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Inspection Summary


Overall summary & rating

Outstanding

Updated 16 February 2017

Milton Grange provides intermediate care for up to 37 older people who require a period of rehabilitation or assessment into their abilities and need for support. People who meet the admission criteria usually stayed for up to six weeks. The service was divided into four separate units which specialise in different areas. Two units were for low level nursing and personal care for people who require a period of rehabilitation to recover from an injury or illness. For example following a fall, infection or other illness which makes it unsafe for them to be at home but does not necessarily warrant a hospital admission. The third unit supported people who had a mental health need such as anxiety, depression, schizophrenia or substance misuse, which could result in hospital admission if not resolved. The fourth unit supported people living with a dementia type illness for a period of rehabilitation. Although the units specialise in these areas, people may have more than one condition which means some overlap is needed. There may be clients on the low level nursing unit who also has a dementia diagnosis or there may be a person on the mental health unit with a low level nursing need. Allocation to units is decided upon within the assessment process and depends on which need is paramount at the time.

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 shortf

Inspection areas

Safe

Good

Updated 16 February 2017

Milton Grange was safe.

The management and storage of medicines was safe, and people received their medicines as prescribed.

There were enough support staff, nurses and therapists on duty who had been appropriately recruited to safely meet people’s needs.

Staff were able to recognise different types of abuse and told us what actions they would take if they believed someone was at risk.

Risks assessments were in place and risks were well managed.

Effective

Good

Updated 16 February 2017

Milton Grange was effective.

Staff were trained in the principles of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards and were knowledgeable about the requirements of the legislation.

People were supported to maintain a healthy diet. There were nutritional assessments to identify people who may be at risk of malnutrition.

Staff knew people well and recognised when they may need to be referred to an appropriate healthcare professional for example the GP or district nurse.

There was an induction programme in place and staff received the training and support they required to meet people’s needs.

Caring

Outstanding

Updated 16 February 2017

Milton Grange was exceptionally caring.

People were supported by staff that were wholly committed to providing high quality care and had an excellent understanding of their needs.

Staff worked with people to ensure they were always actively involved in all decisions about their care and treatment.

Staff communicated clearly with people in an extremely caring and supportive manner.

People were encouraged to make their own choices and had their privacy and dignity respected.

Staff consistently supported people to enable them to remain as independent as possible.

Responsive

Good

Updated 16 February 2017

Milton Grange was responsive.

People benefitted from a person centred service, which actively sought their views and promoted individual well-being, inclusion and openness.

Staff knew people well and they received the care and support they required to gain their independence and confidence.

People were involved in planning their own goals and identifying what support they needed to return to independent living.

People had the opportunity for social interaction with staff on a regular basis throughout each day.

Well-led

Outstanding

Updated 16 February 2017

Milton Grange was exceptionally well-led.

The vision and values of the service were consistently demonstrated by staff in their interactions with people and with each other.

The registered manager had created an holistic, open, transparent and inclusive atmosphere. She had an exceptional oversight of the service and worked with staff to promote continual learning and development to improve people’s lives.

Staff were aware of their responsibilities and told us they felt completely supported by the registered manager and their colleagues.

There was a robust system of quality assurance. Audits were analysed to identify where improvements could be made. Action was taken to implement improvements.