We carried out a review of the data available to us about Milkwood House Care Home on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Milkwood House Care Home, you can give feedback on this service.
This inspection took place on the 22 and 23 January 2018 and was unannounced. During our previous inspection on 30 June 2016 we found 2 breaches, of which one was a continuing breach of regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014. The other was a breach of regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We asked the provider to write an action plan to show how they would address these concerns anrd the provider identified 30 November 2016 for the completion of these actions. During this inspection we checked whether the provider had completed their action plan to address the concerns we had found. We found the provider had made the required improvements.
Milkwood House is a ‘care home’. People in care homes receive accommodation and personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
Milkwood House accommodates up to 38 people including those who are living with dementia. The home is set in secure grounds near to the town of Petersfield. People are accommodated in either a bedroom with en suite facilities or have the use of a communal bathroom. Other facilities included a dining room and a lounge. At the time of our inspection there were 35 people living in the home.
The home has a registered manager. 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.
There was guidance in place to protect people from risks to their safety and welfare, including the risks of avoidable harm and abuse. Staffing levels were sufficient to support people safely. The provider had an effective recruitment process in place to make sure the staff they employed were suitable to work in a care setting. There was a new electronic medicines management system in place and medicines were safely administered and as prescribed.
Staff received appropriate training and supervision to maintain and develop their skills and knowledge to support people according to their need Staff were aware of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards. People were supported to eat and drink enough and they had access to healthcare services, such as GPs and district and practice nurses when their health care needs changed.
Care workers had developed caring relationships with people they supported. People were encouraged to take part in decisions about their care and support, and their views were listened to. Staff respected people's independence, privacy, and dignity. The care and support given was based on assessments and care plans which took into account people's abilities, needs and preferences. People were able to take part in activities which reflected their interests and preferences. The provider had a complaints procedure in place, and any recent complaints had been responded to and actions taken to learn from them.
People said that they thought the service was well led and that the registered manager listened to them and acted upon what they said. Staff told us they felt the registered manager was good, supportive, and approachable and felt able to raise any concerns with them. The registered manager demonstrated a good understanding of the needs for the service.
Audits were used to drive improvements in the service. The operation manager’s visits were used to identify areas of the service for improvement and these were actioned. People’s records were accurate, completed in a timely manner and stored securely.
Milkwood House Care Home provides accommodation and personal care for up to 43 older people, including those who are living with dementia. The home is set in secure grounds near to the town of Petersfield. People are accommodated in either a bedroom with en suite facilities or have the use of a shared bathroom. Other facilities included a dining room and a quiet lounge with a ‘pub style’ area. At the time of our inspection there were 33 people living in the home.
The home has a registered manager 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 in the Health and Social Care Act 2008 and associated Regulations about how the service is run.
Robust procedures were not in place to ensure people were not harmed as a result of missed medicines due to problems in the supply of people’s medicines. We identified some errors in the recording of people’s medicines. Whilst monitoring procedures were in place we were concerned that medicines incidents and errors were not always being identified and acted on to protect people and ensure the safe management of their medicines. Following our inspection the registered manager took action to prevent the risk of a reoccurrence. More time was required for these improvements to be fully embedded into practice.
People told us they were safely cared for at Milkwood House. However, peoples care plans and risk assessments were not always evaluated and updated following a fall to ensure their care plan was appropriate and up to date information and guidance was available to staff to mitigate the risk of further falls. This could leave people at risk from inappropriate care following a fall. A system was not in place to enable the registered manager to effectively monitor risks to people from falls and ensure changes and improvements were made to reduce the risks to people from falls. The registered manager took action following our inspection and implemented a tool to monitor falls and identify where changes and improvements could be made to reduce the risks to people from falls. More time was required for this improvement to be fully embedded into practice.
Staff were aware of their responsibilities to safeguard people and protect them from abuse and the registered manager acted on concerns.
