Milestones Support Services

Updated 3 June 2023

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 Health and Social Care Act 2008.

Inspection team

The inspection team consisted of 1 inspector.

Service and service type

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was a registered manager in post.

Notice of inspection

We gave the service 72 hours' notice of the inspection site visit. This was because it is a small service and we needed to be sure that the registered manager would be available to support the inspection. The inspection activity started on 21 April 2023 when we requested records and spoke with people on the telephone. A visit to the provider's office was then announced and completed on 28 April 2023.

What we did before the inspection

We reviewed information we had received about the service since the last inspection.

We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used information gathered as part of a monitoring activity that took place on 25 May 2022 to help plan the inspection and inform our judgements. We used all this information to plan our inspection.

During the inspection

We spoke with the relatives of 3 people who received personal care about their experience of the care and support provided. We spoke with 5 staff, including the registered manager who is also the nominated individual, about their role and experiences of caring for people. The nominated individual is responsible for supervising the management of the service on behalf of the provider. We reviewed a range of records. This included 2 people’s care records, medicine records, staff training records, quality monitoring records, accident and incident records, and the providers policies and procedures.

Updated 3 June 2023

About the service

Milestones Private Limited is a domiciliary care agency which is registered to provide personal care and support to people in their own homes. The service offers daytime and night-time care and support. The service is registered to provide support to children from 4 to 18years old, older people, younger adults, people with mental health needs, a learning disability or autistic spectrum disorder, and a physical disability. At the time of our inspection the service was supporting 8 people with 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.

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

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

Right Support:

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. People were supported by staff who understood and were trained in recognising the signs of abuse. Risks associated with people’s care were assessed but the management of risks was not always sufficiently recorded to demonstrate people had received the right support. Staff supported people with their medicines in a way that promoted their independence and achieved the best possible health outcome.

Arrangements were in place to ensure a consistent group of staff supported people. Families said staff usually arrived at the times agreed to provide the support needed to people. Staff knew people’s preferred communication needs and relatives confirmed staff were able to communicate effectively with people.

Right Care:

People’s needs were met through the delivery of care and support tailored to meet their needs and preferences although some areas of risk management needed improvement. People's needs were assessed prior to them using the service to ensure these could be met. Care plans been completed involving people and their family members where appropriate. Staff supported people’s privacy, dignity, and cultures. Relatives told us staff were respectful to their family member. Staff told us they had completed regular training and had the skills and knowledge required to meet people's specific needs. Staff were aware of people’s nutritional needs and supported people to eat and drink where this was required. People’s preferred method of communication was established and respected by staff.

Right Culture: The registered manager promoted an open and inclusive culture which had created a welcoming, warm, and friendly approach. People’s families spoke positively about the way the service was managed and the quality of service provided. Records across the service were not always clear to demonstrate effective systems were in place to capture people’s feedback and demonstrate any issues for improvement had been acted upon. Staff recruitment checks had not been fully completed before they started to work for the service to confirm they were safe and suitable to work with people. Some reportable incidents had not been notified to CQC as required. Staff were positive in their views of the service and support they received and confirmed the registered manager was approachable and available when they needed them.

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 13 February 2020). The service remains rated requires improvement. This service has been rated requires improvement for the last two inspections.

Why we inspected

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

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

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

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Milestones Private Limited on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to safe care and treatment and good governance at this inspection.

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

We will request an action plan from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.