Archived: Milestone House

On this page

• 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 continued breach of legal regulation in relation to person centred care.

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 their new care plan which had been created on the electronic care planning system. Their old care plan had been adjusted after the last assessment to include information about when staff should escalate constipation concerns. However, this care plan had not been followed, and constipation concerns had not been escalated.

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 at the last assessment they had not been supported to go on holiday. No holidays had taken place since we last assessed the service and no actions had been taken to work towards some of the goals.

Since the last assessment, most people had been reviewed by the local authority to check that their care and support needs were being met. The local authority told us that although basic needs were being met, people were isolated because they spent a lot of time indoors.

Care plans were not always person-centred. Oral care was lacking and vague in the care plans and within the care records. When it was mentioned, it did not detail what sort of support required, whether people had their own teeth or dentures. It was not clear that people were having their needs met in relation to their oral health care. Oral care records for 1 person showed, they had been supported with teeth cleaning once a day. Their care plan specified they needed support twice a day to do this. Another person’s care plan stated they needed support twice a day, they had only been supported twice a day 5 times in a month, there were 6 days in the month where there was no documented oral hygiene support. Their record only showed 1 refusal of oral hygiene support in the month.

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 checked the handover records for the service between 04 February 2026 and 04 March 2026, there were no entries from staff recording or handing over any concerns about constipation for the people we identified that had not opened their bowels for long periods of time. We joined a staff handover meeting between the day staff and the night staff. During this meeting staff discussed the bowel movements of 2 people out of 9.

There was a lack of continuity in relation to assessments, the manager told us they had referred people on for assessments. A healthcare professional told us, they and their colleagues had not been successful in getting in contact with the service, due to no responses to phone calls so they had closed referrals without seeing people.

The provider supplied appropriate, accurate and up-to-date information in formats that were tailored to individual needs. The service had signs and way marking. 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.

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. We observed a staff member sign to a person to ask if they would like help to wash their hair when they took their bath. The person signed back and said no, as they had been to the hairdressers and wanted to leave their hair.

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 told us no surveys had taken place since we last assessed the service. They planned to complete surveys with people in 2026. Some people were unable to feedback, so staff gauged their happiness levels through observations and changes in their behaviour. We observed easy to read complaints processes on the inside of people’s bedroom doors.

Staff told us they would support people to make complaints about the service if they wished to. Staff were aware that people had copies of the policy in their bedrooms.

The manager shared how they were also planning to develop surveys in 2026 for staff and relatives. We received positive feedback from relatives about how their comments, concerns or complaints had been handled.

The provider did not always make sure that people could access the care, support and treatment they needed when they needed it.

People were not always supported with medical appointments and follow up appointments. The diary at the service showed a person had been scheduled to have a learning disability health check on 05 March 2026. The person was non-verbal and unable to communicate their health needs. The appointment had been cancelled by the service as there was no transport to support the person to the appointment. The manager told us another person had missed a dental appointment in January 2026 for the same reason. They told us that the provider was committed to funding transport such as taxis to avoid anyone else missing appointments.

Other people’s care records showed that they had received medical help. 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 experiences. Some people who used bigger wheelchairs were not enabled to access the community and carry out activities as their peers.

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. A person had a funeral plan in place.

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.