Archived: Milestone House

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated this key question inadequate. At this assessment the rating has changed to requires improvement. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

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

This service scored 42 (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 make sure people’s care and treatment were effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them. Assessments had not been updated since the last assessment. They were not always clear and detailed to give staff all the information they need to provide care and support. As well as the bed rail risk assessment the provider had completed entrapment risk assessment checklists to make sure bed rails were suitable for the type of bed and mattress.

Some assessments included information about what people could do for themselves. Some care plans and assessments had been added to the electronic care planning system, some had not yet been transferred. Each person’s care plan and assessments were also reassessed once a month. Staff were knowledgeable about people’s care and support needs. They were able to describe peoples preferred routines, the best ways to communicate with people and how to support people with their physical and emotional well-being.

Some relatives told us they were involved in their loved one’s assessments and care planning processes.

The provider did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them.

It was not always evident that enough drinks were offered to keep people safe and healthy. Records showed that some people were not having enough fluids to keep well. Some people required their drinks to be measured as they had a prescribed thickener added to their drinks to make it safe for them to swallow. Other people were at risk of not drinking enough to stay well. We observed staff prompting some people to have fluids. A person had been out to their day service and returned early afternoon. Staff had repeatedly encouraged them to drink and when the person told staff they had a drink at their day centre, staff sensitively explained that was many hours before, they explained what could happen to their health if they did not drink enough. The person then independently took some sips of their drink. People appeared to like the food. A person told us, “I had egg on toast this morning.” The manager told us that there had been changes to the food, they were now using fresh food and less processed foods.

Care plans and risk assessments clearly described what modified diet people were prescribed and the care plans followed The International Dysphagia Diet Standardisation Initiative (IDDSI) framework. The guidance was also available in the kitchen to staff responsible for preparing, cooking and serving meals. Kitchen staff and those responsible for supporting people with their food had a good understanding of people’s assessed needs in relation to type and texture of food as well as any allergies and food intolerances. We observed staff supporting people to eat food which met their assessed needs.

Staff told us they helped people to make their meal choices if they needed it. We observed staff asking people what food choices they would like.

Care plans showed that some people had goals and aspirations but did not show how and if people had been supported to achieve their goals such as taking holidays. A person’s care records included goals of to continue attending a day service, ‘to maintain those daily living skills’ and ‘continue going into the community’. Their care records listed information about what made them happy and what made them sad. What made the person happy was; community-based activities, helping to wash up and their day service. We reviewed the person’s care records for the period 1 January 2026 to 4 March 2026. This showed the person had been out of Milestone House 2 times (on 20 February and 3 March 2026) in that time period. There was no mention of the person attending the day service. The daily records showed no evidence that the person had been supported to complete daily living skills.

The provider did not always work well across teams and services to support people. They did not always share their assessment of people’s needs when people moved between different services. Staff did not always work with health professionals in a timely manner to ensure people got the care and support they needed. Evidence reviewed during this assessment showed health concerns regarding constipation had not always been shared appropriately. A person’s care plan stated they tended to overeat, and they were at risk from becoming obese. The care plan stated the person had reached their target weight and the GP wanted the person to maintain this weight. The care plan entry was not dated and there was no recorded weight or a plan on how to support the person to maintain their weight at target.

The manager told us they had good links with the GP surgery as well as other health and social care professionals (including links with the learning disability community nursing team). A healthcare professional told us, “I have no concerns regarding Milestone House. They are helpful, supportive and well informed about their patients.”

People’s care records evidenced people had seen GP’s and other health professionals to meet their health needs. A staff member said, “We would use pictures to communicate with them we stress how important health is and encourage them to live healthy.”

Staff worked closely and communicated with day service staff in relation to some people who attended day services as part of their weekly routines.

The provider did not always support people to manage their health and wellbeing, so people could not maximise their independence, choice and control. Despite people having health action plans in place, staff did not always support people to live healthier lives, or where possible, reduce their future needs for care and support. Since the provider’s vehicle had broken in May 2025, people had not always been supported to have their health needs met. Records showed that some people’s health appointments were cancelled by the service due to no transport. The provider had not always sought alternative means of transport to support these appointments. During the assessment we discussed with the provider and manager that we had been having difficulty contacting the service by telephone and email. The manager told us that the telephone system had a unique PIN to retrieve messages, and no one knew what the PIN was. The provider had changed the email address of the service and had not told CQC or some other health professionals. This had impacted on health professionals following up on referrals to assess people’s changing health needs. A healthcare professional told us that some referrals had been closed as the service had not responded to calls and messages to arrange appointments.

