Milford House is a ‘care home.’ People in care homes receive accommodation and nursing or 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. Nursing and personal care is provided for up to 65 adults in two adapted buildings, known as The Coach House and Milford House.

At our last inspection in August 2017, we rated the service as Requires Improvement because people were not always provided with safe or effective care. This was because they were not always protected from the risk of avoidable harm and people’s care records were not always accurately maintained to account for people’s care. We did not ask the provider for an improvement plan as there were no regulatory breaches. At this inspection we found the provider had made improvements to the standard of Good. There were 52 people accommodated, who were predominantly older adults, including some people living with dementia or a physical disability.

There was a registered manager at the time of our inspection. 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 of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Improvements were made to ensure people received safe care and effective care. People were protected from the risk of harm or abuse by staff who understood and followed relevant guidance to ensure this.

Known potential risks to people’s safety associated with their health conditions, care equipment and environment, were assessed before people received care, monitored and regularly reviewed. People’s medicines were safely managed.

Staff understood and consistently followed the provider’s operational care policies for risk management, care and medicines’ systems; which helped to ensure people’s care was consistently safe and effective.

People received holistically assessed, interagency agreed care. A range of health improvement initiatives were in progress utilising evidence based techniques. This, together with partnership working and the provider's introduction of relevant care technology systems, helped to ensure people received timely, informed and effective care.

Staff were effectively trained, supported and deployed. People were supported to have maximum choice and control of their lives and to help recruit new staff. Staff were skilled, knowledgeable and experienced and they supported people in the in the least restrictive way possible.

There was a strong emphasis on the importance of eating and drinking well for people at the service. Creative methods were used to help promote and ensure this. People were supported to maintain and improve their health and nutrition in consultation with external health professionals when needed.

Environmental upgrading and refurbishment was completed in consultation with people who used the service. This was done in a way that took account of their related needs, choices and independence.

People received care from kind, caring and compassionate staff, who ensured people’s dignity and rights in their care. Staff consulted with people and their representatives and followed what was important to people for their individual care, preferred daily living routines and lifestyle preferences.

People receive individualised care, that was usually timely, agreed and regularly reviewed with them, or their representatives when required. Staff understood and followed their roles and responsibilities for people’s care and knew how to communicate with people in the way they understood.

The provider had developed accessible information systems and ways to communicate with people, relatives and staff at the service; which helped accurately inform people’s care provision.

People were

Milford House provides accommodation for up to 65 older people, some who are living with dementia, who require personal or nursing care. There were 51 people using the service at the time of our inspection.

This inspection took place on 16 and 17 November 2016. The first day was unannounced.

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’s records were not completed consistently so the care being provided was not always as indicated in the records. This meant there was the potential for unsafe care. The records had not always been updated to reflect changes in people’s care needs.

Systems to ensure the service ran safely were not always following relevant guidance. Some maintenance checks were not being undertaken as scheduled and others had not been renewed as indicated on the records.

Medicines were managed safely. People were safeguarded from abuse because the provider had relevant guidance in place and staff were knowledgeable about the reporting procedure.

There were sufficient staff to meet people's needs and recruitment practices were satisfactory.

Consent to care and support had been sought and staff acted in accordance with people’s wishes. Legal requirements under the Mental Capacity Act and Deprivation if Liberty Safeguards had been followed consistently where people were potentially being restricted. People told us they enjoyed their food and we saw meals were nutritious. People’s health needs were met. Referrals to external health professionals were made in a timely manner.

People and their relatives told us the care staff were caring and kind and that their privacy and dignity was maintained when personal care was provided. Relatives were involved in the planning of their care and support. There was a range of activities and events available to enable people to take part in hobbies and interests of their choice. There was a clear procedure for the management of complaints.

The leadership of the service was praised by external professionals and relatives and communication systems were effective. The provider had obtained feedback about the quality of the service from people, their relatives and staff.