People and their relatives told us there were sufficient staff available to meet people’s needs safely. The provider carried out an assessment to identify the levels of staffing required to meet people’s needs and the registered manager confirmed additional staff were available when required. The provider had not maintained an improvement they had made following our last inspection to ensure their application form in use required new staff to submit a full employment history to enable the provider to check they were suitable to work with people. During our inspection the provider addressed this shortfall and changed their application form to require new staff to give a full employment history. More time was required for this improvement to be fully embedded into practice.
People were supported by staff who received regular supervision and appraisal in their role. Staff had access to a range of training to ensure they remained competent to meet the needs of the people they supported. Some staff training required updating such as; manual handling, dementia and the Mental Capacity Act (2005) and we were assured this would be addressed following our inspection.
The registered manager had made applications to the relevant authority to legally deprive people of their liberty as required. However, not all applications were made following a recorded best interest process in line with the Mental Capacity Act (2005). The registered manager has taken action following our inspection to ensure decisions would be made and recorded following the best interest checklist to ensure people’s rights were upheld. More time was required for this improvement to be fully embedded into practice.
People spoke positively about the quality and variety of the food in the home. People’s nutritional needs were assessed and met. People at risk of poor hydration were monitored for their fluid intake. However, this was not always totalled or targeted to enable staff to effectively monitor whether the person was receiving sufficient fluids to prevent the risk of dehydration. This could place people at risk of poor hydration.
People were supported to access a range of healthcare services as required. Staff acted promptly to ensure people’s healthcare needs were met.
People told us they were treated with dignity and respect by staff. The registered manager monitored people’s experience of the way their care was delivered. People’s preferences in the way they were supported were known by staff and people told us they were supported to meet their needs.
People’s wishes for their end of life care were discussed with them and recorded. This included people’s decisions to refuse treatment, which were made known to staff to ensure they were respected.
People or those that knew them well were involved in developing their care plans. Care plans were personalised and detailed people’s needs and choices. However, care plans were not always updated to reflect people’s current needs, which could place people at risk of inappropriate care.
People had access to activities that were group based or one to one support if preferred or needed. People told us they enjoyed the activities on offer at the home and were supported to meet their social and spiritual needs and interests.
The provider’s complaints process was displayed in the home. People and their relatives told us they were confident the registered manager would listen and respond to complaints. The registered manager used information from complaints to make improvements.
A quality assurance system was in place however, the system was not sufficiently robust to ensure that improvements were always identified, acted on and sustained to drive continuous improvement.
People and their relatives spoke positively about the registered manager and the improvements they had made to the service over the past year. People and their relatives were asked for their feedback on the service and this was acted on.
We found two 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 the report.
We carried out an unannounced comprehensive inspection of this service on 9 March 2015. Breaches of legal requirements were found. We issued warning notices for breaches in relation to medicines, care and welfare, safeguarding people from abuse, and assessing and monitoring the quality of service provision. We issued compliance actions for the remaining breaches. These related to: requirements relating to workers, supporting workers and records. The provider was required to meet the requirements of the warning notices by 4 May 2015. Following the comprehensive inspection, the provider submitted a report of actions and informed us that they would meet the requirements of the compliance actions by 10 May 2015.
We undertook this focused inspection to check that the provider had met the requirements of the warning notices and followed their action plan to address all regulatory breaches, and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Milkwood House Care Home’ on our website at www.cqc.org.uk.
Milkwood House Care Home is a 43 bed residential care home registered to provide care for older people who may experience dementia. At the time of the inspection there were 29 people using the service.
Since the previous inspection the registered manager had left the service and a new manager had been appointed. They told us they would be submitting their application to become the registered manager for the service shortly. 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.
Medicines were safely administered and recorded as prescribed. However, although the provider had taken action to ensure medicines were stored at the correct temperature they had not fully resolved this issue to ensure people’s medicines were effective. There was variation in the level of detail contained within care plans to support people whose behaviour may challenge, and for people with breathing or heart conditions, who may require emergency medicines. This meant staff may not have access to sufficient guidance to support people safely.
