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Inspection carried out on 10 September 2019

During a routine inspection

About the service

Milton Lodge is a care home for up to twenty-one older people who require nursing or personal care. It is situated in a residential area of Fleetwood. The home has three floors and is serviced by a passenger lift to all levels. Two bedrooms have shared occupancy for two people. There are two rooms with en-suite facilities. At the time of our inspection there were 20 people living at Milton Lodge Rest Home.

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

People were protected from risk of abuse and avoidable harm by staff who understood how to recognise and respond to concerns. People told us they felt safe when supported by staff. Risk assessments had been developed to minimise the potential risk of harm to people during the delivery of their care. People were safely supported to receive their medicines as prescribed.

People's needs were assessed, and care and support had been planned proactively and in partnership with them. People were provided with a nutritious and varied diet. Staff had received regular training and supervision to support them to meet people's needs. 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.

People told us staff were kind, caring, attentive and treated them with respect. They said staff respected their privacy and dignity and supported them to be as independent as possible. The service provided people with information about local advocacy services, to ensure they could access support to express their views if they needed to.

People received person-centred care which was responsive to their needs. People’s communication needs had been assessed and where support was required these had been met. People were entertained and stimulated by the activities provided for them. The registered manager managed people’s concerns and complaints appropriately and people told us they felt listened to.

The service worked in partnership with a variety of agencies to ensure people received all the support they needed. People were happy with how the service was managed. Staff felt well supported by the registered manager. The registered manager and provider completed regular audits and checks, which ensured appropriate levels of quality and safety were maintained at the home.

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 08 April 2017).

Why we inspected

This was a planned inspection based on the previous rating.

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.

Inspection carried out on 14 March 2017

During a routine inspection

The inspection visit at Milton Lodge Rest Home took place on 14 March 2017 and was unannounced.

Milton Lodge is a care home for up to twenty one older people who require nursing or personal care. It is situated in a residential area of Fleetwood. The home has three floors and is serviced by a passenger lift to all levels. Four bedrooms have a shared occupancy for two people. There are two rooms with en-suite facilities. At the time of our inspection there were 21 people living at Milton Lodge Rest Home.

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 last inspection on 30 November and 01 December 2015, we asked the provider to take action to make improvements with regard to meeting people’s nutritional and hydration needs. We asked the registered provider to submit an action plan to demonstrate what improvements they were going to make. We used this inspection visit in March 2017 to check the required improvements had been made

During this inspection, we found action had been taken to improve the service. Staff were present and available to monitor and offer appropriate support to people with their meals. Mealtimes were relaxed and social experiences where friends and relatives were welcome. We saw regular snacks and drinks were available between meals to ensure people received adequate nutrition and hydration.

As part of our inspection visit, we had a walk around the home, we found these areas were clean, tidy and well maintained. The provider had ensured risks to individuals had been assessed and measures put in place to minimise such risks. However, throughout our inspection visit, we noted the kitchen door remained open and there were times when the kitchen was empty and the dining room unstaffed. We have made a recommendation about environmental risk management.

We observed the management of staff throughout our inspection. We found staffing levels ensured people were safe. There was an appropriate skill mix of staff to ensure the needs of people who lived at the home were met.

Staff received training related to their role and were knowledgeable about their responsibilities. They had the skills, knowledge and experience required to support people with their care and support needs.

Staff had received abuse training and understood their responsibilities to report any unsafe care or abusive practices related to the safeguarding of vulnerable adults. Staff we spoke with told us they were aware of the safeguarding procedure.

The provider had recruitment and selection procedures to minimise the risk of unsuitable employees working with vulnerable people. Checks had been completed prior to any staff commencing work at Milton Lodge Rest Home. This was confirmed from discussions with staff.

Staff responsible for administering medicines were trained to ensure they were competent and had the required skills. There were appropriate arrangements for storing medicines safely.

People and their representatives told us they were involved in their care and had discussed and consented to their care. We found staff had an understanding of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).

We found people had access to healthcare professionals and their healthcare needs were met. We saw the management team had liaised with healthcare providers and responded promptly when people had experienced health problems.

A complaints procedure was available and people we spoke with said they knew how to complain. People and staff spoken with felt the management team were accessible, supportive and approachable.

Comments we received demonstrated people were satisfied with their

Inspection carried out on 30 November and 1 December 2015

During a routine inspection

This inspection took place on 30 November and 1 December 2015 and was an unannounced inspection. Milton Lodge Rest Home is a care home for up to twenty one people. It is situated in a residential area of Fleetwood. The home has three floors and is serviced by a passenger lift to all levels. Some bedrooms have a shared occupancy for two people. There are two rooms with en-suite facilities. Communal bathing facilities and toilets are available throughout the home. There are a range of aids and adaptations available to support people to maintain their independence. The home was fully occupied when we carried out our inspection.

