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Inspection Summary


Overall summary & rating

Requires improvement

Updated 10 February 2018

This inspection took place on the 9 and 10 January 2018. It was an unannounced visit to the service.

Milton House 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.

Milton house accommodates 12 people in one adapted building. It is registered for people with epilepsy, learning and or physical disabilities. At the time of this inspection six people lived there.

The service had 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.

At the previous inspection in January 2017 the provider was in breach of Regulation 18 of the Health and Social Care Act. 2008. This was because sufficient numbers of suitably qualified staff, competent, skilled and experienced staff were not consistently provided. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key question safe and well-led to at least good. At this inspection we found systems had been put in place to ensure the minimum staffing levels were always maintained. However people’s needs had increased and changed since the previous inspection. As a result sufficient staff were not available at key times of the day to enable staff to safely meet people’s needs. The nominated individual immediately agreed to review the staffing levels and confirmed after the inspection that a third staff member would be rostered from 8am till 18:00 to provide an extra staff member at peak times. We have made a recommendation for the provider to keep the staffing levels under review in response to changes to people in line with best practice and dependency levels.

The people we spoke with and relatives were very happy with the care provided. Relatives commented “I am really grateful, I feel very lucky [person’s name] is there. I really can’t fault them.” Another relative commented “Staff have time for [person’s name} and they always show genuine concern and understanding. “

At this inspection the service was providing caring and responsive care. Improvements were required to ensure safe, effective and well- led care was maintained.

People were safeguarded from abuse but risks to people were not identified and managed. Staff were proactive in referring people on to the relevant professionals when people’s needs changed. However the service was slow to act on recommendations and advice from those professionals to promote a person’s safety.

Systems were in place to promote safe medicine administration. However the service failed to ensure they had an adequate supply of one person’s medicine and failed to seek medical advice to ensure the person’s health and well- being.

People consented to their care and staff worked to the principles of the Mental Capacity Act 2005. They were provided with information on how to make a complaint and this was reinforced to people at residents meetings.

People had care plans in place which outlined their needs and the support required. Their nutritional needs were identified and met. People had access to activities and keyworkers were looking at ways of developing more person centred activities in conjunction with the activities team.

The home was clean and homely. People were provided with equipment to promote their safety and independence. Systems were in place to ensure the environment was kept clean and prevent cross infection. The equipment provided was serviced and safe.

Staff had the required recruitment checks prior to commencing work at the service. They were inducted, traine

Inspection areas

Safe

Requires improvement

Updated 10 February 2018

The service was not always safe

People were not provided with sufficient staff in the morning to promote their safety.

People were protected from potential abuse and the risk of infection. However people’s individual risks were not always identified and risks were not managed.

People were supported by staff who were suitably recruited.

Effective

Requires improvement

Updated 10 February 2018

The service was not always effective.

People’s nutritional needs were met. They had access to other health professionals. However the outcome of health appointments and follow up appointments were not routinely recorded and in some occasions follow up appointments were cancelled without explanation.

People were supported by staff who were suitably inducted, trained and supervised.

People were supported and enabled to make decisions about their day to day care. The principles of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS) were complied with.

Caring

Good

Updated 10 February 2018

The service was caring.

People were supported by staff who were kind, caring, helpful and inclusive.

People’s privacy, dignity, independence and respect was promoted.

People were provided with support to promote communication and involvement in their care

Responsive

Good

Updated 10 February 2018

The service was responsive.

People had care plans in place which outlined the care required to promote consistent care.

People were supported to pursue their interests and activities were provided, although people’s involvement in them had decreased.

People were provided with the information on how to raise a concern or complaint.

Well-led

Requires improvement

Updated 10 February 2018

The service was not always well -led.

The registered manager had failed to inform the commission of an incident which they are required to notify us of.

People’s records and other records required for the running of the service were not suitably maintained and up to date.

Systems were in place to monitor and audit the service. Those audits were not effective in picking up issues that needed addressing in a timely manner.

People, relatives and staff were given the opportunity to feedback on the service.