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Milton Grange Requires improvement


Inspection carried out on 20 January 2020

During a routine inspection

About the service

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 n

Inspection carried out on 17 October 2016

During a routine inspection

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 carried out on 7 May 2013

During a routine inspection

We spent time on each of the units at Milton grange. People we met had varied and complex needs. Not all of them were well enough to tell us about their experiences. However, we were able to speak with eleven people using the service, three relatives, and seven staff. These conversations, in addition to observations made, and records viewed, provided us with a good understanding of how well people�s needs were being met.

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.

Inspection carried out on 18 May 2012

During an inspection in response to concerns

We used a number of different methods to help us understand the experiences of people using the service, because some of the people using the service had varying and complex needs which meant they were not all able to tell us their experiences. We spoke to two relatives and one visitor who were visiting the home.

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 �.

Inspection carried out on 2 August 2011

During an inspection in response to concerns

Two people we spoke with said they liked living at the home, but one said they wanted to go home now. Another person said you couldn�t expect staff to do everything for you, and you needed to do things for yourself. One person said they wanted to go in the garden but felt �they� (staff) would not let them �they never do�.

Reports under our old system of regulation (including those from before CQC was created)