You are here

Archived: Milton Lodge Residential Care Home Requires improvement

The provider of this service changed - see new profile

We are carrying out a review of quality at Milton Lodge Residential Care Home. We will publish a report when our review is complete. Find out more about our inspection reports.

Reports


Inspection carried out on 13 July 2016

During a routine inspection

This was an unannounced comprehensive inspection that took place on 13, 14 and 15 July 2016. At the last inspection completed in December 2015 the provider was not compliant with all the regulations and a Warning Notice was served. This was because accurate, complete contemporaneous records were not maintained in respect of each person living at the home. Two requirement actions were also made; one concerning the failure to meet the requirements of the Mental Capacity Act 2005 and another concerning the support, supervision and appraisal of staff.

Milton Lodge is registered to accommodate and provide personal care for up to 18 people. The home aims to meet the needs of older people, including those living

with dementia. At the time of this inspection there were 12 people living at the home.

Since the last inspection in December 2015, the person who was the registered manager had ceased working at the home and a new manager had been appointed. They were in the process of registering with the Commission but were absent on the days of our inspection. The provider, the duty manager and senior care workers therefore assisted us throughout the inspection. We also spoke with two other members of staff, a visiting relative and a person’s legal representative.

Overall, the relative and staff were very positive about the standards of care and the way people were cared for and supported.

People were safe living at the home as steps had been taken to make sure the environment and the way people were cared for and treated were safe. Some improvement was still needed concerning record keeping.

Staff had been trained in safeguarding adults and were knowledgeable about the types of abuse and how to take action if they had concerns. Training had been booked for newly appointed staff.

Accidents and incidents were monitored to look for any trends where action could be taken to reduce likelihood of their recurrence.

There were sufficient staff to meet the needs of people accommodated.

Recruitment procedures were being followed to make sure that suitable, qualified staff were employed at the home but there could be some improvement in record keeping.

Medicines were administered by trained staff and generally managed safely. Improvements could be made with better monitoring of medicine administration records to reduce gaps in recording.

The staff team were both knowledgeable and informed about people’s care and support needs. There were good communication systems in place to make sure staff worked to agreed objectives.

Staff felt supported by management but there could still be improvement in making sure formal supervision sessions with a line manager took place in line with the home’s procedure.

Staff were aware of the requirements of the Mental Capacity Act 2005 and acted in people’s best interests where people lacked capacity to make specific decisions, although this could be better evidenced in the records. People were consulted and gave consent to their care where they were able.

The home was compliant with the Deprivation of Liberty Safeguards with appropriate applications being made to the local authority.

People were provided with a good standard of food and their nutritional needs met.

People’s care needs had been assessed. Comprehensive and detailed care plans had been developed to inform staff of how to care for people. The plans were person centred, covered all areas of people’s needs and were generally up to date.

We saw staffing supporting people in a compassionate and caring way. The relative we spoke with was satisfied with the standards of care provided at the home. Staff were knowledgeable about people’s needs.

A member of staff was employed to provide activities to keep people meaningfully occupied.

There was a complaint system in place and this was well-publicised.

Should people need to transfer to another service, systems were in place to make sure that important information would be passed o

Inspection carried out on 10 and 11 December 2015

During a routine inspection

Milton Lodge is registered to accommodate and provide personal care for up to 18 people. The home aims to meet the needs of older people, including those living with dementia. At the time of this inspection there were 16 people living at the home.

This was an unannounced comprehensive inspection carried out over two days by two inspectors on 10 and 11 December 2015. We last inspected the home in January 2015 when we found the service was not meeting four regulations. These related to the care and treatment provided to people, the safety and suitability of the premises, staff recruitment and record keeping. This inspection was brought forward because of concerns we received.

Care plans and risk assessments were not up to date and could lead to staff not knowing how to care and support people consistently. This was a continuing breach of the regulations.

The home was not fully meeting the requirements of the Mental Capacity Act 2005. Applications had been made to the local authority for people at risk of being deprived of their liberty; however, one person Deprivation of Liberties Safeguarding authorisation had expired and the home had not taken steps to make another referral. There could also be improvement in recording when ‘best interest’ decisions were made on behalf of people. We required improvement in this area.

Staff were not supported through one to one supervision and annual appraisals. We required improvement in this area.

There were some systems in place to monitor the quality of service provided to people but these were not being consistently applied.

There was poor leadership and oversight of the home, contributing to poor record keeping, a decline in standards of care leading up to the inspection and a lowering of staff morale.

People’s consent was gained for how they were cared for and supported where this was appropriate.

Medicines were managed safely in the home.

People were supported by a caring staff team and the standards of care provided in the home were improving following a period of decline in the months leading to the inspection. People’s privacy and dignity were respected.

People were provided with a good standard of food and their nutritional needs met.

Staff provided a programme of activities to keep people meaningfully occupied. Accidents and incidents were monitored and audited to see if there were any trends that could make systems and care delivery safer.