At the last inspection in April 2014, the service was meeting the requirements of the regulations that were inspected at that time. There was a registered manager in place. 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.

Feedback from people who lived at the home, their relatives and a visitor was very positive. People told us they felt safe. Staff demonstrated they had a good understanding of the needs of people they supported. Staff were aware they should report concerns should they identify when someone was at risk of abuse. Staff had received safeguarding vulnerable adults training. We noted that following reporting a recent safeguarding incident to the Local Authority, the provider and registered manager had failed to submit a notification to CQC. They told us in future they would ensure they notified the Commission of such events. We found notifications regarding other incidents affecting the health and well-being of people who lived at Milton Lodge Rest Home were reported to CQC in a timely way.

Records in staff files showed us their employment, induction and training records were in place. Any gaps in staff`s employment history was explained. This meant we could confirm staff had been recruited safely. We found staff were supported through a formal process of induction. There was an up to date training matrix. This indicated staff were supported to keep up to date with their personal development.

People told us staff were friendly and caring and this was observed during our inspection. We found members of the staff team were welcoming and there was a friendly atmosphere in the home. Relatives were encouraged to visit and be involved in the care of their loved ones. People were supported to comment about the support they received, and questionnaires were available for people and their relatives to comment on the quality of care they received. We found many positive comments were received by the staff team. Any concerns people may have were dealt with in a timely way.

The registered manager had recently increased her staffing levels and recruited an activity co ordinator. People we spoke with and comments we read were very positive with regard to the development of this new role within the staff team. We found the activity co ordinator was a vibrant member of the staff team. However we found the deployment of staff at lunchtime on our first day of inspection and the management of staff breaks was not always managed for the benefit of the people who lived at the home. Staff provided cover for each other during times of absence. This meant people benefitted from being supported by staff who knew them well and understood their care needs. However we found the registered manager was providing cover for one of the cook`s annual leave on both days of our inspection. This showed us staff resources and skills were not always managed effectively. There was an on call system in place for staff to call in case of an emergency.

Care plan records showed us people were involved in their care and had discussed and consented to their care support. We found staff had a received training regarding the Mental Capacity Act 2005 (MCA).

The registered manager had procedures in place to protect people from abuse and unsafe care. Following a recent increase in the number of falls people sustained at the home, she had taken a range of measures in their risk management. This included working in partnership with the district nurse team and increasing the level of night time observations for people. This had reduced the number of falls. However we found the risk management for people regarding their nutrition was not thorough. We found that nutritional risk assessments were not part of their care planning risk management process. A nutritional risk assessment would assist staff to identify those people who were at risk of malnutrition. Staff did however tell us if they had any concerns they would contact the GP for advice. We found snacks and drinks were available. We found there was a breach in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 in relation to the lack of risk management and care planning to meet the nutritional and hydration needs of people. You can see what action we told the provider to take at the back of the full version of this report.

The registered manager told us since the last inspection they had invested in re decoration and re furbishment in some areas of the home. There was a new wet room shower room installed and new flooring in some areas of the home. The provider told us they had plans to invest in new equipment such as the lift and new stair lifts. Although it was clear there had been investment in the home, we found there were some shortfalls. We found that the majority of the upstairs windows did not have window restrictors in place. We also found the hot water temperature in the bathroom to be too hot. The registered manager took immediate action. She arranged for the maintenance person to attend the home on the first day of our inspection. The hot water temperature was immediately adjusted to a safe level. All windows in the home were checked, and arrangements made to purchase window restrictors. The registered manager told us she anticipated this work would be completed by the end of the week. She advised she would write to CQC once this work had been completed. We have made a recommendation about the maintenance of the home.

Staff knew and understood people’s history, likes, dislikes, needs and wishes. We found staff demonstrated positive relationships with the people they supported and their relatives. We found staff treated people with respect and patience. Staff offered choices and encouraged people to retain their independence wherever possible.

The provider had employed an area manager to undertake a range of independent audits in the home. Although we found there were quality monitoring systems in place we found these were not always effective. We did identify some gaps in their monitoring systems such as the maintenance of some aspects of the building, and the management of people`s nutrition.

