We carried out a review of the data available to us about Milton Grange on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Milton Grange, you can give feedback on this service.
Milton Grange is a residential care home providing short term rehabilitation, including personal care for up to 37 older people. During the pandemic the service had also provided accommodation to some people discharged from hospital who were waiting for other, longer term placements to become available or to return home with a package of care. At the time of the inspection there were 29 people using the service. The service was split into four areas covering those living with dementia, older people and those living with mental health issues. During the past 12 months, 377 people had used the service.
People’s experience of using this service and what we found
Regular auditing was carried out and overseen by the registered manager. There had been a high number (34) medicine errors and near misses that occurred in the previous 12 months. Following the inspection, we were sent documents that confirmed medicine audits took place and any learning shared with staff. We discovered one medicine error on the day of inspection which was immediately addressed.
Care was person centred and this was reflected in care plans that had recently been updated and reviewed. The registered manager promoted a positive culture at the service. The service was welcoming and friendly. Staff we spoke to spoke highly of the registered manager, their support and visible presence throughout the service. People, relatives and staff were given opportunities to feedback about the service. Positive working relationships had been established with partner agencies for example, the hospital discharge co-ordinators.
People told us they felt safe. Staff had received training in safeguarding and were confident in reporting concerns. Staff told us that appropriate action was always taken quickly to protect people. Accidents and incidents had been reported, investigated and any learning shared with all staff. Risk assessments had been completed for all aspects of people’s care and wound care management followed NICE guidelines. Medicines were stored and disposed of safely. Safety checks and reviews had been completed on fire, gas and electrical equipment.
We found the complaints policy had been fully updated and reviewed. Complaints had been recorded and investigated in a timely way with conclusion letters sent to complainants. People and relatives told us they were confident in raising complaints and issues, knowing that they would be dealt with appropriately.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection and update
The last rating for this service was requires improvement (published 1 April 2020). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.
Why we inspected
We carried out an unannounced comprehensive inspection of this service on 20th January 2020. A breach of regulation was found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment.
We undertook this focused inspection to check they had followed their action plan and to confirm they now met regulations. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those regulations.
We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.
The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has improved to Good. This is based on the findings at this inspection.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Milton Grange on our website at www.cqc.org.uk.
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.
Milton Grange is a residential care home providing short term rehabilitation, including personal care to up to 37 older people. At the time of the inspection there were 34 people using the service. The service is split into two areas, one provides support for people living with dementia or other mental health issues, there were nine people in this area during our inspection. The remaining 25 people received support in the generic unit. In the past 12 months approximately 450 people had used the service.
Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.
People’s experience of using this service and what we found
Documentation in care plans relating to care plans were poor. NICE guidelines had not been followed and little information was included about intervention and treatment. In addition, although a pain chart was included which identified increased pain being experienced, no ongoing monitoring was shown. You can see what action we have asked the provider to take at the end of this full report.
The service had not correctly recorded complaints. Several incidents that by definition fell under the service complaints definition had been included in a minor incident folder. Some investigation had taken place but no analysis of trends was possible due to incorrect recording. Several people we spoke with did not know the process of making a complaint. The complaints policy had written on the front, ‘next review 2015.’ We have made a recommendation about the management of complaints.
Some care plans lacked detail. Some areas of personal details were missing, consent forms had not consistently been completed and use of the MUST tool was inconsistent. One plan lacked detail about the reasons for a fall that had resulted in the person being at the service and therefore no specific detail was available to focus the reablement plan on. Another plan failed to highlight a unique characteristic of a person which directly impacted on their support. The registered manager lacked oversight on these issues with no effective auditing process in place for care plans.
Staff had received training in safeguarding and were able to describe to us what action they would take. People told us that they felt safe. Accidents and incidents had been recorded and lessons learned taken forward. Risk assessments bespoke to people had been completed and medicines were stored and administered safely. Fire and other safety checks had been completed. Staff had been recruited safely with all required checks having been completed.
Staff training was up to date and a training plan showed us how training was managed and refresher training organised. Staff training was relevant to people’s needs. Induction for new staff was thorough and ongoing supervision and appraisals ensured staff were supported. The service provided rehabilitation for people preparing them to return home safely and this was supported by access to health and social care professionals. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.
Staff were kind to people and people were treated with dignity and respect. Staff had a good understanding of people and their day to day needs, likes and dislikes. People’s privacy was respected and they could choose whether to spend time in their bedrooms or to socialise with others. Independence was a key element of the service and people were encouraged and supported in all areas in preparation for their return home.
A range of activities were readily available for people and these could be enjoyed in groups or one to one with staff in their own rooms. People’s communication needs were considered and processes were in place to support people around the service. The registered manager had received end of life training and one of the intermediate care managers at the service attended the East Sussex end of life care clinal reference group. Staff who had experienced these situations were able to tell us about the appropriate care they had provided.
The registered manager provided opportunities for people, relatives and staff to feedback about the service. The registered manager although very new to the role was well thought of by staff and relatives. The registered manager understood the duty of candour, was honest and had positive plans for the future development of the service. The service had a good working relationship with partners and professionals.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
Outstanding. (Report published 16 February 2017)
Why we inspected
This was a planned inspection based on the previous rating.