Staffing levels had recently increased at key times of the day to make sure there were sufficient staff to meet people’s needs.

Robust recruitment procedures were followed, meeting a requirement of the last inspection in January 2015, to make sure competent and suitable staff were employed to work at the home. The provider told us that new members of staff were being recruited at the time of inspection.

The staff team were well-trained and there were systems in place to make sure staff received update training when required. Staff had been trained in safeguarding adults and were knowledgeable about how to refer any concerns of abuse

The home had a well-publicised complaints policy and when a complaint was made, they were logged and responded to.

Inspection carried out on 14 and 15 January 2015

During a routine inspection

Milton Lodge is registered to accommodate and provide personal care for up to 18 people. The home aims to meet the needs of older people, including those living with dementia. At the time of this inspection there were 17 people living at the home.

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

This was an unannounced inspection carried out over two days on 14 and 15 January 2015.

People or their representatives felt that the home provided a safe service. Steps had been taken to keep people free from harm in most respects. However, at this inspection, we found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, which correspond to regulation  the Health and Social Care Act 2008 ( Regulated Activities) Regulations 2014.

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

The registered manager needed to improve the systems when people required monitoring of fluid intake or repositioning. Personal evacuation plans were also not in place in the event of an emergency. You can see what action we told the provider to take at the back of the full version of the report.

Overall, there were robust recruitment procedures in place but there was an instance where a member of staff had been recruited where robust checks had not been followed. You can see what action we told the provider to take at the back of the full version of the report.

Staff were aware of their responsibility to protect people from harm or abuse. They had been trained and were aware of the action they should take if they suspected abuse or ill treatment.

New staff completed induction training to equip them with the skills and knowledge to meet people’s needs.

There were sufficient numbers of staff on duty to meet people’s needs.

People or their representatives had been included in planning how care and treatment was provided through assessment of needs.

People’s legal rights were fully protected because legal requirements of the Deprivation of Liberty Safeguards (DoLS) had been followed. The provider had complied with the requirements of the Mental Capacity Act 2005.

There was a safe system in place for the administration, recording, and storage of medicines.

People’s nutritional needs were met and there were systems in place to make sure people had enough to drink, although improvements were required in monitoring and taking action, when required, in respect of fluid monitoring and repositioning of people.

Staff received regular training and were knowledgeable about their roles and responsibilities. The staff knew people they were supporting well and supported people to maintain their independence.

Staff were caring and met people’s needs, respecting their privacy and dignity. The staff were also knowledgeable about people and how to meet their needs.

Care planning was person centred and people were treated by staff as individuals. However, some people’s care plans were not up to date and there were increased risks that people’s needs might not be met. You can see what action we told the provider to take at the back of the full version of the report.

Relatives were welcome to visit at any time without restrictions. At the time of the inspection there was a vacancy for an activities coordinator. The staff were doing their best to provide some activities at quieter times of the day.

There were complaint procedures in place and any complaints made had been investigated and responded to.

There was a good morale amongst the staff team but improvements were required with respect to the management of the home with respect to record keeping and quality assurance.

Inspection carried out on 5 June 2013

During an inspection to make sure that the improvements required had been made

At this inspection we spoke with the deputy manager, care workers on duty, three people who lived in the home and one visiting relative. On the day of our visit 13 people lived at Milton Lodge.

During this inspection we followed up on some outstanding areas from our last inspection of the home that was conducted on 4 January 2013. They concerned the respect and dignity afforded to people who lived in the home, care and welfare, the home's environment and cleanliness and record keeping.

People told us care staff were polite and treated them with respect and dignity. We observed care staff were patient, friendly and upheld the privacy of the people who lived in the home.

We found that care plans accurately reflected people’s needs and had been drawn up with their involvement.

We observed the home had made improvements concerning the environment and many rooms and communal areas had been redecorated, had new carpets and new bedding provided.

The provider had measures in place to identify, assess and manage risks to the health, safety and welfare of people using the service and others.

Records we looked at were accurate, up to date and were easily accessible to us during our visit.

Inspection carried out on 4 January 2013

During a routine inspection

The home specialises in the care of people with dementia. The majority of the people who live at Milton Lodge were not able to give an account of what it was like to live at the home because of their mental frailty. We were able to speak with three of the people who lived in the home; however, we were only able to gain a limited understanding from them of what it was like to live there.

People's views and experiences were taken into account in the way the service was provided and delivered in relation to their care. However, sometimes people's privacy and dignity was not respected.

People's needs were assessed but care and treatment was not consistently planned and delivered in line with their individual care plan.

People who use the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

People told us they were comfortable in their surroundings but the environment was not always adequately maintained.

People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard.

Records were kept securely but people were not protected from the risks of unsafe or inappropriate care and treatment because records were not consistently accurate and up to date.

Reports under our old system of regulation (including those from before CQC was created)