About the service: New Milton House is a residential care home that is registered to provide personal care for up to 39 people. Accommodation is provided over two floors. There are numerous lounges and dining rooms for people to use within the building. People also have access to secure outdoor space. At the time of our inspection there were 39 people living in the home.

People’s experience of using this service:

There were three breaches at our last inspection and the registered manager was asked to submit an action plan on how they would address these shortfalls. We received this and we saw improvements at this inspection. However, there were still areas for continued improvement and we found two breaches at this inspection in relation to staffing and dignity and respect.

People and their relatives were positive about the home, its staff and the manager. They raised issues about staffing numbers, activities and the environment. People told us that staff were kind and friendly and knew them well.

People and their relatives felt that they received safe care. They received their medication at times they needed this and by staff who were trained to administer this safely. There was scope for improvement in the management of topical creams.

There were insufficient experienced, knowledgeable staff to meet the needs of the people living in the service. We noted times when people had to wait for assistance and staff lacked awareness of how to support people who were living with dementia.

Recruitment was managed safely. The necessary checks were completed prior to staff starting work, however there were no checks on staff’s health and whether they needed any reasonable adjustments to complete their job.

Staff received inductions when they started work and received ongoing training and support and supervision to maintain and develop their skills and knowledge. However, this was not always effective as staff told us this was all on line and staff did not receive training on how to support people living with dementia even though there were two specific dementia units.

We noted that people were not always treated with dignity and their privacy was not respected as staff were often discussing people’s personal issues in communal areas.

The home was clean, however there was scope for improvement as the home would benefit from adaptions for people living with dementia. Regular checks were completed on equipment to ensure safety and staff had access to personal protective equipment to reduce risks of infection control.

People had access to activities, however these were not varied and were limited for people living with dementia.

We received positive comments about the registered manager. However we saw the systems in place to make improvements to the service had not identified all the issues we found in this inspection. Improvements which had been identified had been actioned.

The registered provider was acting within the principles of the Mental Capacity Act 2005. Where necessary, people’s capacity was assessed, and decisions were taken and recorded in people’s best interests looking at the least restrictive options.

People’s health needs were effectively assessed and monitored. Where people needed access to other health professionals, referrals were completed, and advice recorded.

People knew how to complain and were confident that that their concerns would be listened to and acted upon.

More information is in the full report below.

Rating at last inspection: Requires improvement (Report published 13 June 2018).

Why we inspected: This inspection was brought forward due to concerns that had been raised with us.

Enforcement: This is the second time the service has been rated requires improvement. We have asked the provider to send an action plan of how they will address the breaches in regulation and improve the service to at least good. Full details are at the back of this report.

Follow up: We will continue t

We carried out an unannounced inspection of New Milton House Residential Care Home on 23 March 2018.

New Milton House Residential Care Home 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. New Milton House Residential Care Home is registered to provide care to 39 people. At the time of this inspection the home was providing care to 35 people. The building was split in to two units, one was specifically for people with dementia and the other was a residential unit.

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 manager was going through the process of registration with the Care Quality Commission.

People we spoke with told us they felt safe at the home and people’s relatives also told us they felt people were safe. During our visit, however we identified concerns with the service.

During our inspection, we identified three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulated Activities 2014 in respect of Regulation 9 person centred care; 11 need for consent and 12 safe care and treatment; of the Health and Social Care Act 2014 Regulations.

You can see what action we told the provider to take at the back of the full version of the report.

People received support with their health care. However care plans had not been updated accurately and contained guidance that if followed would pose a risk to people's health and safety. Care plans did not always reflect people’s up to date needs and were in some cases contradictory.

Medication management including storage, documentation, administration, and protocols for medications prescribed to be taken ‘as and when’ was not safe or sufficient.

We found that the Mental Capacity Act 2005 and the Deprivation of Liberty (DoLS) 2009 legislation had not always been followed and any conditions on authorisations to deprive a person of their liberty were not being met.

Audits were regularly carried out by the provider and the manager, however it was not always clear on the action plans whose responsibility it was to carry out any actions identified.

Staff were recruited safely, however evidence that staff received a proper induction was not in place. We saw that staff had received suitable training that the provider identified as mandatory to do their job role effectively. All staff had been supervised in their role and staffing levels were consistent and were adapted to meet people’s needs.

The staff at the home knew the people they were supporting and the care they needed. We observed staff to be kind and respectful towards people. The home provided a range of activities to occupy and interest people.

People and relatives we spoke with said they would know how to make a complaint, none of the people or their relatives we spoke with had any complaints. Care plans showed that people's GPs and other healthcare professionals were contacted for advice about people’s health needs whenever necessary.