We have found evidence that the provider needs to make improvements. Please see the safe, responsive and well-led sections of this full report.
You can see what action we have asked the provider to take at the end of this full report.
Enforcement
We have identified a breach in relation to safe care and treatment at this inspection.
Follow up
We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
The aim of the service is to maximise people’s ability to live independent lives, improve their health and prevent admission to hospital. In addition to short term intermediate care the service could also provide a place of safety for example if a person’s home situation changed suddenly and immediate alternatives could not be found. For example if their main carer is hospitalised and the person would be unable to care for themselves or if a safeguarding concern had been raised and it was unsafe for the person to remain in that situation. Milton Grange is run by East Sussex County Council. There was a Day Centre at Milton Grange which was also run by East Sussex County Council for people living with dementia. This was used by some people at Milton Grange and, if it is felt they may benefit from this, after their discharge to avoid social isolation.
There is a registered manager at the service. 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.
This was an unannounced inspection which meant the provider and staff did not know we were coming. It took place on 17, 18 and 19 October 2016.
We found Milton Grange to be a value led service where staff fully engaged with and promoted the values of the provider. This was evident throughout our inspection. People were supported by staff who had a strong understanding of them as individuals and their needs. They were empowered and encouraged to plan and meet their rehabilitation goals to enable them, as far as possible, to return home. Staff worked closely with community health professionals and therapists to maximise people’s well-being.
People’s choices and wishes were at the heart of the organisation and the aim was for people to return home. They received excellent care in a way that was personalised and responsive to their changing needs. Staff treated people with kindness and respect. They spent time with people and encouraged them to make their own choices. People’s dignity was fully respected and maintained. People benefitted from a person centred service, which actively sought their views and promoted individual well-being, inclusion and openness.
People told us they felt safe whilst staying at the service. There were systems in place that ensured medicines were well managed and people received their medicines when they needed them. These systems were regularly audited and action taken to rectify shortfalls and prevent a reoccurrence.
There were enough support staff, nurses and therapists on duty to meet people’s needs and ensure they received the person centred care they required. The staffing levels ensured people had the opportunity for social interaction with staff on a regular basis throughout each day and not just for task based care such as personal care. People’s mental well-being was also a key priority for the manager and the provider. .
Staff had been robustly recruited and were suitable to work at the home. They had a clear understanding of what constituted abuse and told us what actions they would take if they believed someone was at risk.
Risks to people's safety were thoroughly identified, assessed and managed. Assessments identified people's specific needs, and showed how risks could be minimised whilst allowing people to live independent and fulfilling lives.
Staff had a clear understanding the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. They were knowledgeable about the requirements of the legislation and knew how to support people in the least restrictive ways.
The manager and chef worked hard to ensure people were supported to eat and drink food of their choice and maintain a healthy diet. Nutritional assessments were in place and helped staff to identify people who may be at risk of malnutrition.
Staff knew people exceptionally well and recognised when they may need to be referred to an appropriate healthcare professional for example the GP or district nurse.
There was a robust induction programme for all staff to ensure they had the appropriate knowledge and skills before they commenced working unsupervised. Staff received on-going training and support they required to ensure people’s needs were met. They enjoyed working at the service and felt well supported in their roles. They had access to a wide range of training which equipped them to deliver their roles effectively. We could not tell the difference between agency and permanent staff which demonstrated the highly effective training and support provided.
The registered manager recognised that they also needed to continually learn and develop and worked with a wide range of professionals to continually develop the service.
The vision and values of the service were constantly demonstrated by staff in their interactions with people and with each other. Staff had a clear understanding of their responsibilities. They were always well supported by the registered manager and their colleagues.
The registered manager had created an open, transparent and inclusive atmosphere. There was strong oversight of the service and the registered manager worked with staff to promote continual learning and development to improve people’s lives.
There was a robust system of quality assurance in place. Audits were analysed to identify where improvements could be made. Action was taken to implement improvements and drive the service forward.
People we spoke with were complimentary about the service. Some people expressed surprise at just how much they were enjoying their stay. People spoken with universally said they found staff kind and helpful.
Relatives also spoke positively about the service and the care their parent, or spouse received. They told us that they felt staff kept them informed about any issues that arose with their relative.
We looked at a random selection of care plans. These showed that people were assessed, and their needs and support were clearly recorded to inform staff. We checked arrangements for medication and found that a safe system was in place. We viewed six staff recruitment files. We found that appropriate checks of new staff were made to ensure they were fit for their role. We were satisfied that systems for quality monitoring and complaints management were in place.
We were told that people's privacy and dignity was respected. One relative said 'they do ensure peoples' dignity is upheld and are very respectful'. We were also told that 'staff are polite and friendly'. One relative said that they are kind.
They confirmed that their relatives' door was always knocked on before staff entered. Another relative said that the staff tell them what has been happening and informs them of any changes.
People spoken with said the food is good and there is plenty of it.
A relative said 'they try different food to tempt my relative'.
We were told by the people who used the service 'Its good plain food, too much though on my plate'.
People told us that they liked their rooms and that they were cleaned regularly.
One visitor said 'excellent care, all the staff know my relatives needs, well looked after', the staff are very respectful and caring '.