Archived: Milestone House

On this page

• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

Caring – this means we looked for evidence that the provider involved people and treated them with compassion, kindness, dignity and respect. At our last assessment we rated this key question requires improvement. At this assessment the rating has remained requires improvement. This meant people did not always feel well-supported, cared for or treated with dignity and respect.

The service was in continued breach of legal regulations in relation to person centred care.

This service scored 45 (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 always treat people with kindness, empathy and compassion, or respect their privacy and dignity. Registered persons had consistently failed to make improvements to the service to improve people’s lives. Although there had been some improvements at this assessment, the service remained in breach of regulations. This was the 6th consecutive inspection where the provider had failed to meet the regulations. This evidenced that the provider did not always treat people with respect.

Despite the provider’s failings, we observed that staff supported people in a way which showed they were kind and respectful manner. People were praised and encouraged to engage and participate in activities and tasks and celebrate achievements.

People and relatives gave positive feedback about staff. A person said, “Staff are nice.” People’s privacy was respected. We observed staff knocking on people’s doors before they entered. A relative said, “We know the staff, we go there regularly and have got to know them. We are happy with what we hear and see.”

The provider did not always treat people as individuals or make sure people’s care, support and treatment met people’s needs and preferences. They did not always take account of people’s strengths, abilities, aspirations, culture and unique backgrounds and protected characteristics.

People’s care plans included likes, dislikes and preferences, including their preference to be supported by male or female staff. People’s religious and cultural needs were not documented. At the previous assessment staff told us people used to enjoy church services which took place regularly. They said these stopped during the COVID-19 pandemic and never started back up again. At this assessment, a staff member said, “I don’t really think they are (religious needs met) as I don’t know what everyone’s religion is. We assume that nonverbal service users are Christian. We just assume they are as they can’t tell us.” Another staff member told us, “We do not have any religious ones, we would support taking them to church if they wanted.” There was no evidence to show that the provider had explored access to church services. Care records did not show that people had been supported to attend church services.

The provider did not always promote people’s independence, so people did not always know their rights and had choice and control over their own care, treatment and wellbeing. The provider had taken some action to find alternative ways of supporting people to access the community to attend their chosen activities and important appointments since the vehicle had broken. A person was now collected to go to their day service and another person used a taxi. Other people who did not attend day services had no improvement and were still isolated as they had not been enabled to access the community.

We observed people had choices such as when to get up, what clothes to wear and what to eat. Staff were able to describe what things people could do for themselves and when they needed support. When describing people’s daily routines, staff explained each person’s level of support. This included when the person required verbal prompts, physical assistance and time so the person could complete the task by themselves.

We observed people independently using the bathroom to have their baths. A person used the call bell for staff assistance to get out the bath as they needed some support. Staff explained the person only needed support with getting out of the bath and with washing their hair.

Staff facilitated people having visitors to their home, and ensured people could contact their friends and family when they wished. A person told us their parents were away on holiday, but they were visiting them when they returned. Their care records showed this was a regular occurrence.

Staff told us how they supported people to maintain contact with their relatives. A Staff member said, “We support them by making sure that their devices are ready, we set up phone calls and face times, and we remind them to contact them.”

Relatives told us, “I can call whenever I want. They are good at that”, “They are very good we see her twice a week and when we go away she has an iPad and we communicate with her that way, all done by staff” and “I think they would contact me if they had any concerns with him. [Person] wouldn’t ask himself.”

The provider did not always listen to and understand people’s needs, views and wishes. Staff did not always respond to people’s needs in the moment or act to minimise any discomfort, concern or distress.

People did not always have enough to do to keep them occupied and stimulated. People were unable to get out in the community as the vehicle was out of use. This meant they were restricted to short walks in the local community which was hampered by the weather. There was limited choice of activities available for people. Some people went out in the community to day services. Other people stayed at home. We observed people sat watching television, a person spent time making a rug, a person utilised a sensory piece of equipment which they enjoyed the sound of. There were no outside activities or events being brought into the service. The manager told us a flower arranging activity was starting the following week. Staff member told us they were unable to get many people out as the service had no vehicle. A person had their own vehicle which they used and sometime a person was invited to join them when they went out.

A person’s care plan stated they were able to participate in daily living such as cleaning, making simple snacks and can set the table. The care plan stated the person was not able to cook any longer and would require support and supervision when accessing the kitchen. There was no plan on how to support the person to participate in these activities or maintain their independence. A review of the daily notes did not evidence there was any involvement in drink or snack making or any other task of daily living.

A person said, “I have been to the centre today and I had my hair cut.” A relative told us, “I know that they give him games and toys. He has a tv which he uses regularly.” Another relative said, “They are starting to (do activities) now especially since the new manager. She goes out twice a week and she seems happy.”

We observed staff responding to people’s needs in a timely manner. Staff attended call bells and listened to what the person wanted.

The provider did not always care about and promote the wellbeing of their staff. They did not always support or enable staff to deliver person-centred care. At the last assessment we reported the provider did not have systems and processes in place to promote and support staff wellbeing. This had not changed. Staff told us they still had no well-being support. A staff member said, “There is nothing really in place. I think there was a time when it felt like if your face fits then you get help. I don’t think that has changed.” Other comments included, “I am not aware of any staff wellbeing packages or support for staff”, “There is no counselling or mental health support for staff” and “There isn’t any if there is I have never seen it.”