Archived: Milestone House

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• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

Responsive – this means we looked for evidence that the provider met people’s needs.At our last assessment we rated this key question requires improvement. At this assessment the rating has remained requires improvement. This meant people’s needs were not always met.

The service was in breach of legal regulation in relation to people’s care and support.

This service scored 54 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not make sure people were at the centre of their care and treatment choices and they did not work in partnership with people, to decide how to respond to any relevant changes in people’s needs.

A person suffered with constipation. Constipation was not reflected in the person’s care plan. The person’s care and support plan also did not detail any information about continence care. They had a care and support plan relating to their epilepsy which was not person-centred to them. The epilepsy care and support plan referred to them as the opposite sex throughout.

Care and support plans were in place to detail some people’s goals and aspirations. However, people had not been supported to achieve these goals and aspirations. A person’s goal was to go on holiday in the UK, to enable them to meet up with their family member who lived in that area. There was nothing in their records to show how they had been supported to do this. The person told us they had not been supported to go on holiday and the manager confirmed that holidays for people were not possible.

Care plans were not always person-centred. Oral care was lacking in the care plans and within the care records. It was not clear that people were having their needs met in relation to their oral health care. Staff had not always been recording when they had offered teeth cleaning support or when people had declined. A person’s daily records made no mention of teeth cleaning when their care plan stated staff should support them twice a day. Another person’s records showed they had been supported in the morning to clean their teeth but not in the evening, their care plan also showed they needed support twice a day.

There were shortfalls in how the provider understood the diverse health and care needs of people and their local communities, so care was not joined-up, flexible or supportive of choice and continuity.Information was shared with staff during handover regarding any changes to people’s health or care needs. Staff told us problems with constipation would be discussed on handover and senior staff would escalate this. However, we found that constipation had not always been identified and escalated to gain medical help for people.

Relatives told us, they felt staff supported people to ensure they were aware of appointments and communicated well with GPs and health specialists to ensure people received continuity of care. The GP told us, “They (people) are supported very well” by staff to understand and be involved in their appointment. A relative told us, “I called [manager] about [loved one’s] dental issue and they got this sorted straight away.”

The provider supplied appropriate, accurate and up-to-date information in formats that were tailored to individual needs. Some parts of the service had signs and way marking, there was a lack of signage coming from people’s bedrooms towards the communal lounge. Bedroom doors had people’s names on, which helped people locate their own room. There were information boards around the service which also contained easier to read information so that people had information about the service, staying safe, complaints, and menu information. The menus displayed the choices of food on offer in picture form. However, the food actually given did not always follow. For example, on the 28 May 2025 the menu board at teatime showed that potato waffles and egg or spaghetti hoops on toast was on the menu but people were offered sausage and egg muffins.

Staff were aware of people’s individual communication needs for example, people who may have hearing or visual impairments. Staff shared how they provided information and communicated with different people.

The provider made it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. Staff involved people in decisions about their care and told them what had changed as a result. We observed good practice from staff in relation to listening and involving people with their care and making decisions. People were offered opportunities to feedback about the service; the manager showed us surveys which some people had completed. Those that had responded to the survey had provided positive feedback about the service. Some people were unable to feedback, so staff gauged their happiness levels through observations and changes in their behaviour. People told us they could complain if they needed to. We observed easy to read complaints processes on the inside of people’s bedroom doors. People said, “Staff listen to me. I would talk to them if I needed to complain” and “I am happy and I am ok. I would talk to you if unhappy.”

We received mixed feedback from relatives about how their comments, concerns or complaints were handled and whether they felt listened to. A relative said, “[The registered manager] is only present at the home infrequently and if we wish to contact him, we do so via [the manager], which all takes time. He has been difficult to contact direct.” Another relative told us, “If there any problems they will let me know, I could raise things with the manager.”

The provider made sure that people could access the care, support and treatment they needed when they needed it.The provider set out clear admissions criteria which were that a person had a learning disability and or autism and were aged over 18 years. There were no barriers to anyone meeting these criteria being referred or admitted to the service. People’s needs were assessed before moving into the service and they would only be turned down for a place if the provider thought staff did not have the appropriate skills to provide safe care to an individual. The provider’s statement of purpose verified this.

People were supported with medical appointments and follow up appointments. People’s care records showed that they had received medical help. A relative told us their loved one has visits from healthcare professionals. People were supported to maintain contact with their friends and families.

Staff and leaders did not always actively listen to information about people who are most likely to experience inequality in experience or outcomes. This meant people’s care was not always tailored in response to this. Some improvement was required to ensure every person experienced equality in relation to their environment. A person’s room had poorly fitted carpet tiles. The provider had redecorated people’s rooms and replaced other people’s flooring except the flooring in this person’s room. Management audits identified their flooring needed to be replaced. The service had another bedroom which was empty on the ground floor which could have been made available to the person in order for the flooring works to be completed with minimal disruption to the person and the rest of the service.

People were supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life. A person had a DNACPR (Do not attempt cardiopulmonary resuscitation) form in place. This is an advanced decision not to attempt CPR. It is not about other treatments or care. Their relative had been involved in this decision as the person was not able to communicate their wishes and lacked capacity to understand. People had TEPs (Treatment Escalation Plans) in place. A TEP form records a person's wishes regarding their treatment, particularly in situations where their condition may deteriorate or reach the end of their life. It helps doctors and other healthcare professionals understand the people's preferences for various medical interventions, ensuring they receive care aligned with their wishes.

Discussions with relatives had taken place around their preferences and choices about end-of-life care. Records were clear in cases where people and relatives had chosen not to discuss this element of their care.