Archived: Milestones Care

Updated 16 November 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service and to provide a rating for the service under the Care Act 2014.

Prior to our inspection, we reviewed information we held about the service. This included information received from local health and social care organisations and statutory notifications. A notification is information about important events, which the provider is required to send us by law, such as, allegations of abuse and serious injuries. We also contacted commissioners of the service and asked them for their views. We used this information to help us to plan the inspection.

We did not request a Provider Information Return prior to our inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. However, we gave the provider opportunity to share information with us during the inspection.

The inspection was undertaken by two inspectors. During our inspection visit, we spoke with two people who lived at the home and the relative of one person. We also spoke with four members of care staff, the deputy manager, the service manager, the regional manager and the provider.

To help us assess how people's care needs were being met we reviewed all, or part of, four people's care records and other information, for example their risk assessments. We also looked at the medicines records of all four people, three staff recruitment files and a range of other records relating to the running of the service. We carried out general observations of care and support and looked at the interactions between staff and people who used the service.

Updated 16 November 2018

We conducted an unannounced inspection at Milestones Care on 19 September and 3 October 2018. Milestones care 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 this inspection. Milestones Care accommodates up to four people in one building. On the day of our inspection, four people were living at the home; all of these were people with support needs related to mental health conditions or learning disability.

This was the second time we had inspected the service since they registered with us in October 2014. At our July 2016 inspection we rated the service as Good. At this inspection we found the safety and quality of the service provided had deteriorated. This was the first time this service had been rated as Inadequate.

There was no registered manager in post at the time of our inspection. The previous registered manager had left the service in June 2018. 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. There was a service manager in post at the time of our inspection, they were in the process of registering with CQC. We will monitor this.

During this inspection we found the service provided at Milestones Care was not safe. Risks associated with people’s care and support had not always been effectively assessed or mitigated. Risks such as choking and smoking were not managed safely, this placed people at risk of harm. Opportunities to learn from accidents and incidents had been missed. Environmental risks, specifically, fire risk, were not always managed safely.

People were not properly protected from abuse and improper treatment, referrals were not always made to the local authority safeguarding adults team and there was a risk people’s allegations may not be taken seriously. Safe recruitment practices were not always followed. There were enough staff to ensure people’s safety. Overall, medicines were stored and managed safely and the environment was clean and hygienic.

People were not supported to have maximum choice and control of their lives and were not supported in the least restrictive way possible; the policies and systems in the service did not support this practice. People did not always have timely access to support from health professionals. Staff did not have up to date training in some key areas. This meant there was a risk that people may receive care and support from staff who did not have the necessary skills and qualifications to support them effectively. Although people told us they had enough to eat and drink, risks associated with eating and drinking were not always managed in a safe way.

Overall, people had choices in relation to their day to day support; however, people’s preferences were not always acted upon. Relatives told us they were not always informed about people’s care.

We received some feedback that changes in the staff team lead to a lack of continuity in care. People’s need for advocacy support to help them express their views had not always been identified. People told us staff were kind, caring and respected their right to privacy. We saw positive interactions between staff and people living at the home. People were encouraged to be as independent as possible.

Each person had a support plan in place which detailed their needs and preferences. However, records did not demonstrate that support was always provided in line with directions in these plans. There was a risk people’s complaints may not be treated in a fair and equal manner. Further work was required to ensure the provider met their duties under the Accessible Information Standard.

People were provided with a range of opportunities for social activity. People’s diversity was respected and supported. People had been offered the opportunity to discuss their wishes for the end of their lives and this was recorded in their support plans.

The service was not well led. There was a lack of effective leadership at Milestones Care. Governance systems were not adequate which meant areas of concern were not identified or addressed. The provider had failed to investigate and learn from serious incidents. Where areas for improvement had been identified, the provider had not always taken effective action to ensure people’s safety. The provider had not ensured that staff had a good knowledge of their roles and responsibilities. People and their relatives were not given the opportunity to get involved in the running of the home. There had been a failure to notify CQC of some events within the service. Staff told us they were involved in the development of the home.

During this inspection, we found five breaches of the Health and Social Care Act 2008 regulations. You can see what action we told the provider to take at the back of the full version of the report. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.