Milton Court Care Home

Milton Court is a care home providing personal and nursing care to up to 148 people. The service provides support to older people who are living with physical disabilities, mental health, and dementia. At the time of our inspection there were 98 people using the service.

The service comprises of 6 units, 5 units were in use at the time of the inspection, 2 of these provided nursing care. Each unit has its own communal areas which includes a lounge, dining room and kitchenette. All bedrooms have en-suite shower rooms.

People’s experience of using this service and what we found

The provider did not always support people to follow their interests or provide sufficient engagement opportunities. Records were not always person centred. At times staff were task led. People’s communication needs were not always fully met. Complaints were managed appropriately.

Systems to assess and monitor the service were not always effective. When things went wrong the provider ensured appropriate actions were taken in line with the duty of candour. There was a positive attitude to learning from mistakes.

There were enough staff to keep people safe. People were protected from the risk of harm and abuse. The provider had suitable risk assessments in place to keep people safe. Medicines were managed safely. People were protected from the risk of infection.

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.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was requires improvement (published 08 December 2021). The service remains rated requires improvement. This service has been rated requires improvement for the last 3 consecutive inspections.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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 COVID-19 and other infection outbreaks effectively.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has remained requires improvement based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Milton Court care home on our website at www.cqc.org.uk.

Enforcement and recommendations

We have identified a breach in relation to person centred care at this inspection. We have made a recommendation in relation to the providers governance systems.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Milton Court Care Home is a residential care home, providing personal and nursing care to up to 148 people, some of whom are living with dementia support needs. At the time of inspection, 109 people were living at the service. The service comprises of six units. Each unit has its own communal areas which include a lounge, dining room and kitchen area. On the day of the inspection, one unit had been closed to support staffing levels and staff distribution within the service.

People’s experience of using this service and what we found

Staffing levels were not always sufficient. We saw rotas which showed that assigned staffing levels were not always met due to staff shortages. People and staff gave us mixed feedback on staffing levels within the home, and whether peoples’ needs were always met in a prompt manner. The registered manager was open and honest regarding the staff recruitment difficulties at this time.

We received mixed feedback from staff regarding the support they received from management team, and the general morale within the home.

An activity programme was in place, but participation in activities was negatively affected by the staffing shortages.

Medicines were stored and administered safely.

The service was clean, tidy, and well maintained. Infection control procedures were effectively followed by staff.

Staff were recruited safely, and inducted and trained to ensure they had the skills to carry out their roles.

A complaints system was in place. People knew how to use it, and the management responded to people appropriately.

Staff treated people with kindness, dignity and respect. We observed positive interactions between people and staff, and feedback from people about staff relationships were good.

The management notified CQC of specific events, as and when required.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was Requires improvement (published 16 June 2021)

Why we inspected

The inspection was prompted in part due to concerns received about staffing levels and ongoing management of the service . We also wanted to look at the action that had been taken since our last inspection, when a breach of regulation occurred.

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 COVID-19 and other infection outbreaks effectively.

We have found evidence the provider needs to make improvements.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service is Requires improvement. This is based on the findings at this inspection.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Milton Court Care Home on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

The service comprises of six units, Sandringham, Windsor, Balmoral, Kensington, Highgrove and Buckingham. Kensington & Buckingham providing nursing care. Each unit has its own communal areas which includes a lounge, dining room and kitchenette. All bedrooms have en-suite shower rooms.

People’s experience of using this service and what we found

Many people we spoke with referred to there not being enough staff and spoke of staff being very busy. Not everyone could tell us how this impacted on their care, but some people were able to express their views. Comments included staff’s ability to provide timely personal care, and delays in the serving of their meals. A person told us, “The problem here is the shortage of staff. I got up at 5.55am this morning, I had to wait until 08.30am before they came and did my care. They didn’t even bring me a cup of tea.” They went onto say, “Sometimes my care is rushed, especially if they are short staffed.”

Staff spoke about their roles and responsibilities, which included providing personal care, serving and supporting people with their meals, and completion of records. Staff told us their ability to provide timely and good quality care reflective of their role was impacted by there not being enough staff.

The needs of people had been considered in determining staffing numbers. However, comments received from people and staff indicated that staffing numbers were not sufficient to meet peoples’ needs.

We observed staff interactions with people. We found improvements were needed as not all staff communicated with people whilst supporting them. We saw a member of staff remove soup away from a person, which they hadn’t eaten. Staff did not ask the person if they wanted it.

Staff did not always enable people to undertake daily living activities as they did not always ensure people with the necessary items. For example, we saw a person being given their breakfast, they asked if we would get their dentures. We asked a member of staff who found them. The person told us they couldn’t eat without them.

Staff were critical of the registered manager and management team. Staff spoke of not feeling valued, appreciated, or listened to. Staff spoke of poor communication and expressed improvements to communication and the opportunity to share their views as being a priority.

Views about meals were mixed, some stated they were of good quality and they enjoyed them, whilst others said the quality was not very good and sometimes their meal was cold.

A majority of people spoke positively about the staff. A person told us, “Some staff are excellent, kind and they listen to me, generally speaking they are excellent and respectful.” We saw positive staff interactions with people. A person who was distressed was being comforted by a member of staff, talking with them and making eye contact.

