Archived: Milton House

Updated 28 January 2022

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

This inspection was conducted by two inspectors.

Service and service type

Milton House 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.

The service did not have a manager registered with the Care Quality Commission. This means the provider is legally responsible for how the service is run and for the quality and safety of the care provided. There was a manager in post who was planning to become the registered manager. We refer to them as the manager throughout this report.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service.

During the inspection

We carried out observations of people's experiences throughout the inspection. We spoke to two people who used the service about their experience of the care provided. We spoke with eight members of staff including the nominated individual, the manager and care workers, including agency care workers. The nominated individual is responsible for supervising the management of the service on behalf of the provider. We spoke to two family members about their experience of the care provided. We reviewed a range of records. This included positive behavioural support plans and medicines records for two people. We looked at three staff files in relation to recruitment and a variety of records relating to the management of the service.

After the inspection

We spoke to two relatives about their experience of the care provided and received feedback from one member of staff. We reviewed a range or records. This included three people’s care records and four people’s medicine records. We reviewed a variety of records relating to the management of the service, including risk assessments, quality assurance records, training data and policies and procedures. We continued to seek clarification from the provider to validate evidence found. We received feedback from two professionals who were in regular contact with the service and from one staff member.

Following our first three site visits and review of documentation, we were not assured people were receiving safe care and treatment. We made the decision to carry out a further site visit on 7 January 2022. We spoke with three care workers. We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us. Observations from this visit have been included within this report.

Updated 28 January 2022

About the service

Milton House is a residential care home providing personal care to four people at the time of the inspection. The home can accommodate up to six people in one building and there are multiple communal areas. They predominantly support people living with a learning disability and/or autism.

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

The provider had not established an effective system to ensure people were protected from the risk of abuse. Risks to people's health and wellbeing had not been monitored or mitigated effectively. People were at risk of harm because staff did not always have the information, they needed to support people safely. A number of safety concerns in relation to the environment were identified. The service was not always clean. Medicines were not managed safely, and medicine administration records were not always complete. The provider had not ensured there were sufficient numbers of competent and skilled staff to support people safely. Fire risk was not managed safely. At our last inspection we found safeguarding incidents had not always been reported as required to the local authority. At this inspection we identified a continued lack of reporting of safeguarding incidents.

At the last inspection we found care plans and risk assessments lacked sufficient detail to ensure people were supported safely. At this inspection we found improvements had not been made. We observed care plans and risk assessments continued to lack sufficient detail to support people safely.

People were not protected from the risks of COVID 19 and other infectious disease and we could not be assured the provider was making sure infection outbreaks could be effectively prevented or managed.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

Based on our review of key questions safe and well-led, the provider was not able to demonstrate how they were meeting the underpinning principles of Right support, right care right culture. The service was not maximising people's choices, control or independence. People were not always supported to make meaningful choices. There was a lack of person-centred care and people's human rights were not always upheld. A lack of timely action by leaders to ensure the service was well staffed and safeguarding incidents were responded to meant people did not lead inclusive or empowered lives.

People were not given regular opportunities to discuss their individual care needs or wider issues in the home. People had care plans in place. However, these were not always written in a way that was person-centred and easy to understand. We observed people were not always supported in an open, inclusive and empowering way.

Systems in place to promote staff learning and development were ineffective. Improvements were not clearly identified.

The service was not well led. At our last inspection the quality assurance systems to assess and monitor the service were not always in place, and where they were, they were not effective. At this inspection we found the provider did not have enough oversight of the service to ensure it was being managed safely and quality maintained. Quality assurance processes had not identified all of the concerns in the service and where they had, sufficient improvement had not taken place. Records were not always complete. People and stakeholders were not always given the opportunity to feedback about care or the wider service. Indicators of a closed culture were identified, and staff morale was low. This meant people did not always receive high-quality care

The provider had failed to notify CQC of significant events that happened in the service as required by law.

The provider had not displayed their rating for Milton House within 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 and update

The last rating for this service was Inadequate (published 28 September 2021) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had not been sufficient and the provider was in breach of nine regulations, eight of which were continued breaches.

This service has been in Special Measures since 16 August 2021.

Why we inspected

The inspection was prompted in part due to concerns received about information shared being incomplete or inaccurate, withholding of information, people not being supported appropriately to prevent them from becoming distressed, lack of communication between the nominated individual and staff, incidents not being taken seriously and responses to safeguarding enquiries not being met. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

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 remains inadequate. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. Please see the Safe and Well-Led sections of this full report.

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

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.

We have identified breaches in relation to staffing, person-centred care, safe care and treatment, management of risk, safe management of infection prevention and control, safeguarding people from abuse, safe management of medicines, premises and equipment, duty of candour, assessing and monitoring risk, good governance, failure to display ratings and failure to report to CQC.

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

Follow up

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.