Milbanke Home for Older People

Updated 7 March 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was carried out by 2 inspectors and a pharmacist inspector.

Service and service type

Milbanke 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.

Registered Manager

This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided. At the time of the inspection there was not a registered manager in post. A new manager had been in post for one month and had applied to register with CQC. We are currently assessing this application.

Notice of inspection

This inspection was unannounced. Inspection activity started on 31 January 2023 and ended on 06 February 2023.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and commissioners who work with the service. We also looked at information we had received and held on our system about the home, this included notifications sent to us by the provider and information passed to us by members of the public. The provider completed the required Provider Information Return (PIR). This is information providers are required to send us annually with key information about the service, what it does well and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke with 7 people who lived at Milbanke, 2 relatives and the manager. In addition, we spoke with 8 members of staff including senior carers, domestic staff, catering staff and the area manager. We observed staff interaction with people, also, we reviewed a range of records. These included care records of 4 people, medication records, and 2 staff files in relation to recruitment. We also reviewed a variety of records relating to the management and maintenance of the service. We had a walk around the premises and looked at infection control measures.

After the inspection

We continued to seek clarification from the registered manager to validate evidence found. We looked at their quality assurance systems the provider had in place and staff training records.

Updated 7 March 2023

About the service

Milbanke Home for Older People is a care home for up to 45 older people who require nursing or personal care. It is situated in a residential area of Kirkham. The home supports people living with dementia and mental health needs. There are accessible gardens for people to use and car parking is available at the home. At the time of our inspection visit there were 33 people who lived at the home.

People’s experience of using this service and what we found

We found medicines were not always administered safely. Risks to people were not always well assessed and managed to ensure correct information was available for staff to deliver support for people. We found shortfalls in their procedures for the recruitment of staff. Staffing levels were not always sufficient during the 24-hour period. At night people could be at risk due to the number of staff on duty. One person said, “Sometimes at night I have to wait a while if I need some attention.”

People were supported to have maximum choice and control of their lives and staff supported

them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. However, for best interest decisions and Deprivation of Liberty Safeguards, we found were not routinely completed to ensure those with authority consented to care and treatment.

There was a programme of staff training and regular updates were documented for staff to attend courses. However not all staff had received regular updates and refresher training. The management team were aware of this and were in the process of updating there training schedule.

Auditing systems for managing risk were sometimes ineffective as they had failed to identify concerns we found.

Designated staff kept the building clean and tidy and maintenance checks were in place and up to date. Staff were seen to wear appropriate personal protective equipment (PPE) as latest guidance stated. Safeguarding training was provided, and records showed staff had been trained and regular updates provided. Staff were aware of the processes to follow to enable people to be safe. A staff member said, “We have access to safeguarding training and the new manager is keen to have all staff trained and skilled.”

Mealtimes were relaxed and organised and comments from people were complimentary about the quality and quantity of meals and snacks provided. One person said, “We have a great cook who makes some great cakes. “A relative said, “I know there is always plenty of choice and drinks available anytime.”

The provider was clear about their responsibilities to notify CQC of incidents about significant events that occurred at Milbanke. People and relatives told us they had confidence in the new manager and management team who were open and transparent. They sought people's views in various ways. The manager was receptive to our inspection and was aware of concerns and shared with us documented action plans they had ongoing to make improvements prior to our visit. Staff spoke positively of the new management team and shared with us how things had improved and continued to improve throughout the service.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was Good (published 14 October 2019.)

Why we inspected

We received concerns in relation to the management of medicines, staffing levels, quality assurance systems and people’s care needs. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

You can see what action we have asked the provider to take at the end of this full report.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

Enforcement and Recommendations

We have identified breaches in relation to medicines management and risk management. Some risk assessments lacked detail about the actions to take and control measures to lessen risks. Instructions for medicines that were given as and when required were not always available and when they were present, they did not always contain any person- centred information. We also made 6 recommendations around recruitment, staffing levels, risk management, staff training, and quality assurance systems.

Please see the action we have told the provider to take at the end of this report.

Follow Up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.