Archived: Milestones Care

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.

Milestone Care provides accommodation for up to four people living with a learning disability, mental health and physical health needs. Three people were living at the service at the time of the inspection.

Milestone Care is required to have a registered manager. 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. A registered manager was in place.

People who used the service were protected from abuse and avoidable harm. Staff had received adult safeguarding training and were aware of their role and responsibilities in protecting people. Information was available for staff, people who used the service and visitors about the procedure to report any safeguarding concerns.

Risks associated to people’s individual needs had been assessed and planned for. Risk plans were monitored and amended when required. Staff were aware of risks associated to people’s needs and how to reduce risk from occurring. Risks associated to the environment and premises had also been assessed and safety checks had been completed.

The provider had ensured safe staff recruitment checks were completed before staff provided care and support. This was to ensure that as far as possible, people were cared for by suitable staff. Staffing levels were sufficient and flexible in meeting people’s individual needs and safety. People who used the service received their medicines as prescribed and these were managed correctly.

Staff had received an induction when they commenced their employment and ongoing training to keep their skills and knowledge up to date. Staff received opportunities to meet with the registered manager to review their work and development needs.

Staff involved people as fully as possible in discussions and decisions and gained consent before care and support was provided. Where required people’s mental capacity about specific decisions relating to the care and support had been appropriately completed. However, best interest decisions had not been recorded. The registered manager took immediate action to make the required improvements to ensure the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards legislation was fully adhered.

People who used the service were involved in the menu planning, food shopping and meal preparation. People received sufficient to eat and drink and external advice had been sought to support staff to promote healthy eating. The service involved external health and social care professionals appropriately in meeting people’s individual needs.

Staff had a good understanding of people’s diverse needs and what was important to them, and people who used the service said they were kind and caring. Staff supported people to participate in activities, interests and hobbies of their choice. People’s privacy, dignity and independence was respected and promoted.

People’s care records showed a person centred approach was used by staff. Information was based on people’s individual choices, routines and what was important to them. A complaints policy was in place and people who used the service knew how to make a complaint. Information about independent advocacy services was available for people should they have required this support.

People who used the service received opportunities to share their views about the service. Where people had requested changes or improvements these had been responded to.

Staff felt valued and supported and were positive about the leadership of the service. The registered manager had checks in place that monitored the quality and safety of the service. These included daily, weekly and monthly audits. In addition the provider had developed an ongoing action plan that showed continued improvements to the service were being made.