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Inspection carried out on 14 December 2017

During a routine inspection

Milward House is a residential care home registered to provide accommodation and personal care for a maximum of 28 people. The home specialises in providing care to older people, with a strong Christian faith. Some people at Milward house were living with dementia. At the time of our inspection there were 26 people living in the service. Milward House is located in Tunbridge Wells and is arranged over three floors.

Milward House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

There was a registered manager at the service. 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.

People were kept safe from abuse and harm and staff knew how to report suspicions around abuse. Risks were minimised through the use of effective control measures. There were sufficient numbers of staff deployed to meet people’s needs and ensure their safety. People received their medicines when they needed them from staff who had been trained and had their competency checked. Staff understood the best practice procedures for reducing the risk of infection and audits were carried out to ensure the environment was clean and safe. The service used incidents, accidents and near misses to learn from mistakes and drive improvements.

People had effective assessments prior to a service being offered. This meant that care outcomes were planned and staff understood what support each person required. Staff were trained in key areas and had the skills and knowledge to carry out their roles. People were supported to receive enough to eat and drink; staff used food and fluid charts to record intake for people at risk of malnourishment or dehydration.

People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice. The principles of the Mental Capacity Act were being complied with and any restrictions were assessed to ensure they were lawful and the least restrictive option.

The service worked in collaboration with other professionals such as district nurses and people’s GP’s to ensure care was effectively delivered. People maintained good health and had access to health and social care professionals. Environments were risk assessed to ensure people were safe in their homes and staff could work without the risk of danger.

Staff treated people with kindness and compassion in their day to day care. Staff knew people’s needs well and people told us they valued and liked their care staff. People and their relatives were consulted around their care and support and their views were acted upon. People’s dignity and privacy was respected and upheld and staff encouraged people to be as independent as safely possible.

People received a person centred service that was supportive of their needs. People’s needs were fully assessed and care plans ensured that personal details were carried through to care delivery. There was a complaints policy and form and complaints were used to improve the service offered to people.

Staff were open to any complaints and understood that responding to people’s concerns was a part of good care. End of life care had been planned for people who wished to do so. The service had end of life care plans but these did not make it clear how people would be supported to prepare for the end of life phase.

There was an open and inclusive culture that was implemented by effective leadership from the registered manager. People and staff spoke of a