People were safe from the risk of abuse. Staff had undertaken safeguarding training and understood their roles and responsibilities to protect people. Staff documented all incidents to ensure there was a record of any injury people had sustained. The manager had referred people to the local authority safeguarding team where relevant to safeguard them. People whose behaviours may present a risk to themselves or others had been referred to relevant professionals such as the Community Mental Health Team to ensure they received the support they required.
If people experienced a fall, staff followed the provider’s falls protocol to ensure they received the support they needed to promote their safety. Risks to people had been assessed and managed appropriately.
Staff had been required to provide a full record of their employment history to ensure their suitability to work with people.
Staff were required to undertake the care industry standard induction training. They had completed a range of training to support them in their role and there was a rolling programme of training for staff across the course of the year. Staff received regular supervision. People were cared for by staff who were supported effectively in their role.
People were weighed regularly. If they were identified as at risk from weight loss, staff took action and referred them to the GP for review. Risks to people associated with malnutrition were identified and managed effectively.
The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The manager had submitted DoLS applications to the local authority for people who lacked the capacity to consent to their care and treatment. People were protected from the risks of any controls on their liberty being unlawful.
The audit and reporting systems were being operated effectively in order to identify issues that could impact upon the quality of people’s care or their safety. Consideration had been given to people’s feedback about the service. People were protected as their records were complete and contained appropriate information. Records were easy to locate and stored safely.
The provider had taken sufficient action to meet the requirements of the warning notices and compliance actions. In relation to care and welfare, safety, assessing and monitoring the quality of service provision, requirements relating to workers, staff support and records. The provider needed to make further improvements to medicines in order to fully meet the requirements of this regulation.
You can see what action we told the provider to take at the back of the full version of this report.
The inspection took place on 9 March 2015 and was unannounced. Milkwood House Care Home is registered to provide residential care for up to 43 older people who may experience dementia. At the time of the inspection there were 33 people using the service.
The service has a registered manager. 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.
Most people told us they felt safe. However, people were not adequately safeguarded from the risk of abuse. Incidents had not been identified as potential safeguarding alerts and reported to the relevant authority, which left people at risk. Staff did not fully understand their safeguarding responsibilities to enable them to protect people.
Risks to people were not always assessed or there were not always plans in place to manage them. People had not always been monitored after experiencing a fall. People had not always been weighed or their risk of malnutrition screened. Adequate action was not taken by staff when they lost weight. People were at risk from complications following falls and from malnutrition.
People’s medicines had not been stored or disposed of safely. Stocks of medicines did not always match records. People’s medicines had not been managed safely. People were at risk of receiving inappropriate medicines.
The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Some people had DoLs in place, but applications had not been submitted by the provider for all relevant people. One person’s care had been provided by three staff on occasions due to their behaviours which challenged staff, with no legal safeguards in place. People had not always been protected from the risks of unlawful control.
Staff underwent recruitment checks but had not provided a full employment history. Staff had only been required to provide their last 10 years history and there was no explanation of their employment history prior to this date. This did not fully protect people from the employment of unsuitable staff. Staff had not all completed an effective induction to their role or all required training to meet the needs of people. Staff had not received sufficient supervision. People were cared for by staff who had not been supported effectively.
The registered manager had not operated the audit and reporting processes effectively in order to identify issues in relation to people’s safety and the quality of their care. They had not given due regard to people’s feedback. People’s records did not contain all of the required information for staff to provide their care safely. These records could not always be readily located.
Not all staff had consistently demonstrated the provider’s values. The culture of the service was not reflective or analytical of incidents and practices. This resulted in ineffective processes and procedures not being identified or challenged. People’s care was negatively impacted upon. Staff had not been well-led by the registered manager. The provider took prompt action following the inspection in response to the issues identified.
