This inspection took place on the 30 June and 1 July 2016 and was unannounced. During our previous inspection on 8 June 2015 we found one continuing regulatory breach in relation to the unsafe management of people’s medicines. Following the inspection, the provider wrote to us to say what they would do to meet these legal requirements by 21 August 2015. 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 most of the required improvements, however, at this inspection we identified that further improvements were required to ensure the management of medicines was safe and met the requirements of the regulation. 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.