Inspection carried out on 3 April 2014

During a routine inspection

During our inspection we looked at care, food and nutrition, the safe management of medicines, staff recruitment, and quality monitoring systems. We spoke with people living at the home, visitors, professionals, and members of the staff team. Care practices were also observed throughout the inspection and over lunch time. We did this to confirm people were having their care needs met.

Is the service safe?

We saw that people were treated with respect and dignity by the staff. Risk assessments were reviewed on a monthly basis. Information such as falls were analysed to ensure that managers and staff learned from events such as accidents and incidents. This reduces the risks to people and helps the service to continually improve. There was a stable staff team in place with minimal staff recruitment being required. There was a structured recruitment process in place. However in one file we looked at we found that this recruitment process could have been more robust.

Is the service effective?

People�s health and care needs were assessed. People and their relatives were supported to be involved in their plans of care. People we spoke with told us the home was very responsive when meeting people`s health care needs. There was regular contact with local GPs, District Nurse team and pharmacist. Visitors were made to feel welcome, and were able to use various rooms within the home to spend time with their relative. Visiting times were flexible and there were several thank you cards from relatives on display in the home.

Is the service caring?

We observed people were supported by kind, caring and attentive staff. We saw that staff showed patience and gave encouragement when supporting people. People commented, �They are wonderful from the minute I come downstairs there is tea and toast. If I need help I get it.� A relative told us, �The girls are amazing they really are. I visit every day, and without doubt the staff are caring�.

People using the service and their relatives completed an annual satisfaction survey. This meant that should any shortfalls or concerns be raised they could be identified and addressed. The provider had not received any negative feedback since the last inspection.

Is the service responsive?

People we spoke with told us the home was very responsive when meeting people`s health care needs. There was regular contact with local GP`s, District Nurse team and pharmacist. We were told that specialist equipment was organised very quickly to ensure people were appropriately supported within the home.

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way. The registered manager completed a range of quality audits to monitor and review the quality of the services they provided within the home. This helped to ensure that people received a good quality service at all times.

Inspection carried out on 15 August 2013

During a routine inspection

We observed the care and support people received, and spent time in the communal lounges of the home over lunch. We observed staff being attentive and caring. We saw that people living in the home enjoyed flexible routines dependent upon their individual needs and preferences.

We observed staff providing stimulating activities and we saw that people appeared to enjoy the activities. People we spoke with told us, �I feel safe here it`s what`s prompted me to think about staying here permanently�. �The staff are well trained and good with each other.� �I�ve been out a few times in my wheelchair�.

The manager told us they worked closely with the local doctors and pharmacy and were supported to meet the needs of the people living at the home. We looked at the staffing rotas over a four week period. This showed us there were sufficient staff on duty, with a range of skills and experience to meet the needs of the people who lived at the home.

There were a range of audits and systems in place to monitor the quality of the service being provided. This showed us that people benefitted from living in a well-managed home. An annual survey had taken place involving people who lived at the home and their relatives. One comment made stated,� All the staff are welcoming and friendly to visitors but more importantly they really care about the ladies welfare and comfort.�

Inspection carried out on 7 February 2013

During a routine inspection

We spoke with people living at the home, the owner, manager and staff. We also received comments from other professional agencies. We contacted Lancashire County Council's Contracts Monitoring Team, who told us they have no current issues with the service.

We also observed the care and treatment of people living at Milton Lodge. We saw that people were well cared for in a caring and supportive environment. There was a relaxed atmosphere and pace to the daily activities and people appeared to be happy and relaxed in their home environment.

Responses we received at the time of the inspection were positive and included,� Well it�s perfect for staying here�.

�The staff are really good; they know the people so well they really care for everyone�.

� They are happy girls, they are the best�.

Inspection carried out on 3 August 2011

During an inspection in response to concerns

We spoke to people living at the home, the owner, manager and staff. We also received comments from other professional agencies including social services and Lancashire Council's Contracts Monitoring Team, who told us they have no current issues with the service.

Responses we received at the time of the site inspection were positive and included, �There always around for us, they are very patient".

�If I need anything I just have to ask".

By talking to people using the service we found they were very happy with the care they receive. �Staff are always busy but there if you need them", �These girls do a great job".

People told us they get all the care and treatment they need. �They keep eye on me".

A person we spoke to said "Nothing is too much trouble for the staff here".

Staff we spoke to said they felt the staff team was strong and that they work well together. "Some of us have worked together for a long time and it�s a nice place to work". By speaking to people using the service we were told they are asked about their care and treatment. "They are always asking if there is anything I need".

Staff told us they informally get the views of people just by talking to them. �We get to know a lot about people and things they need just by talking to them and their families".