Milbanke Home for Older People

Milbanke Home for Older People is a care home for up to 45 older people who require nursing or personal care. It is situated in a residential area of Kirkham. The home supports people living with dementia and mental health needs. There are accessible gardens for people to use and car parking is available at the home. At the time of our inspection visit there were 33 people who lived at the home.

People’s experience of using this service and what we found

We found medicines were not always administered safely. Risks to people were not always well assessed and managed to ensure correct information was available for staff to deliver support for people. We found shortfalls in their procedures for the recruitment of staff. Staffing levels were not always sufficient during the 24-hour period. At night people could be at risk due to the number of staff on duty. One person said, “Sometimes at night I have to wait a while if I need some attention.”

People were supported to have maximum choice and control of their lives and staff supported

them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. However, for best interest decisions and Deprivation of Liberty Safeguards, we found were not routinely completed to ensure those with authority consented to care and treatment.

There was a programme of staff training and regular updates were documented for staff to attend courses. However not all staff had received regular updates and refresher training. The management team were aware of this and were in the process of updating there training schedule.

Auditing systems for managing risk were sometimes ineffective as they had failed to identify concerns we found.

Designated staff kept the building clean and tidy and maintenance checks were in place and up to date. Staff were seen to wear appropriate personal protective equipment (PPE) as latest guidance stated. Safeguarding training was provided, and records showed staff had been trained and regular updates provided. Staff were aware of the processes to follow to enable people to be safe. A staff member said, “We have access to safeguarding training and the new manager is keen to have all staff trained and skilled.”

Mealtimes were relaxed and organised and comments from people were complimentary about the quality and quantity of meals and snacks provided. One person said, “We have a great cook who makes some great cakes. “A relative said, “I know there is always plenty of choice and drinks available anytime.”

The provider was clear about their responsibilities to notify CQC of incidents about significant events that occurred at Milbanke. People and relatives told us they had confidence in the new manager and management team who were open and transparent. They sought people's views in various ways. The manager was receptive to our inspection and was aware of concerns and shared with us documented action plans they had ongoing to make improvements prior to our visit. Staff spoke positively of the new management team and shared with us how things had improved and continued to improve throughout the service.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was Good (published 14 October 2019.)

Why we inspected

We received concerns in relation to the management of medicines, staffing levels, quality assurance systems and people’s care needs. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

You can see what action we have asked the provider to take at the end of this full report.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

Enforcement and Recommendations

We have identified breaches in relation to medicines management and risk management. Some risk assessments lacked detail about the actions to take and control measures to lessen risks. Instructions for medicines that were given as and when required were not always available and when they were present, they did not always contain any person- centred information. We also made 6 recommendations around recruitment, staffing levels, risk management, staff training, and quality assurance systems.

Please see the action we have told the provider to take at the end of this report.

Follow Up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Milbanke Home for Older People is a care home for up to 45 older people who require nursing or personal care. It is situated in a residential area of Kirkham. The home is split into four units supporting older people with personal care and people living with dementia and mental health needs. There are accessible gardens for people to use and car parking is available at the home. At the time of our inspection visit there were 36 people who lived at the home.

People’s experience of using this service and what we found

People were protected from the risk of abuse and avoidable harm by staff who understood how to recognise and respond to concerns. People told us staff were available when they needed them and they felt safe in their care. The environment was clean and maintained. People were safely supported to receive their medicines as prescribed.

People's needs were assessed, and care and support had been planned proactively and in partnership with them. People were provided with a nutritious and varied diet. Staff had received regular training and supervision to support them to meet people's needs. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People told us staff were kind, caring, attentive and treated them with respect. They said staff respected their privacy and dignity and supported them to be as independent as possible. The registered manager provided people with information about local advocacy services, to ensure they could access support to express their views if they needed to.

People received person-centred care which was responsive to their needs. People’s communication needs had been assessed and where support was required these had been met. The registered manager managed people’s concerns and complaints appropriately and people told us they felt listened to.

The registered manager worked in partnership with a variety of agencies to ensure people received all the support they needed. People were happy with how the service was managed. Staff felt well supported by the registered manager. The registered manager and provider completed regular audits and checks, which ensured appropriate levels of quality and safety were maintained at the home.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 26 April 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner

Milbanke Home for Older People is a residential home operated by Lancashire County Council. The home is located close to the centre of Kirkham. Accommodation is provided for up to 45 elderly people who require personal care, dementia care or are living with mental health needs. The home is split into four courts. There is a passenger lift to gain access to both floors. There are accessible gardens for people to use and car parking is available at the home.

