28 April 2023
During an inspection looking at part of 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.