We carried out a review of the data available to us about Milestone House 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 Milestone House, you can give feedback on this service.
About the service
Milestone House is a residential care home providing personal care to four people at the time of the inspection. The service can support up to seven people providing short breaks for adults with learning disabilities and people on the autistic spectrum.
People’s experience of using this service and what we found
The service was able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture.
Right support: Model of care and setting maximised people's choice, control and independence.
People and their relatives were involved in their care planning to ensure they were supported to live their best lives, as independently as possible. Support was provided which promoted people to develop their daily living skills and access a range of activities and events. People and their relatives told us they received care and support from staff who they knew and had their preferences respected.
Right care: Care was person-centred and promoted people's dignity, privacy and human rights.
Records were up to date and decisions made on behalf of people under the Mental Capacity Act 2005 were consistently applied or reviewed to ensure they continued to be the least restrictive option and in the persons best interest. Care records included person-centred information for staff to follow.
People told us staff were respectful, caring and understanding around their emotional and physical needs.
The service worked closely with a range of health professionals to ensure people received the most up to date care which promoted their health and wellbeing; enabling them to live as normal lives as anyone else.
Right culture: The ethos, values, attitudes and behaviours of leaders and care staff ensured people using the service led confident, inclusive and empowered lives.
The culture of the service was open and were responsive to people who they empowered to express their views. People spoke positively about the service they received and the way the service was managed. The registered manager and staff team were passionate about providing people with a personalised service which promoted their independence.
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 January 2020) and there was a breach of regulation in relation to quality assurance at the service. 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 regulation.
We recommended the provider consider best practice guidance on the prevention and control of infection and update their practice accordingly.
At this inspection we found the provider had made improvements.
We recommended the provider consider best practice guidance to review staffing using an accredited staffing tool to ensure people receive a person-centred service.
At this inspection we found the provider had made improvements.
Recommendations
We have made a recommendation for the provider to review guidance about the management of CQC notifications.
Why we inspected
We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the key questions Safe and Well-led which contain those requirements. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this 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.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Milestone House on our website at www.cqc.org.uk.
Follow up
We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
Milestone House is a respite and short stay service for up to seven people with a learning disability and autistic spectrum disorder in one adapted building. At the time of inspection there were four people accommodated.
The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support in a respite care setting that is appropriate and inclusive for them.
People’s experience of using this service and what we found
Since our last inspection the registered manager, together with staff had worked to update records and improve quality monitoring processes. The checks had not always highlighted areas for improvement, or where they did action plans were not always recorded effectively. We found one person’s medicines were not stored safely in line with best practice guidance. Management systems need to work better to ensure safety and quality for people.
We have made recommendations regarding infection control and to make sure the care service meets people’s individualised needs.
People, their relatives and staff told us they were confident in the management of the service and good personal and professional relationships existed.
People were supported to have maximum choice and control of their lives and staff supported in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. Staff knew about people, their interests and helped them to join in with their preferred activities whenever possible, which demonstrated a commitment to people’s wellbeing.
The service applied the principles and values the principles and values of Registering the Right Support and other best practice guidance to provide short breaks for people and their main carers. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence. Everyone was committed to providing people with care and support based on their preferences and choices. People were supported to attend their day centres when they were on respite care to promote continuity. This area could be developed further to make sure people’s goals and aspirations were clear and shared outcomes identified.
For more details, please see the full report which is on the Care Quality Commission website at www.cqc.org.uk
Rating at last inspection and update
The last rating for this service was requires improvement (published 24 October 2018) and there was one breach 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 enough improvement had not been made and the provider was still in breach of regulations. The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.
Why we inspected
This was a planned inspection based on the previous rating.
Enforcement
We have identified a continuing breach in relation to regulation 17 (Good Governance) under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Effective quality and monitoring systems were not established. Records had not always been updated in a timely way to reflect people’s changing needs or changes to the service being provided.
Please see the action we have told the provider to take at the end of this report.
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.
Milestone House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
Milestone House is a respite and short stay service for up to seven adults with a learning disability and/ or autistic spectrum disorder in one adapted building. Many of the people also had a sensory or physical disability. It supports people in the Scarborough and Ryedale areas. At the time of inspection there were four people having respite stays and thirty people accessed the service for regular respite.
At the last inspection in February 2016 the service was rated good. At this inspection we found the service had not maintained this standard and rated it requires improvement.
The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.
A registered manager was in post. 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.
The service had experienced a year of staffing shortages, which had meant the registered manager and staff had focused on providing day to day care.
One member of staff had been appointed and started work without an up to date DBS check in place to consider their suitability to working with vulnerable adults. We spoke with the registered manager and nominated individual about a gap in the provider’s recruitment policy and processes that had allowed this situation to occur.
Care records were not up to date and did not include details of all aspects of people’s needs. Risk assessments were not always in place to ensure people were supported safely and consistently with specific risks. Mental capacity assessments and best interest decisions had not been completed by the service to ensure staying at the service was in people’s best interests.
The registered manager and provider had not completed audits covering all aspects of the service to ensure quality and safety standards were being monitored and maintained.
These issues had not had an impact on people’s care and were a breach relating to the governance of the service. You can see what action we told the provider to take at the back of the full version of the report.
Medication was well-managed at the service. A booking in and out system helped ensure that the turnover of medication as people arrived to stay at the service and returned home was safely managed.
Staff understood people’s care needs and communication. They worked effectively with other services to ensure people received joined up care. Staff worked with relatives to improve their understanding of people and consider alternative ways of providing care to meet people’s support needs.
Staff were supported by team leaders and a registered manager. They received an induction to help them familiarise themselves with their role. Supervision and appraisals were used to encourage staff development and set appropriate targets for them to work towards.
