Milford House

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 good. At this assessment the rating has remained good. This meant people were safe and protected from avoidable harm.

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 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.

Leaders completed regular monitoring and analysis of incidents to identify themes and trends. The provider employed a regional clinical development nurse who supported leaders with monitoring for areas such as falls and skin integrity. They told us, they had identified a recent trend of unwitnessed falls. In response to this, learning sessions with the staff were organised and a falls champion identified. Reviews of people’s engagement in social activities were completed and people who were high risk of falls had their care needs reviewed. This work had reduced incidents of falls which improved outcomes for people.

The regional director told us the organisation reviewed incidents, accidents and events nationally both internally and externally. In response to any major concerns learning events were organised and information cascaded to all of the providers services. Staff had opportunities to reflect on incidents and to discuss actions to prevent recurrence during processes such as handovers, supervisions and staff meetings. Staff said incidents were well managed. One member of staff said, “Incidents are investigated and we get feedback about the outcome. Incidents are escalated to management quickly.”

People and relatives did not share any concerns about learning culture within the service. One relative told us. “We have absolutely no concerns, staff always flag any issues. We are impressed staff learn when things go wrong and they are very open about this.”

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.

Information was shared when people were admitted or discharged from the service. For example, if people were going into hospital, staff could print an emergency pack from the electronic care planning system. This provided hospital staff with key information about people’s needs.

Staff told us when people returned from hospital the electronic system triggered an immediate review of their care plan. This prompted staff to review and update information on people’s needs. If people stayed in hospital for longer periods of time, leaders visited them to re-assess their needs prior to discharging back to the service. This enabled staff to identify if any additional equipment or other resources were needed to help people return safely.

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 provider shared concerns quickly and appropriately.

Staff demonstrated a good understanding of their safeguarding responsibilities and said they completed regular safeguarding training. Records confirmed all staff had training on safeguarding. Staff were confident leaders would take appropriate action if they reported safeguarding concerns but were also aware how to raise these concerns outside of the organisation if they needed to.

Safeguarding concerns had been shared with the local authority and notified to the Care Quality Commission (CQC) as needed. Leaders kept detailed records of what incidents had been reported and action taken as a result. Information on safeguarding processes was available at the service, visible on posters.

People can only be deprived of their liberty to receive care and treatment with appropriate legal authority. In care homes this can be done through a procedure called the Deprivation of Liberty Safeguards (DoLS), which is part of the Mental Capacity Act 2005 (MCA). We checked whether the service was working within the principles of the MCA and how they managed DoLS within the service. Where appropriate the provider had applied to the local authority for (DoLS) authorisations. For those that had been approved, there were no conditions attached.

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.

The regional director told us risk assessments and supporting care plans had to be written within 24 hours of people moving into the service. We found risks to people’s health, safety and welfare had been assessed and plans developed to manage those risks. Staff demonstrated a good understanding of the risks people faced and how to support them safely. Staff told us risk management plans were regularly reviewed and updated as people’s needs changed. Staff had immediate access to updated plans through the electronic care planning system and were notified of any changes. Care records demonstrated plans to manage risks had been followed, including repositioning of people to reduce the risk of pressure injury and regular wellbeing checks.

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 environment was spacious with wide corridors which enabled people to mobilise easily and safely. Fire escapes were free from obstruction, and there were no trip hazards. Lighting in communal toilets and bathrooms was automatic, which helped minimise the risk of people falling.

Environmental risks had been assessed and mitigated. For example, restrictors had been fitted to windows to minimise the risk of people falling from height. Radiators had cool touch coverings, and water from hand wash basins was regulated to ensure a safe temperature. This minimised the risk of people sustaining a burn or scalding injury.

There were regular audits of the environment. This included daily walkarounds by leaders and the maintenance person. One of these checks identified a tree in the garden was growing towards overhead cables, so work to address this had been organised.

Records demonstrated a range of monitoring checks including the flushing of water outlets not readily used and showerhead cleaning. These interventions minimised the risk of legionella. Weekly and monthly checks of the fire alarm systems including the emergency lights, were undertaken. Any shortfalls identified were immediately addressed or added to the service’s overall improvement plan. Senior leaders and the facilities team could access this plan, to monitor the progress of any works required.

External contractors were used to service equipment such as portable electrical appliances, mobile hoists and fire systems. A recent fire risk assessment had identified some internal doors required work to meet up to date guidance. Leaders and the maintenance person told us an external company had been instructed to complete these works, as a matter of priority.

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.

Staff were employed safely. Checks had been consistently completed on all staff prior to employment. For example, the provider contacted previous employers for references and completed a check with the Disclosure and Barring Service (DBS). The provider had made changes to move all recruitment records onto online systems which gave the provider better oversight of personnel records.

There was a dependency tool used to help calculate staffing numbers. During our site visits we observed there were sufficient numbers of staff available to help people when needed. The regional director told us the service did not need to use agency staff as they were fully recruited for nursing and care positions. The provider had a designated member of staff for recruitment. This had helped the service better recruit into vacancies which took pressure off leaders. Staff said there were enough of them to meet people’s needs safely. People and relatives felt there were enough staff available.

Once staff completed a thorough induction, they had regular updates and refresher training. This included assessments of competence for areas such as medicines and moving and handling. The provider employed a learning and development worker for the region who visited regularly and helped monitor training compliance.

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.

People’s rooms were clean and well maintained. Staff told us they had a system which helped them make sure rooms had a thorough, ‘deep clean’ at least monthly. There were cleaning schedules which guided staff to know which areas to clean and when. Staff kept records of their domestic work which demonstrated all communal areas were also cleaned regularly.

Staff were provided with training on infection, prevention and control (IPC) which was refreshed annually. Regular IPC audits were completed which checked all areas such as cleanliness and compliance with IPC policies and procedures. Staff had access to personal protective equipment, and we observed staff using this safely and appropriately.

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

Medicines were stored safely in locked cupboards or trolleys, within a locked air-conditioned room. There was a refrigerator to store medicines that needed a lower temperature. All storage areas were clean and ordered, and records demonstrated the temperatures were regularly monitored. This ensured the medicines were safe to use.

There were frequent spot checks of the medicines and regular audits of the administration systems. This ensured any potential errors were quickly identified and addressed. Medicines were disposed of safely when no longer required.

Staff received training in the safe administration of medicines and their competency was assessed. We observed staff administered people’s medicines safely, in accordance with individual preferences. Staff took their time and observed the person taking the medicines, before signing the medicine administration record (MAR). This ensured an accurate record, which could be used to demonstrate medicine effectiveness if required.

Staff knew people well including their health conditions and prescribed medicines. They confidently described when a variable dose or an ‘as required’ medicine was to be given. However, there was not always written guidance about these medicines for staff to refer to if needed. A staff member with the responsibility of medicine administration told us they would address this immediately. They told us there was a planned meeting with the pharmacy, to discuss improvements to the systems. This included ensuring all medicine instructions printed on the MAR were up to date and accurate.