Background to this inspection
Updated
16 June 2015
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
Before our inspection we reviewed information that was gathered about the service. This included notifications and the provider information return (PIR). The PIR is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. A notification is information about important events, which the provider is required to send us by law. We also spoke with the local authorities responsible for contracting and monitoring some people’s care at the home.
This inspection took place on 16 October 2014 and was unannounced. The inspection team consisted of two inspectors, a pharmacist inspector and a specialist advisor with experience of palliative and end of life care.
We spoke with 10 people who lived in the home, five people’s relatives, three registered nurses, nine care staff and a visiting health worker. We also spoke with the registered manager and a senior manager for the provider. We observed how staff provided people’s care and support in communal areas. This included use of the Short Observational Framework for Inspection (SOFI), which is a specific way of observing care to help us understand the experience of people who could not talk with us. We also looked at 16 people’s care records, 17 people’s medicines records and other records relating to how the home was managed.
Updated
16 June 2015
This inspection took place on 16 October 2014 and was unannounced.
Accommodation for people who require nursing or personal care is provided at this location for up to 65 older adults, some of whom were living with dementia and a small number of people receiving end of life care. Milford House comprises of two dedicated units - Milford House and The Coach House. At the time of our visit a total of 59 people were living in the home. This included 27 people receiving nursing care, who were mostly accommodated in the Coach House unit and 32 people receiving personal care who were accommodated in the Milford House unit.
A registered manager was 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 of the Health and Social Care Act 2008 and associated Regulations about how the service is run.
We found that some people’s medicines were not always safely managed. This meant they were not fully protected from risks associated with unsafe medicines practices because their medicines were not always properly stored, recorded or given.
The arrangements for the planning and delivery of people’s care did not always protect them against the risks of receiving inappropriate care or treatment. Care staff did not always fully understand people’s care requirements relating to their health conditions and needs because people’s care plans did not always provide sufficient information about this for people’s care.
People were not always protected against the risk of care being provided without the appropriate consent or authorisation of a relevant person. The Mental Capacty Act 2005 (MCA) was not always being followed for some people who were unable to consent to, or make specific decisions about their care and treatment, and where decisions were being made about this in their best interests.
The provider’s checks of the quality and safety of people’s care did not fully protect people from the risks of unsafe or inappropriate care and treatment.
People’s care plans and medicines records were not sufficiently robust to fully protect people against the risks of unsafe or inappropriate care and treatment. This was because accurate records were not always kept so that staff could easily follow them.
Staff treated people receiving end of life care with care and compassion and nursing staff were familiar with and tried to ensure some of the known good practice priniciples for this. However, the provider’s end of life care strategy and policy did not show best practice standards for staff to follow, or fully inform people about the care they should be able to expect to receive.
Most people received their medicines as prescribed and records were kept of medicines received into the home and given to people. We observed that staff gave people their medicines in a safe way that met with recognised practice. Action was being taken to improve reporting procedures for staff to follow, in the event of any medicines errors.
One person’s freedom was being restricted in a way that was necessary to keep them safe. The restriction, known as a Deprivation of Liberty Safeguard (DoLS), was formally authorised by the relevant local authority responsible for this.
People using the service, their representatives and staff were informed about how to recognise and report abuse. The registered manager took the action required to notify us and the relevant authorities of the alleged abuse of some people using the service. Subsequent investigations showed that people had not been subjected to any harm or abuse and that they had received the care they needed.
Staffing levels were considered and determined in a way that helped to make sure they were sufficient for people’s care needs to be met. Staff mostly received the training and support they needed and there were robust arrangements for staff recruitment. Further staff training was planned relating to people’s health conditions and a medicines checking procedure.
People’s care records showed potential or known risks to their safety and their written care plans usually showed how those risks were being managed and reviewed. Staff mostly understood and followed these, which helped to minimise risks to people’s safety. The provider’s emergency contingency arrangements and reports from local fire and environmental health authorities showed that people were being protected from related risks to their safety.
People were safely supported to eat and drink and they received adequate nutrition. Overall, people were satisfied with the meals provided and the improvements that were being made to the quality and choice of meals. People’s health and nutritional status was regularly checked and staff consulted with external health professionals and followed their advice for people’s health care needs when required.
Staff communicated well with people and listened and acted promptly on what they said and when they needed them. Staff supported people in a gentle and caring manner and met their dignity, privacy and independence needs. Staff understood and supported people to maintain relationships with people that were important to them. People were also supported to maintain their preferred daily living routines and lifestyle interests and preferences that were important to them.
Overall, people were positive about the management and running of the home. Managers and senior staff were open and visible to people throughout the home. Communication and reporting procedures for people’s care were mostly sufficient and understood by staff. Action was being taken to review a reporting procedure, following an unnecessary delay in the reporting of a medicine error.
Staff understood their roles and responsibilities and the provider’s aims and values for people’s care. People, their relatives and staff were regularly asked for their views about the care provided and knew how to raise any concerns about this. Staff were informed about any improvements that were needed for people’s care and the reasons for them. Improvements were usually determined from the provider’s checks of people’s care or from comments, complaints and other relevant feedback they received about the service. Some improvements were planned or in progress. These related to people’s continence care, dignity in care, medicines and cleanliness and infection control.
We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, which correspond to a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.