Milford House

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated this key question good. At this assessment the rating has remained good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

This service scored 75 (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 made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

Management completed assessments of people’s needs before they were offered a place in the service. Information about people’s needs gathered at assessment was used to produce a detailed care plan. Staff told us they received good information about people’s needs and they had access to all care plans. The regional director told us any complex assessments had to be agreed with them prior to placements being offered. This was an additional check carried out to make sure the service could safely and effectively meet people’s needs.

Assessments of needs continued after people moved into the service. This helped to make sure any changes of needs were identified in a timely way.

The provider planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards. The provider had systems to make sure all leaders and staff were kept up to date with good practice and any changes to legislation and national guidance. For example, there were events such as webinars and conferences where good practice standards were high-lighted, and success stories shared.

Any changes to standards were cascaded to all staff and if needed additional training was provided. For example, local specialist nurses had been asked to provide training and learning sessions on areas such as nutrition and skin integrity.

Staff were aware of people at risk of malnutrition and dehydration. Information about the support people needed was included in their care plan, and care records demonstrated staff followed these plans. Mealtimes were relaxed and inclusive. Food looked appetising and people had choice. For example, at lunchtime, staff asked people what drink they would like. We also observed staff asking people what meal they would like by showing them the 2 options using ‘show plates’ or by asking people verbally. People also confirmed this happened at every mealtime. This meant people were able to effectively make a choice about the meals they ate.

The provider worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

The provider worked with other services, such as specialist nurses, speech therapists and occupational therapists to ensure people received the care they needed. Staff were knowledgeable about where they needed to go to obtain specialist health advice and guidance. This helped to make sure people had care and support that was timely. The local GP visited weekly and more often if needed. This helped people to know who their local GP was and build a relationship.

Staff had daily meetings and shift handovers where information about people’s needs were shared. Any changes were discussed and if needed records could be updated. Staff said they had good communication and teamwork. One member of staff told us, “There is good teamwork, there is a whole home approach. We work together to meet people’s needs.”

The provider supported people to manage their health and wellbeing to maximise their independence, choice and control. Staff supported people to live healthier lives and where possible, reduce their future needs for care and support.

Records demonstrated people were supported to use a range of health services, including the GP and specialist nurses. Staff escalated any changes to people’s health to the relevant healthcare professionals and made sure people’s health needs were reviewed if needed.

People were also able to access specialist services for mental health and dementia if required. Whilst the service did not specialise in dementia care, people may develop early signs of dementia and require additional guidance.

Staff encouraged people to make healthy choices whilst recognising people’s right to make their own decisions. The service provided people with healthy options on menus, regular healthy snacks and drinks. People were encouraged to move frequently to maintain mobility and relieve pressure on skin.

The provider routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

Staff maintained records of care they had provided, for example, how much food and fluid people had taken and observations of people’s skin conditions as needed. Records demonstrated changes were shared with other health services where needed to ensure people received appropriate treatment.

There were monthly clinical governance meetings for nursing staff and leaders. The providers clinical development nurse also attended to assist with monitoring of people’s outcomes. Minutes of the meetings were recorded and demonstrated staff were monitoring and discussing areas such as weight monitoring, people’s risk of malnutrition scores, falls information and analysis and any referrals to health professionals. This oversight made sure any changes in risks to people’s safety and wellbeing were identified in a timely way and known by all clinical staff.

The provider told people about their rights around consent and respected these when delivering person-centred care and treatment.

Staff had been trained in the Mental Capacity Act 2005 (MCA) and demonstrated a good understanding of making sure they got people’s consent. Staff understood the need to follow the best interest decision making process if people were assessed to lack capacity to consent to a specific decision. Records demonstrated these processes had been followed where people lacked capacity to consent to their care and treatment.

People and relatives did not share any concerns about this quality statement.