There was a manager in place who was registered with the Care Quality Commission. 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.

We last inspected Milbanke Home for Older People March 2015. We identified no breaches in the regulations we looked at.

During this inspection carried out in March 2017 we found the registered provider was working in line with the principles of the Mental Capacity Act 2005. Appropriate applications to deprive people of their liberty were made to the local authorities as required. We observed care and support being provided in a safe way. Documentation recorded the care and support people required to maintain their safety.

Staff were able to explain the actions to take if they were concerned someone was at risk of harm or abuse. People who lived at the home told us they felt safe. One person told us, “Oh I’m safe. Everyone looks after me so well.” During the inspection visit we identified an occurrence which required reporting the Lancashire Safeguarding Authorities. We have made a recommendation regarding this.

Documentation we viewed evidenced people were involved in the planning of their care and people we spoke with confirmed this. People told us they were supported to see health professionals if the need arose and we found this was recorded in care documentation.

We looked at the auditing systems to identify shortfalls at the home and drive improvement. We found that when accidents or incidents occurred, the registered manager reviewed these. Staff spoken with were able to explain the steps taken to minimise the risk of reoccurrence. There were audit systems to identify if improvements were required at Milbanke Home for Older People.

We found medicines were managed safely. We observed medicines being administered and saw this was carried out safely. Staff told us they received training to enable them to administer medicines correctly and we saw documentation which evidenced this.

We reviewed staff files and found there were processes that ensured staff were suitably recruited. Staff we spoke with confirmed checks had been carried out prior to starting work at the home.

Staff told us they met with their line manager on an individual basis to discuss their performance. Staff with were complimentary of the training provided and told us further training was being arranged to ensure their skills remained up to date. Staff spoke positively of the registered manager. We found staff meetings took place to enable information to be shared and guidance sought if this was required.

We discussed staffing with people who lived at the home. People told us they considered there were enough staff to support them. Relatives and staff we spoke with raised no concerns regarding the staffing provision at the home.

People who lived at Milbanke Home for Older People told us they considered staff were caring. One person told us, “Everyone here is nice, so nice.” We observed people being supported with kindness and compassion.

During the inspection we saw activities were available for people to participate in if they wished to do so. We observed people joining in crafts, dominoes and a musical activity. The activities were seen to be enjoyed by people who lived at the home.

There was a complaints policy available at the home. People told us they would talk to staff if they had any concerns.

People told us they enjoyed the food at the home. We observed breakfast and the lunchtime meal and saw this was a positive experience for people who lived at Milbanke Home for Older People. Staff gently encouraged people to eat and we saw people enjoyed their meal.

People who lived at the home told us they could speak with the registered manager if they wished to do so. Staff we spoke with also gave positive feedback. They told us they found the registered manager to be approachable and supportive. Relatives we spoke with also told us they found the registered manager to be approachable.

We saw evidence that meetings were held to gain peoples’ views and a survey was provided to people who lived at the home.

People using the service told us; 'I am settled here. The staff are very good.' And 'Staff will get a doctor if I am ill.'

We received much positive feedback from relatives. We were told; 'We can see a marked difference in her. She now seems to have a purpose.' And from another relative, 'We are very pleased with Milbanke.'

We ate lunch with some people living at the home. We saw that staff supported people to choose their meal and provided assistance to those who needed support to eat. The majority of people we spoke with were happy with the meals provided at the home.

The home was well maintained. We saw that people were able to personalise their bedroom, with their own furniture, pictures and ornaments. The people we spoke with were happy with the accommodation.

Staff were recruited effectively and received appropriate training and support. This helped to ensure care was delivered safely and to an appropriate standard. People living at the home told us; 'The staff are all helpful. We have a laugh and a joke together.' And 'They are all lovely.'

Relatives told us; 'The management of the home is very good.' And 'I've never had any cause for concern.'

There were effective systems in place to gain feedback about and monitor the quality of the service.

People who used the service told us, "I am happy here. I like to read to keep me occupied", "I am happy here and satisfied with the care that I get" and "I am very happy here. I cannot thank the staff enough". People said they were well looked after and happy with their care.

Staff training and robust policies and procedures for the protection of vulnerable adults helped keep people safe.

People told us that food was good to help meet their nutritional needs.

Plans of care had been developed with people who used the service to ensure their wishes were taken into account.

Staff told us they were well trained and supported to help them care for the people who lived at Milbanke.