Milford 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. Milford House accommodates up to 80 people in one adapted building. At the time of our inspection 57 people were living at the home.

The home was last inspected in July 2016 and we identified three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The service was not meeting the requirements of the regulations relating to staffing, medicines management and support for people to eat and drink. At this inspection we found the registered manager had taken action necessary following the last inspection and was meeting the requirements of the regulations.

This inspection took place on 7 November 2017 and was unannounced. We returned on 9 and 13 November 2017 to complete the inspection.

There was a registered manager in post 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 and associated Regulations about how the service is run.

People who use the service and their relatives were positive about the care they received and praised the quality of the staff and management. Comments from people included, “I’m quite happy. They are all kind”; “I am well treated by staff. They treat us with compassion and kindness” and “The staff are very good to me. They’re lovely”. A relative told us, “I am very happy with the care provided. We have a good laugh with the staff.” We observed staff interacting with people in a friendly and respectful way. Staff respected people’s choices and privacy and responded to requests for assistance.

People told us they felt safe when receiving care and were involved in developing and reviewing their care plans. Systems were in place to protect people from abuse and harm and staff knew how to use them. Medicines were stored safely in the home and staff had received suitable training in medicines management and administration. People received the support they needed to take their medicines.

There were sufficient staff available to provide safe care. People told us staffing levels had improved since the last inspection and most people said staff responded promptly when they called them. Nurses and care staff said they were able to provide safe care for people. A relative told us “Sometimes they are busy but there has been a definite improvement since about a year ago. Being short staffed is occasional now rather than regular like it was before. There has not been a time when [my relative] has not received the care they should”.

Staff understood the needs of the people they were providing care for and had the knowledge and skills to meet their needs. Health and social care professionals who had contact with the service were positive about the care people received and skills of staff. Comments included, “I have been very impressed with the standard of care, clinical competence and engagement of the staff. They exercise very effective and safe clinical judgement” and “Staff have had a couple of very complex wounds to deal with during the past year and have managed things very well. One resident had a fantastic outcome with healing of a chronic wound by the dedication and determination of the staff at the home.”

Staff received a thorough induction when they started working at the home. They demonstrated a good understanding of their role and responsibilities. Staff had completed training to ensure the care and support provided to people was safe and effective to meet their needs.

The service was responsive to people’s needs and wishes. People had regular meetings to provide feedbac

Milford House is registered to provide accommodation, nursing or personal care for up to 80 people. On the day of the inspection there were 67 people living at the service. The registered manager informed us they consider the home to be full with 72 people and five rooms were currently closed to admissions due to building works and refurbishments.

The service provides care for people with dementia, learning disabilities, autistic spectrum disorder and older people.

Milford House consists of two floors with access to the upper floor by a lift or stairs. There are some shared bathrooms, other shower facilities and toilets. Communal areas include lounges on both floors, other smaller seating areas, two dining rooms and gardens to the outside.

A registered manager was employed by 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.

The inspection took place on 19th and 20th July 2016 and was unannounced.

Most people and their relatives told us they felt safe when receiving care. Staff were able to tell us about people’s needs and how to care for them however, it was difficult to locate staff when people sought and required assistance. Safe recruitment practices were followed before new staff members started working at the home. People and their relatives were positive about the care they received and said staff had sufficient knowledge to provide support and keep them safe.

Administration and medicines management systems required improvement in order to fully protect people. For example, some medicines were not stored in line with storage requirements and medicines were left unattended during medicines rounds which meant they were not being managed in line with current regulations.

People’s risk assessments had been made and recorded in people’s care records however; guidance provided in people’s care plans in line with the risk was not always available.

Arrangements were in place for keeping the home clean and help reduce the risk and spread of infection. People’s rooms and sanitary ware in bath and shower rooms was kept clean however, some areas of the home had not been cleaned and required attention.

Staff received regular training in relation to their role and the people they supported. Staff received regular supervisions and an appraisal where they could discuss personal development plans. This meant staff received the appropriate support to enable them to provide care to people who used the service.

People were not always supported to have enough to eat and drink. Food and fluid charts were not always used where required or completed in order to determine whether people had received sufficient diet and fluids. Support was not always given where people required support with their meals or to drink. The weather was very hot during the two days of our inspection and not all people were offered additional fluids in response to this to help keep them hydrated.

People and their relatives told us they had access to health services and there was a GP performed weekly visits to the home with additional visits according to any changing healthcare requirements.

Most people were treated in a kind and caring way and staff were friendly, polite and respectful when providing care and support to people however, this was not consistent throughout the inspection.

The provider was meeting the requirements of the Mental Capacity Act 2005 (MCA) and the associated Deprivation of Liberty Safeguards (DoLS). The registered manager and staff had a good understanding of supporting people to make decisions and choices.

Staff understood the needs of the people they were providing care for. Care plans were individualised and contained info

People we spoke to were happy with the care and support they received. Records showed that people's needs and wishes had been identified and detailed care plans had been put in place. We found that people's choices had been respected. People could choose what to do with their day, and had been able to personalise their rooms. One person's care plan stated that they 'woke naturally therefore their getting up time varies from day to day.'

One relative told us that the "staff were professional" and stated that they had "never gone home worried about the quality of care being provided." They also told us that their relative had appreciated the staff's friendliness.

Records showed that staff had received safeguarding training. The staff we spoke to confirmed that they knew what action to take if a concern was raised. People we spoke to told us that they would be able to talk to the manager, or a member of staff, if they had any worries.

We found that the home had a positive approach to staff training. Records showed that staff had received the training and support required to enable them to provide people with the care and support they needed. Staff we spoke to were happy with the training they had received and they told us that they were able to request additional training.

The home had a quality assurance programme in place. We saw that areas which required further attention had been identified. Measures had been put in place to address them.

When we inspected there were 70 people living in the home. We spoke with 16 people who use the service, six visitors and 11 staff. We also made our own observations during the visit.

People who use the service told us they were satisfied with the service they received. People felt the staff supported them and met their needs. One person using the service said "I am being looked after properly."

People told us that staff treated them with dignity and respect. One person said “staff are so respectful.” We saw staff speaking and responding to people in a kind and respectful manner.

The care records showed us that people's health needs had been assessed before they came to live in the home. These records included information from health and social care professionals which helped ensure people got the care and treatment they needed.

Recruitment records showed that new staff had been checked to ensure they were suitable to work with vulnerable people. The home trained their staff and had procedures which protected people from abuse. People told us they did not have any complaints but would speak to the manager or staff if they had any concerns. One person said “I would tell the manager because she runs an open door policy.”

The service provided nutritious food which people had selected and the care staff ensured people were given suitable diets and remained hydrated.

The evidence we collected showed us the service kept people safe and met their care needs.