Milford Manor provides care and support for up to 30 older people with complex mental health needs and some living with varying degrees and types of dementia. At time of our inspection, 27 people were resident at Milford Manor.

The service had two registered managers 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.

We found mental capacity assessments were in place to assess if a person had the mental capacity to make key decisions affecting their daily living needs and chosen lifestyle. However, for more significant decisions, such as having door gates in front of people’s rooms, mental capacity assessments were not in place. We saw evidence that least restrictive options had been discussed.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Staff had received training to provide them with the skills and knowledge to support people. A health and social care professional said “The staff have the skills, patience and expertise to work with individuals in a holistic and meaningful way.”.

Staff displayed a good understanding of how to keep people safe from potential harm or abuse and what actions they would take should they suspect abuse had taken place.

People were not able to tell us if they felt safe living at Milford Manor. We observed people moving freely around the home. Comments from relatives included: “They are fantastic here, I feel my (husband) has safe care, they explain what they are going to do before they do it and there are always two helping to turn him. He can’t get out of bed now but when he needed the hoist there were always two and they knew what they were doing”, “I have never seen anything which makes me uncomfortable and I come here every day”, “They go above and beyond the line of duty” and “Can’t fault them at all.”.

Visiting professionals spoke positively about the support people received. Feedback received included “As a specialist mental health team we rely on providers who can meet the needs of clients who have complex and often challenging needs.” and “I am confident that the service is meeting people’s needs in a very challenging environment.”.

People were treated with dignity and their right to privacy was respected. Staff knocked on people’s doors before entering and sought people’s permission before undertaking any care tasks. We found staff had a good understanding of people’s needs, interests, likes and dislikes. We observed a range of positive and caring interactions during our inspection.

People were supported to have sufficient food and fluids. People were offered a choice at meal times and where people did not want what was on the menu alternatives were available.

People’s medicines were managed safely. Systems in place ensured that people received the medicines as prescribed and at the correct time.

There were systems in place, which encouraged relatives to share their views on the service. Complaints were investigated and responded to appropriately.

Safe recruitment practices were followed before new staff were employed to work with people. Checks were made to ensure staff were of good character and suitable for their role.

Staff told us they felt supported by the management team. The management team had a clear vision of developing the service for the future and providing quality care to vulnerable people, living with complex mental health needs.

We have made a recommendation about mental capacity assessments for specific decisions.

This was an unannounced inspection which took place on 17 March 2015.

Milford Manor Care Home is registered to provide care (without nursing) for up to 30 people. There were 26 people resident on the day of the visit. The house is an old listed building which offers accommodation over three floors. People have their own bedrooms and there are spacious shared areas within the home and gardens.

There is a registered manager running 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, their relatives and care and health professionals told us that they felt the home was safe. They told us they had never seen anything they were uncomfortable with and one relative said, ‘‘I trust the staff completely’’. Care staff were trained in and understood how to protect people in their care from harm or abuse.

The home had enough staff to keep people safe although people with behaviour that may cause themselves or others distress or harm were sometimes left unsupervised. We recommended that the service seek advice about this issue.The recruitment process ensured the staff employed were suitable and safe to work with people who lived in the home. Care staff had built strong relationships with people who lived in the home. Staff members had good knowledge of people and their needs. The staff team were supported by the management team to ensure they were able to offer good quality care to people.

People were given their medicines in the right amounts at the right times. However, it was not always clearly recorded when medicines prescribed to be taken when necessary should be administered or what time, time specific medication was given. Since the inspection the service has told us how they have dealt with these issues. The home took all health and safety issues seriously to ensure people were kept as safe as possible. The home looked at any accidents and incidents and learnt from them. They tried to ensure they did not happen again, if possible.

The service understood the relevance of the Mental Capacity Act 2005, Deprivation of Liberty Safeguards (DoLS) and consent issues which related to the people in their care. The Mental Capacity Act 2005 legislation provides a legal framework that sets out how to act to support people who do not have capacity to make a specific decision. DoLS provide a lawful way to deprive someone of their liberty, provided it is in their own best interests or is necessary to keep them from harm. They registered manager had made the appropriate DoLS referrals to the Local Authority. Additionally they had taken any necessary action to ensure they were working in a way which recognised and maintained people’s rights.

People were supported to contact GPs and other health professionals when necessary. People’s relatives told us their family members were provided with very good health care. Health professionals told us the service worked closely with them to ensure people’s health was properly looked after. People were offered good quality and nutritious food which was described as, ‘‘very good’’. Staff used physical intervention to help people to control behaviour that caused harm or distress to themselves or others. The service told us that they had made immediate plans for staff to receive specialised training in this area.

The service recognised people’s individual needs. They provided activities designed to encourage participation so that people enjoyed their life. However, they recognised that some people enjoyed their life more if they were able to wander around or do what they felt comfortable with . People were cared for as individuals and their choices and wishes were respected. People were treated with dignity and respect and were encouraged to maintain their independence for as long as possible.

People’s relatives, staff and other professionals told us the home was managed well. They had ways of making sure they kept the quality of care they offered to a good standard. However, some individual records did not contain enough detail to instruct staff what actions to take in specific circumstances such as behaviour management.

We recommended that the service seek advice on the deployment of staff to care safely for people whose behaviour may cause harm or distress to themselves or others.