Archived: Milton House

Updated 10 February 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 9 and 10 January 2018 and was unannounced. It was carried out by one inspector.

Prior to the inspection we requested and received a Provider Information Record (PIR) on the service. The PIR is a form that the provider submits to the Commission which gives us key information about the service, what it does well and what improvements they plan to make. We reviewed other information we held about the service such as notifications and safeguarding alerts. We contacted health care professionals involved with the service to obtain their views about the care provided. We have included their written feedback within the report.

Some people who used the service were unable to communicate verbally with us. 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.

During the inspection we walked around the home to review the environment people lived in. We spoke with the registered manager, the deputy manager, three care staff and two people who used the service. We spoke with three relatives by telephone after the inspection. We looked at a number of records relating to individual’s care and the running of the home. These included four care plans and medicine records, shift planners, handover records, two staff recruitment files, staff training and five staff supervision records.

We asked the provider to send further documents after the inspection. The provider sent us documents which we used as additional evidence

Updated 10 February 2018

This inspection took place on the 9 and 10 January 2018. It was an unannounced visit to the service.

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.

Milton house accommodates 12 people in one adapted building. It is registered for people with epilepsy, learning and or physical disabilities. At the time of this inspection six people lived 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.

At the previous inspection in January 2017 the provider was in breach of Regulation 18 of the Health and Social Care Act. 2008. This was because sufficient numbers of suitably qualified staff, competent, skilled and experienced staff were not consistently provided. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key question safe and well-led to at least good. At this inspection we found systems had been put in place to ensure the minimum staffing levels were always maintained. However people’s needs had increased and changed since the previous inspection. As a result sufficient staff were not available at key times of the day to enable staff to safely meet people’s needs. The nominated individual immediately agreed to review the staffing levels and confirmed after the inspection that a third staff member would be rostered from 8am till 18:00 to provide an extra staff member at peak times. We have made a recommendation for the provider to keep the staffing levels under review in response to changes to people in line with best practice and dependency levels.

The people we spoke with and relatives were very happy with the care provided. Relatives commented “I am really grateful, I feel very lucky [person’s name] is there. I really can’t fault them.” Another relative commented “Staff have time for [person’s name} and they always show genuine concern and understanding. “

At this inspection the service was providing caring and responsive care. Improvements were required to ensure safe, effective and well- led care was maintained.

People were safeguarded from abuse but risks to people were not identified and managed. Staff were proactive in referring people on to the relevant professionals when people’s needs changed. However the service was slow to act on recommendations and advice from those professionals to promote a person’s safety.

Systems were in place to promote safe medicine administration. However the service failed to ensure they had an adequate supply of one person’s medicine and failed to seek medical advice to ensure the person’s health and well- being.

People consented to their care and staff worked to the principles of the Mental Capacity Act 2005. They were provided with information on how to make a complaint and this was reinforced to people at residents meetings.

People had care plans in place which outlined their needs and the support required. Their nutritional needs were identified and met. People had access to activities and keyworkers were looking at ways of developing more person centred activities in conjunction with the activities team.

The home was clean and homely. People were provided with equipment to promote their safety and independence. Systems were in place to ensure the environment was kept clean and prevent cross infection. The equipment provided was serviced and safe.

Staff had the required recruitment checks prior to commencing work at the service. They were inducted, trained and supported in their roles.

Staff were kind, caring and had a good knowledge of the people they supported. They worked well as part of a team but communication needed to improve to ensure all aspects of people’s care were met.

The provider had systems in place to audit the service and get feedback to improve practice. However aspects of auditing were ineffective in picking up issues and acting on them in a timely manner. Some aspects of people’s records were not suitably maintained and up to date.

The service had a registered manager who had responsibility for managing two locations. Relatives, staff and professionals were complementary of the registered manager. In view of the findings of this inspection and the failure to improve the overall rating from the previous inspection, the provider may wish to review their management arrangements for this location.

The provider was in breach of three regulations and was not meeting the requirements of the law. You can see what action we told the provider to take at the back of the full version of the report.’