People’s needed were assessed and documented. However, we found improvements were needed to ensure people’s care needs were consistently documented throughout their records.

People’s medication was administered safely. The service was clean and tidy. The registered manager worked in line with government guidance for COVID-19 infection prevention and control measures, including visiting arrangements of family members.

Staff said some changes had had a positive impact. Staff spoke well of the support they received from their immediate staff team and spoke positively about their training.

The registered manager had taken up their role in January 2021. The registered manager and regional manager had identified improvements were needed and had developed an action plan detailing their priorities to bring about change.

Systems and processes to monitor the quality of the service and review risk were in place. The registered manager and senior managerial staff who visited the service, undertook a range of audits to assure themselves as to the quality of the service.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was Good (published 29 December 2017).

Why we inspected

The inspection was prompted due to whistle-blowing concerns received about staffing levels. A decision was made for us to inspect and examine these risks. As a result, we undertook a focused inspection to review the key questions of Safe and Well-led only.

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 COVID-19 and other infection outbreaks effectively.

We have found evidence the provider needs to make improvements.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from Good to Requires improvement. This is based on the findings at this inspection.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Milton Court Care Home on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection.

We have identified a breach in relation to their being insufficient staff to meet people’s needs consistently, and in a timely way at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

People’s experience of this service and what we found.

People and staff felt that staffing levels were not always safe within the service. Formal assessment of people’s needs had not been used in calculating appropriate staffing numbers.

The service was clean and tidy. Thorough cleaning took place regularly, which included touchpoint areas such as door handles.

Procedures were in place to facilitate contact between people and their families, when this was allowed.

Visitors to the service were required to undergo a temperature check, and wear correct Personal Protective Equipment (PPE) at all times.

Suitable arrangements were in place to ensure that if anyone were to move in to the service, they would do so safely. This would include a negative COVID-19 test before moving in, and isolating for a 14-day period within the service.

Staff had access to sufficient supplies of PPE including masks, gloves, aprons and hand sanitiser. The manager had been proactive in ensuring stock levels remained good for the staff. We observed staff using PPE correctly throughout the service during our inspection.

Staff followed guidelines with the donning and doffing of PPE, and had an area within the service where this could be done safely.

Regular testing was completed for staff and people living at the service. This meant prompt action could be taken should anyone test positive for COVID-19.

Regular checks and audits around infection control were completed to ensure the registered manager had oversight on the service, and could address any issues promptly if found.

Rating at the last inspection

The last rating for this service was Good (published 30 December 2017).

Why we inspected

We undertook this targeted inspection to follow up on specific concerns which we had received about the service. As part of CQC’s response to care homes with outbreaks of coronavirus, we are conducting reviews to ensure that the Infection Prevention and Control practice (IPC) was safe and the service was compliant with IPC measures. This was a targeted inspection looking at the IPC practices the provider has in place, as well as staffing levels within the service.

We have found evidence the provider needs to make improvements. Please see further detail in the Safe section of this report.

You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Milton Court Care Home on our website www.cqc.org.uk

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.

Milton Court Care Centre 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

Milton Court Care Centre accommodates up to 148 older people in a purpose built building which has four floors. Each floor has its own adapted facilities. One floor provided general nursing, two floors provided care and support for people living with dementia and memory loss and one floor provided residential care. At the time of our inspection there were 130 people staying there.

The service had 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.

People received care from staff that knew them and were kind, compassionate and respectful. However, people’s experience of care differed dependent on which area of the home they lived. Care at times was task focussed and there was limited interaction with people outside of completing care tasks.

People’s needs were assessed prior to coming to the home and detailed person-centred care plans were in place and were kept under review. Risks to people had been identified and measures put in place to mitigate any risk.

There were appropriate recruitment processes in place and people felt safe in the home. Staff understood their responsibilities to keep people safe from any risk or harm and knew how to respond if they had any concerns.

There were sufficient staff to meet the needs of the people; staffing levels were kept under review. Steps were being taken to reduce the number of staff deployed from an agency which provided staff cover for absences to ensure consistency in the quality and standard of care.

Staff were supported through regular supervisions and undertook training which helped them to understand the needs of the people they were supporting. People were involved in decisions about the way in which their care and support was provided. Staff understood the need to undertake specific assessments where people lacked capacity to consent to their care and / or their day to day routines. People’s health care and nutritional needs were carefully considered and relevant health care professionals were appropriately involved in people’s care.

People were cared for by staff who were respectful of their dignity and who demonstrated an understanding of each person’s needs. This was evident in the way staff spoke to people and the activities they engaged in with individuals. Relatives spoke positively about the care their relative received and felt that they could approach management and staff to discuss any issues or concerns they had.

There were comprehensive systems in place to monitor the quality and standard of the home. Regular audits were undertaken and any shortfalls addressed.

The registered manager was approachable and people felt confident that any issues or concerns raised would be addressed and appropriate action taken.

The service strived to remain up to date with legislation and best practice and worked with outside agencies to continuously look at ways to improve the experience for people.