Background to this inspection
Updated
7 January 2017
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.
This inspection took place on 15 and 16 November 2016 and was unannounced. The inspection team consisted of one inspector and one inspection manager..
Prior to this inspection we reviewed all the information we held about the service, including data about safeguarding and statutory notifications. Statutory notifications are information about important events which the provider is required to send us by law. Before the inspection, the provider completed a Provider Information Return (PIR). This 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.
As some people who live at Milward House were not consistently able to tell us about their experiences, we observed the care and support being provided and talked with relatives and other people involved with people's care provision during and following the inspection. As part of the inspection we spoke with the registered manager, the deputy manager, four support staff, the chef, one speech and language therapist, nine people, three people's relatives and two people who hold power of attorney for people who live at Milward House. We looked at a range of records about people's care and how the service was managed. We looked at five people's care plans, medication administration records, risk assessments, accident and incident records, complaints records, health and safety checks, fire safety documentation, menus, kitchen cleaning rotas, activities programme and quality audits that had been completed.
Updated
7 January 2017
We inspected Milward House on 15 and 16 November 2016. The inspection was unannounced. 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. At the time of our visit there were 19 people living in the home. The home is located in Tunbridge Wells and is arranged over three floors.
At the time of our inspection there was a registered manager at the home. 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.
At our last inspection on 16 and 23 February 2015, we found five breaches of the Health and social Care Act 2008 (Regulated Activities). These breaches were in relation to unsafe care due to poor moving and handling procedures, staff not following cleaning procedures to reduce the risk of infection, people not being secure in the premises and staff not being trained in safeguarding, staff members not receiving sufficient training, the registered provider had not offered meaningful activities for people living with dementia and that care plans were not individualised. The provider sent us an action plan stating that they had addressed the concerns raised.
At this inspection, we found that the provider had taken action on all these areas and was fully meeting the regulations where breaches were found.
The registered provider had systems in place to protect people against abuse and harm. The registered provider had effective policies and procedures that gave staff guidance on how to report abuse. The registered manager had robust systems in place to record and investigate any concerns.
Risks to people's safety had been assessed and actions taken to protect people from the risk of harm. The environment was clean and appropriate measures had been taken to reduce the risk of infection. Medicines were managed safely and people had access to their medicines when they needed them.
Staff were well trained with the right skills and knowledge to provide people with the care and assistance they needed. Staff met together regularly and felt supported by the manager. Staff were able to meet their line manager on a one to one basis regularly. There were sufficient staff to provide care to people throughout the day and night. When staff were recruited they were subject to checks to ensure they were safe to work in the care sector.
Where people did not have the capacity to understand or consent to a decision the provider had followed the requirements of the Mental Capacity Act (2005). An appropriate assessment of people's ability to make decisions for themselves had been completed. Where people's liberty may be restricted to keep them safe, the provider had followed the requirements of the Deprivation of Liberty Safeguards (DoLS) to ensure the person's rights were protected.
People had enough to eat and drink, and received support from staff where a need had been identified. People's special dietary needs were clearly documented and staff ensured these needs were met.
The environment was designed and adapted to meet the needs of people who are living with dementia, through sympathetic re-decoration and usage of the building.
The staff were kind and caring and treated people with dignity and respect. Good interactions between people and their support staff were seen throughout the day of our inspection. Staff knew the people they cared for well and treated them with kindness, compassion, dignity and respect.
People could have visitors from family and friends whenever they wanted. People spoke positively about the care and support they received from staff members.
People received a person centred service that enabled them to live active and meaningful lives in the way they wanted. People had freedom of choice at the service. People could decorate their rooms to their own tastes and choose if they wished to participate in any activity. Staff respected people's decisions.
People felt well cared for and were supported with a variety of activities. However, activities were not always structured meaning that people could potentially become under stimulated. We have made a recommendation about this in our report.
Support plans ensured people received the support they needed in the way they wanted. Peoples health needs were well managed by staff so that they received the treatment and medicines they needed to ensure they remained healthy. Staff responded effectively to people's needs and people were treated with respect.
Staff interacted with people very positively and people responded well to staff. The culture of the service was open and person focused. The registered manager provided clear leadership to the staff team and was an active presence in the home.
Audits to monitor the quality of service were effective and embedded. They identified actions to improve the service and these had been carried out.