We carried out a review of the data available to us about Milton House Nursing and Residential Home on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Milton House Nursing and Residential Home, you can give feedback on this service.
Milton House Nursing and Residential home is a residential care home providing personal and nursing care to up to 22 people in one adapted building. The service provides support to older people and younger adults who may be living with physical disabilities or dementia. At the time of our inspection there were 18 people using the service.
People’s experience of using this service and what we found
People were supported to have their medicines safely by competent and trained staff. We found some improvement was needed in the recording of some medicines however the provider worked to improve this at the time of the inspection. We made a recommendation about this.
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. However, not all records relating to people’s capacity and DoLS applications were clear. We have made a recommendation about this.
Care plans had been developed which helped guide staff on how to provide, person centred care which reflected people’s preferences.
Staff were caring in their approach, acting in the best interests of the people. People enjoyed a variety of activities, which included taking part in community events and local church groups. The provider was keen to expand the activities schedule and was working with people to continually review their interests and greater increase their opportunity.
People and their relatives were asked to give their feedback about the service on a regular basis. The registered manager used these comments to review the care provided, developing action plans when needed, which helped to continually improve the service.
People and relatives were happy with the care provided by the service. One relative said, “The care is fantastic, and they do the best they can do.” One person told us, “[Milton house] has nothing to improve, it’s very good.”
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 requires improvement (published 20 August 2021) and there were 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 been made and the provider was no longer in breach of regulations.
Why we inspected
This inspection was prompted by a review of the information we held about this service and to review the breaches found at the last inspection. 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.
Recommendations
We made a recommendation around the providers management and auditing system of some medicines and we also made a recommendation about their recording of people's capacity. The provider took action to amend and improve practice when this was highlighted on inspection.
Follow up
We will continue to monitor information we receive about the service, which will help inform when we next inspect.
Milton House Nursing and Residential Home is a residential care home providing personal and nursing care to 18 people aged 65 and over at the time of the inspection. The service can support up to 22 people. Milton House Nursing and Residential home accommodates 22 people in one adapted building.
People’s experience of using this service and what we found
The provider’s quality assurance system needed developing at service level so issues could be highlighted and addressed in a timely way. We found evidence of poor practice which was not identified by the provider’s audits.
The assessment and monitoring of risk was not always robust. For example, we observed concerns with the environment and storage of equipment which exposed people to risk.
Not all staff were recruited safely; there were gaps in essential recruitment checks.
Infection prevention and control practices were not consistent.
Lessons were not always learnt from accidents and incidents.
Expressed consent was not always recorded and there was a lack of recording and understanding in relation to the Mental Capacity Act where people were unable to make their own decisions. 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. There were limited activities on a day to day basis.
Language used in care planning did not always promote people were treated with dignity and respect.
Training was inconsistent where staff reported a poor induction experience. Further development was needed in relation to the oversight of staff training and supervision.
People had access to food and drink however some people felt there was not enough choice.
The service worked with other organisations to ensure people got the correct support and the service was decorated and adapted to meet people’s needs.
We found care staff provided high quality care.
There were systems in place to safeguard people and medicines were managed safely.
Staff cared for the people living at the service through compassionate relationships. Staff supported people to live independently and treated people with respect.
Staff had a good awareness of end of life care.
The provider had a policy in place to respond to complaints.
There were enough staff to meet people’s care needs.
Staff felt supported by the registered manager and considered the service had the right vision and culture to improve the governance and recording.
For more details, please see the full report which is on the Care Quality Commission (CQC) website at www.cqc.org.uk
Rating at last inspection
This service was registered with us on 13 September 2019 and this is the first inspection. The last rating for the service under the previous provider was good, published on 31 August 2018.
Why we inspected
The inspection was prompted in part due to concerns received about staffing levels and care practices. A decision was made for us to inspect and examine those risks.
We have found evidence that the provider needs to make improvements. Please see the safe, responsive 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.
The provider took remedial action following the first day of inspection to ensure people’s safety and reduce the risk identified. The provider sought advice and support from third party organisations to consider the issues we identified.
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 consent, infection prevention and control measures, environmental safety risks, good governance and staff recruitment.
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 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.