Milton House

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

Infection control measures had been increased since COVID-19. However, CQC signposted the provider towards the guidance for Personal Protective Equipment (PPE) in Care Homes for their staff as we observed that staff were not following the guidance in relation to the type of masks required. The provider has now confirmed that the correct masks have been ordered.

Risk assessments were in place to support people to receive safe care. We discussed with the manager the need to ensure that all parts of the care file were updated with current risk.

People's medicines were managed safely and there were enough staff available to meet people’s needs. People told us they felt safe. The staff team were consistent and had a good understanding of how to care for people who lived at the service.

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 supported this practice.

People, their relatives and staff were positive about how the service was managed. The manager was visible and approachable.

The management team were eager to learn and share good practice and this helped people remain safe. Systems were in place to audit the care provided.

The last rating for this service was good (published 15 January 2019).

Why we inspected

The inspection was prompted in part due to concerns received in relation to safeguarding and the management of the service. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. We reviewed the information we held about the service. No areas of concern were identified in the other key questions.

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 coronavirus and other infection outbreaks effectively.

We have found evidence that the provider needs to make improvement. Please see the safe and well led sections of this full report.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

We inspected the service on 21 November 2018. The inspection was unannounced. Milton House is a ‘care home’ for older people. 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. On the day of our inspection 23 people were using the service.

At our last inspection on 15 February 2016 we rated the service as good. At this inspection we found the evidence continued to support the rating of good. We were aware of a complaint being investigated by the local authority. While we did not look at the circumstances of the specific complaint, we did look at associated risks at the location.

People continued to receive a safe service where they were protected from avoidable harm, discrimination and abuse. Risks associated with people’s needs including the environment, had been assessed and planned for and these were monitored for any changes. There were sufficient staff to meet people’s needs and safe staff recruitment procedures were in place and used. People received their prescribed medicines safely and these were managed in line with best practice guidance. Staff knew what to do in the event of an accident and action was taken to reduce further risk.

People had their needs assessed and care and support was delivered in line with evidence based guidance. Staff received the training and support they required to meet people’s needs. People were supported with their nutritional needs. The staff worked well with external health care professionals, people were supported with their needs and accessed health services when required. 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. The principles of the Mental Capacity Act (MCA) were followed.

People continued to receive care from staff who were kind, compassionate and treated them with dignity and respected their privacy. Staff had developed positive relationships with the people they supported, they understood people’s needs, preferences, and what was important to them. Staff knew how to comfort people when they were distressed and made sure that emotional support was provided.

People continued to receive a responsive service. People’s needs were assessed and planned for with the involvement of the person. Care plans were in place for each identified need. People received opportunities to pursue their interests and hobbies, and social activities were offered. There was a complaint procedure and action had been taken to learn and improve where this was possible.

The service continued to be ‘well led’. People and staff felt supported by and had confidence in the acting manager. There were systems in place to monitor the quality of service provision and these included seeking the views of people and staff. There was an open and transparent and person-centred culture at the service.

Further information is in the detailed findings below

Milton House provides accommodation which offers personal care to older people and those living with dementia. There were twenty seven people using the service at the time of the inspection.

The service is required to have a registered manager. 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 home manager had been newly appointed in February 2016 and was in the process of registering as manager for the service with the Care Quality Commission.

The service is safe, clean and has effective infection control procedures however updating of the interior decoration is required to be more suitable for people living with dementia at the service.

An activities co-ordinator had been recruited in order to rectify the current lack of activities for people. People were provided support in a person centred way by staff who clearly displayed good knowledge of the people they supported.

Staff had good knowledge of their responsibilities and how to keep people safe. People’s rights were also protected because management and staff understood the framework of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Management applied such measures appropriately.

Effective support was delivered by staff. People’s safety was ensured whilst personal choice and wellbeing was promoted by the staff providing the care. As part of a robust recruitment process staff were recruited and employed upon completion of appropriate checks. There were sufficient staff to meet people’s individual needs. People’s medicines were managed safely by trained staff.

People had enough to eat and drink and staff understood and met their nutritional needs. Staff and managers ensured access to healthcare services were readily available to people and worked with a range of health professionals to maintain good health of the people.

Privacy and dignity was valued by staff and were observed to be respectful and compassionate towards people. Staff understood their roles in relation to encouraging people’s independence whilst mitigating potential risks.

The service was well led. Innovative plans were being developed to drive improvements of the services available to people. The service ran effectively using quality monitoring audits which the home manager and provider carried out to identify health needs and any improvements to the service. A complaints procedure was in place and had been used appropriately by management. Systems were in place to make sure that people’s views were gathered.

The service was caring and responsive to people's changing needs. Staff sought support from other professionals or agencies when needed. Staff had a good knowledge of people's individual needs and offered them appropriate support. People had opportunities for activity and occupation.

People told us that they enjoyed the food provided at Milton House. We found that people's nutritional needs were assessed and monitored to ensure their on-going wellbeing.

We saw that the service had good infection control policies, procedures and practices in place. The service was kept clean and provided a hygienic place for people to live.

Staff were supported to be effective in their role through robust induction processes, good levels of training and on-going supervision.

People told us that any concerns they had were listened to and acted on. We found that any complaints made were investigated and responded to.

Overall we found Milton House to be an effective and well led service.

People told us that the staff who worked at the service were good. One person said, "All the staff who work here are friendly and good at what they do. I haven't had a bad one yet." We found that staff had adequate training to assist them in their role, but felt that this would be enhanced if they undertook good training in dementia care to ensure up to date and consistent practice. Staff had a good understanding of individual people's needs. People were treated respectfully and their individuality understood.

People told us that they were happy with the quality of the service provided. We found that the provider consulted with people and monitored the service to ensure that standards of quality and safety would be maintained.