Relatives and staff knew how to raise complaints and could approach the registered manager if they had any issues. Families gave positive examples of where issues had been rectified.
People received sufficient nutritional intake. Different dietary requirements were catered for.
People were treated with dignity and respect. Staff understood what mattered to people and provided support in discrete, sensitive ways.
People were supported to be independent and develop new skills. They participated in activities of interest to them and accessed the community.
The home environment was accessible and had outside space that people enjoyed using. Bedrooms could be adapted to meet individual preferences and requirements.
There was a registered manager employed at this service. 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.
The service had specialist equipment available which supported peoples safety. Ceiling hoists had been fitted in order that people were moved safely. Safety checks of the equipment had been carried out and it was maintained regularly.
There was a handyman at the service who carried out safety checks around the environment. These checks were clearly recorded. Assessments for the environment had been completed and any risks were clearly identified. There were risk assessments in place for individuals and we saw personal emergency evacuation plans in peoples files outlining the support they would require in the event of a fire. Staff were trained in fire safety and evacuation procedures and checks of fire fighting equipment had been carried out. Medicines were managed safely. An administration of medicines checklist had been introduced for staff to use in managing medicines. This had resulted in the elimination of medicine errors at this service.
Staff had followed safe infection control guidelines. There was personal protective equipment such as gloves available for staff in peoples rooms. When we looked around the service it was spotlessly clean and tidy. The laundry had a good dirty to clean flow ensuring that laundry did not become contaminated.
Accidents and incidents had been recorded and were discussed with staff at meetings or in supervision meetings.
Staff were recruited safely and had the skills and knowledge required to work with people who used Milestone House. When people started working at this service they had an induction and shadowed a more senior person until they were competent. They then went on to do further training which reflected the needs of people at the service and was appropriate to their role. Staff felt supported and we saw that supervision had been carried out albeit sporadically for some people.
Staff at Milestone House were skilled in communicating with people. They used their knowledge of the persons communication preferences and their body language to communicate along side more formal tools such as makaton. They worked within the principles of the mental Capacity Act 2005.
Peoples dietary needs were assessed and there were detailed assessments in place outlining how staff should support them with eating and drinking. referrals to health professionals had been requested where necessary through peoples GP's.
Staff were caring and we witnessed many positive interactions between them and people who used the service. Relatives were confident of staffs ability to support their family member. People who used the service had detailed plans and risk assessments in place outlining what staff needed to do to support them. these were reviewed each time the person visited the service. People chose how they wanted to spend their time and this was supported by staff.
There was a quality assurance system in place at the service. Peoples views were gathered and used to improve the service.
This inspection took place on the 7 October 2014 and was unannounced. At our last inspection on 12 November 2013 we had not found any breaches of legal requirements.
Milestone House is located in a village outside the town of Scarborough. It is operated by North Yorkshire County Council. The service provides a respite and short stay service for up to seven people with learning disabilities, complex needs and autism between the ages of 18 -65 years. One of the seven beds at Milestone House is kept for emergency admissions. On the day of the inspection there were only two people resident until a third person arrived later in the day.
There was a registered manager at this service who had been registered with the Care Quality Commission since 2011. 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.
The service was safe. People told us that they felt safe staying at this service. Staff were recruited safely and they were trained appropriately.
Staff were clear about how to make an alert if they suspected that anyone was at risk of abuse. They had been trained in safeguarding procedures.
People who used the service were kept safe because safety checks were carried out within the environment and on equipment to ensure it was fit for purpose. Medicines were managed safely.
The service was not always effective because staff were not always clear about how to use the training they had received to best effect.
Staff followed the principles of the Mental Capacity Act 2005 by ensuring that where people could not make their own decisions the best interest decision making process was followed to ensure that people’s wishes were carried out, where possible.
People were given a healthy nutritious diet. Adaptations to cutlery and crockery were made where necessary, to aid people’s independence
Staff were caring and kind showing people respect.
Care plans were person centred and up to date. Risks had been identified and assessed to help to keep people safe.
When transitions between services were made it was done thoughtfully and with the full involvement of the person who used the service.
The service was not always well led. The registered manager had not provided documents requested by the Care Quality Commission.
There was an effective quality assurance system in place at this service.
People had individualised support plans and risk assessments in place which helped staff to understand and meet people's needs. A relative we spoke with said 'They know X's needs very well.'
Effective recruitment processes were in place. There were enough skilled and experienced staff in place to meet people's needs, in a timely way.
There was an effective complaints system in place. Information about how to make a complaint was provided to people in a format that met their needs for example, large print. A relative said 'The manager is brilliant. If I had any concerns I would raise them. Little niggles are always sorted out really quickly. I never have need to complain."
The quality of the service being provided was monitored by the management team. Any issues found were acted upon. This helped to ensure that people remained satisfied with the service they received.
People had care plans and risk assessments in place which helped staff meet people's needs. Staff helped people to maintain their independence and make choices for themselves. One comment on a survey from a person using the service was 'My needs are known and are met with a flexible approach.' A relative commented 'XX is happy to stay at Milestone House. They are calm and content.'
People could not tell us if they felt they were protected from abuse. However, staff were aware of the action they must take to protect people. One person had said on their survey 'I feel very safe.'
We found that staff received training in a variety of subjects to help keep their skills up to date. A relative said on a survey 'XX is fortunate to be looked after by such loving, caring and professional staff.' Another comment on a survey was 'The staff are good.'
People's view were being sought about the quality of the service being provided. A person said on their survey 'I think everything is very good. I would not change anything.' We saw that the manager and staff wanted people to enjoy their stay.