care from staff of the same gender. Not all staff were trained in the Mental Capacity Act 2005 (MCA) and DoLS to make sure they knew how to protect people’s rights. People were asked for their consent before staff carried out care or treatment. People were involved as far as possible in their assessments and action to minimise risk was agreed with them. Some staff had not received all the essential training and updates to enable them to carry out their roles effectively.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Whilst no-one living at the home was currently subject to a DoLS,  the registered manager had submitted some applications to the local authority and was aware of the Supreme Court Judgement which widened and clarified the definition of a deprivation of liberty. These safeguards protect the rights of people by ensuring if there were any restrictions to their freedom and liberty these had been authorised by the local authority as being required to protect the person from harm.

Safe recruitment procedures ensured that staff were suitable to work with people. Staff received regular supervision, support and appraisals to monitor and assess their work and performance. Regular staff meetings were held to make sure staff were kept up to date with any changes in the service and had opportunities to make suggestions or raise concerns. The provider had a whistle-blower policy which staff were aware of.

People’s nutrition needs were assessed and their weight was monitored to make sure they were getting the right amount to eat and drink to protect them from the risk of malnutrition. Most people told us they enjoyed the meals provided. Staff made sure that people’s dietary needs were catered for. People received the medicines they needed when they needed them. People were supported to manage their health care needs by the nurses. Advice from other health professionals was followed to make sure people’s health was promoted. Prompt action was taken when people showed signs of illness.

Most staff were respectful, kind, caring and patient in their approach and had a good rapport with people. People knew who to talk to if they had a complaint. Complaints were passed on to the manager and recorded to make sure prompt action was taken and lessons were learned which led to improvement in the service.

People were able to choose from a range of activities to promote their wellbeing, although there were no personalised programmes of activity for people living with dementia or those who were nursed in bed. Christian based activities were provided daily to ensure people’s spiritual needs were met. People were supported to maintain their relationships with people who mattered to them. Visitors were welcomed at the service at any reasonable time and people were able to spend time with family or friends in their own rooms and other areas.

The attitudes, values and behaviours of staff and the management enabled and encouraged open communication with people and their relatives. We received mainly positive feedback from people and their relatives about the service. Quarterly satisfaction surveys and meetings were used to obtain the views of people and their relatives about the service and inform improvement plans.

Records relating to people’s care and the management of the service were well organised and kept up to date.

We recommend that an up to date analysis of the level of support people, including visitors from the adjacent supported living flats, need is maintained and used to determine the number of staff needed on each shift.

We recommend that the providers consider the use of the service by those who are not receiving care or treatment and the impact this has on the care and safety of those that are receiving the service.

We recommend that improvements are made in quality assurance systems to reflect published research and guidance.

26 July 2013

During a routine inspection

We spoke with six people who used the service, or their relatives. They were positive about the service and the care provided. They told us that 'folk are very welcoming and very helpful' and 'they're very caring'. One person told us it was 'very, very good'

People had their needs assessed and care plans developed. There was a church service every morning. Activities were provided in the afternoon.

The service had processes for the safe handling and administration of medication.

People were positive about the staff. They told us 'they know us very well' and the 'staff are very welcoming'. There were usually adequate numbers of staff to provide care. However, not all staff had received the necessary training to ensure they had the skills to carry out their role.

The service had processes for handling complaints.

25 September 2012

During a routine inspection

We spoke with five people who were using the service. Some of the people living at the home were not able to talk to us directly about their experiences due to their complex needs so we used a number of different methods to help us understand their experiences. We spoke with staff, spoke with relatives visiting the home, read records, walked round the home and made observations of the care and support people received.

People told us that staff were kind and caring and gave them the support they needed. They said staff respected that they liked to maintain their independence as much as possible.

People said they were satisfied with their rooms and that they were kept clean and tidy.

People told us they had chosen the home due to its Christian emphasis and they enjoyed the services, prayer meetings and other events that celebrated their faith.

People told us that overall they liked the meals at the home and that there was choice available.

Relatives we spoke with were complimentary about the service and told us that staff were kind and helpful and that communication was good.

30 January 2012

During a routine inspection

People told us they were given choices about their daily routines, such as when to get up and go to bed, what to eat and what to do each day.They told us that before they had moved to Milward House their needs had been assessed and they, or their relatives, had been for a visit to the home to make sure it was suitable for them. One person said they had had known the home when a relative had lived there and had liked it.

People told us they could choose where to eat and that they liked the meals at the home, one person preferred to eat lunch in the lounge and tea in the dining room and said staff respected this.

People said they received the care and support that they needed each day in the ways that they preferred and staff were kind and caring.People said their care was given safely and they felt safe at the home, if they had any concerns they knew they could speak with staff or the manager.

People said they liked the activities on offer and could choose whether or not to attend them, one person said they had enjoyed last year's Christmas events and the Christmas meals had been superb. People told us they liked the meals and were given plenty of choice of what to eat.

Comments about the service from people living there included,

'I have no complaints, I like the food'

'Marvellous meals'

'At night the staff answer the buzzers quickly'

' My family came to look at the home, I was on the waiting list'

'They make sure I eat enough, they do keep weighing you'