Milton Grange

Updated 24 April 2021

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was carried out by two inspectors.

Service and service type

Milton Grange is a ‘care home.’ People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided and both were looked at during the inspection.

The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

The inspection took place on 5 March 2021 and was announced. The inspection covered Infection Prevention and Control measures. The inspection was announced to ensure there were no infection risks that would prevent our visit.

What we did before the inspection

Before the inspection we reviewed the information we held about the service and the service provider. We sought feedback from the local authority and healthcare professionals that are involved with the service. We looked at notifications we had received from this service. Notifications are information about important events the service is required to send us by law. We used all of this information to plan our inspection.

The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to provide some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made judgements in this report.

Due to the Covid-19 pandemic we needed to limit the time we spent at the home. This was to reduce the risk of transmitting any infection. To minimise the time in the service we asked the registered manager to send us some records for us to review prior to and following the inspection. This included documents relating to the management of infection prevention and control and policies relating to complaints, accidents and incidents and safeguarding.

During the inspection

We spoke to nine members of staff including the registered manager nurses, the practice manager, a senior support worker and a rehabilitation support worker. We spoke to four residents at the service. We spent a short time in the home. This allowed us to safely look at areas of the home and to meet people and staff whilst observing social distancing guidelines. It also gave us an opportunity to observe staff interactions with people.

We reviewed a range of records including care plans, medicine records, two staff files relating to recruitment and supervision and further records relating to the auditing of the service, safeguarding, accidents and incidents and complaints.

After the inspection

We continued to seek clarification from the provider to validate evidence found. We spoke to three relatives of residents currently living at the service.

Updated 24 April 2021

About the 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.