Staff had not consistently followed best practice in relation to the Mental Capacity Act (MCA) 2005 Staff were due to receive further training imminently. People were at risk of not having their rights upheld as not all staff understood the requirements of the MCA 2005.
Staff had not always ensured referrals to other services such as mental health teams were made promptly in response to people’s needs.
Records documented people had been involved in their care planning. However, people and their relatives told us they had not felt involved. People’s records contained information about their preferences about their care. However, this information had not been consistently reflected in their care plans, to ensure their care provision reflected their preferences. People’s care plans had not been regularly reviewed with them or their relatives, to enable them to make changes when required.
People who experienced dementia did not consistently receive information in a manner that met their needs; this did not always enable them to make choices. Staff understood how to uphold people’s privacy and dignity. However, one person’s privacy and dignity had not been upheld.
People were cared for by staff who they told us were caring towards them. One person told us “The girls are lovely; they come in and chat; take me to the lounge; give me drinks.” People were seen to be spoken to by staff in a kindly and caring manner.
People had access to a complaints policy and felt able to complain. Even though they had been informed of how to complain they did not always recall whom to complain to or how. People would have benefited if this information was more accessible.
The service was clean. Although not all staff had completed infection control training they followed the provider’s guidance. People were protected from the risks of cross-infection.
We found a number 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. You can see what action we told the provider to take at the back of the full version of the report.
The deputy manager told us that some people were able to eat independently in their rooms. We saw the staff allocation list which had recently been changed to ensure a member of staff had responsibility for checking if these people had eaten their meal or wanted an alternative. This meant that people were supported to be able to eat and drink sufficient amounts to meet their needs.
A home manager was in post at the time of our visit however they had not yet applied to be registered with the Care Quality Commission (CQC). One member of staff told us: 'We have had staff meetings that have kept us up to date' and 'There is more access to the new manager'. All the staff we spoke with commented positively about the working environment, we received comments such as: 'Everybody works so hard, it's so nice to come to work, everybody is working as a team.'
We spoke with the manager who demonstrated that they were aware of their responsibility to report certain incidents to the CQC and the local authority in a timely way.
Staff we spoke with were very knowledgeable about the people they provided care for and this was confirmed by our observations of care. However on the afternoon of our visit we saw two people in their rooms who had not received any support from staff to eat their meal and had not been visited to ensure they had safely eaten their meal independently.
Staff had received recent training in moving and handling to ensure they were aware of how to support people to move safely. They told us that they felt well trained to carry out their role.
During our visit we spoke with three relatives who said that they were pleased with the care their relative received. However one of the relatives told us: "We have not been kept up to date in the last six months about the turnaround of staff.' Another said: 'We have not been introduced to new staff.'
Care plan reviews were now carried out for each person at least every month. We looked at the care records for three people. Each person had an assessment of their needs. The records contained comprehensive, up-to-date information about people's health and social care needs and daily diary notes showed how the care and support was delivered.
At this visit we spoke with one of the people living at the home and their relative and observed interactions between staff and the people living at the home. The person we spoke with told us: 'They are very good; I don't think they could do any more.'
Staff demonstrated a good understanding of people's needs. One of the people we spoke with told us about the staff. 'They know what they are supposed to do.' However we had concerns about the planning and delivery of care for some people. We found that some care plans had identified risks for people but did not contain information about how those risks would be managed.
All the people we spoke with commented positively about the quality of the food. One person told us, 'The food is very good on the whole.'
Staff were aware of infection control procedures and were able to tell us about their cleaning routines. One person we spoke with told us that their room was always kept clean. 'It is nice and clean the bed linen is changed regularly.'
Staff told us that their supervisions highlighted any training needs they may have. "We have lots of training here."
A relative we spoke with said that they did not know of the complaints procedure. They went on to say that if they had any concerns or complaints they would feel comfortable raising them with the registered manager in the first instance.
One relative we spoke to told us that the staff were 'very organised but happy for visitors to come at any time.'