Records showed some people had seen the GP, attended hospital appointments, dentist appointments and opticians when needed. A relative said, “I believe so they have arranged eye appointments for him and they did this very quickly.”

The provider did not always routinely monitor people’s care and treatment to continuously improve it. They did not always ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves.

Each person had a DisDAT (Disability Distress Assessment Tool) in place. The DisDAT tool helps identify distress cues in people who have limited communication. It focuses on documenting a person's typical behavioural cues to better recognise subtle changes that may indicate distress. A person’s care records showed they were regularly becoming distressed and agitated which resulted in them displaying behaviours which others find challenging. This was directed at staff, generally when having personal care. The manager and some staff explained this had reduced in frequency in the last 3 to 4 months. There had been some guidance provided to staff, but this had not been incorporated into their care plan and risk assessments. A staff member said, “The care plan does not give enough information about how to deal with it. It tells you about de-escalation but not what to do if de-escalation doesn’t work. Sometimes agency staff are on at night, a couple of times [person] has been like it with the agency staff, there is no pattern.” Staff had continued to provide personal care to the person, and each time recorded it was provided in the person’s best interest.

We received mixed feedback from staff in relation to support they received when they needed it. Some said support is available, others said support was not forthcoming when requests were made for help and guidance on how to deal with situations out of hours through the on-call system.

The provider did not tell people about their rights around consent or respect these when delivering care and treatment. We checked whether the service was working within the principles of the Mental Capacity Act (MCA), whether appropriate legal authorisations were in place when needed to deprive a person of their liberty. The service had not always worked within the principles of the MCA and if needed. Appropriate legal authorisations were in place to deprive a person of their liberty (DoLS).

When people were assessed as lacking capacity to make decisions appropriate procedures were not always followed to ensure principles within the MCA were followed. Decisions made were not always appropriately documented to demonstrate who had been involved in the decision. For example, 1 person’s file showed they were better at making decisions and choices in the mornings, but their capacity assessments had been completed in the afternoon. This had not been reviewed or changed since the last assessment.

A person’s care records showed there had been a best interest decision making meeting in relation to bathing and personal care. The best interest meeting record was dated 16 March 2021 and detailed that staff, the previous manager as well as the person’s parents were involved. Receiving personal care, continence care and being bathed was a known accelerant to the person becoming agitated and distressed. The best interest meeting did not document any actions in relation to declining continence care and what staff should do.

There were a number of incident forms that staff had completed showing that the person had been agitated and distressed during personal care 7 times in February 2026 and 1 time in March 2026. The person was noted to be screaming, attempting to hit and bite staff. Care notes recorded that staff continued to provide personal care in the person’s best interests. The best interest record detailed that the decision should be reviewed to check that the decision was still appropriate due to the incidents. There was no evidence that this had been reviewed to ensure the least restrictive approach was taken.

It was not always clear in the completed assessments if people lacked capacity or not. It was not always documented that other people (such as relatives, GP, advocate) had been involved in best interest decision making. Some people had an RPR (Relevant Person's Representative) who regularly visited them. An RPR is a role designed to support and represent people who are deprived of their liberty under DoLS, ensuring their rights are protected and their views are heard.

People told us they made choices, and we observed people making choices throughout the assessment. We observed staff supporting a person to choose the type of footwear they wished to wear and whether they wanted to wear socks or not. The person’s decisions and choices were respected. Care records showed where people made choices.

Staff described how they offered people choices including what to wear, what to eat and how to spend their time. We observed staff practice. Where people needed additional support to make choices, alternative methods were used to communicate with people. This included visual aids and use of sign language. Relatives told us that their loved ones were supported to make choices. A staff member said, “I give them a choice and if they are not able to then I follow the care plan. If they are able to get themselves dressed, then you let them do so.”