CQC report explained · a residential care home
What the CQC found at Milestone House
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Good
- Inspectors found that people were protected from avoidable harm. Staffing, infection control, medicines, recruitment, risk management and safeguarding arrangements were judged safe.
- Effective?
- Good
- This key question was not inspected during this focused visit. Its rating carried over from the previous inspection.
- Caring?
- Good
- This key question was not inspected during this focused visit. Its rating carried over from the previous inspection.
- Responsive?
- Good
- This key question was not inspected during this focused visit. Its rating carried over from the previous inspection.
- Well-led?
- Good
- Inspectors found that audits, action plans and safety checks were being used to manage the home and improve standards. The manager was not always clear about when certain incidents had to be reported to the CQC.
What inspectors found, August 2022
Milestone House is rated Good; inspectors found safe, person-centred care, with a recommendation about CQC notifications.
This was an unannounced focused inspection on 20 July 2022. Inspectors checked Safe and Well-led, reviewed care plans, medicines records, recruitment files, audits and other records, and spoke with people, relatives, staff and professionals.
The home was rated Good for Safe and Well-led. Inspectors found improvements in infection control, staffing, medicines, risk management and quality checks. People were supported by staff they knew, and care promoted choice, independence, dignity and wellbeing.
The overall rating improved from Requires Improvement at the previous inspection, published in January 2020. The earlier breach about quality assurance had been resolved. Inspectors recommended that the home review guidance about when it must notify the CQC about certain incidents.
Choice and independence
People and relatives were involved in care planning. Staff supported people to develop daily living skills, make choices and take part in activities.
“People and their relatives were involved in their care planning to ensure they were supported to live their best lives, as independently as possible.” from the report
Kind and respectful care
People said staff understood and respected their emotional and physical needs. Care records contained personalised information for staff to follow.
“People told us staff were respectful, caring and understanding around their emotional and physical needs.” from the report
Safe staffing and medicines
Staffing had been reviewed to meet people's assessed needs, with contingency plans in place. Medicines were stored, administered and disposed of safely.
“Staffing was reviewed and amended to safely meet people's assessed needs.” from the report
Improved management
The previous quality assurance breach had been resolved. Audits, action plans and checks were being used to maintain and improve standards.
“Audits and performance checks were used to manage the service, maintain standards and identify areas for improvement.” from the report
CQC notifications
needs fixingThe manager was not always clear about when certain incidents needed to be reported to the CQC. Inspectors made a recommendation for the home to review the relevant guidance.
“We recommend the provider consider current CQC guidance to ensure management and oversight to ensure all required notifications are submitted to the CQC as required and take action to update their practice accordingly.” from the report
- 01How do you now check that every incident requiring a CQC notification is reported on time?
- 02How will you make sure staffing levels continue to match my relative's assessed needs?
- 03How would you support my relative to develop daily living skills and make their own choices?
- 04How do you involve relatives in care planning and review whether support remains suitable?
- 05How do you manage medicines for people who need support, including people who self-manage them?
This was a focused inspection of Safe and Well-led only; the other ratings used for the overall rating carried over from the previous inspection. This explanation was written from the published report of 18 August 2022 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, January 2020
Rated Requires Improvement; inspectors found kind and effective care, but weaknesses in safety checks, records and quality monitoring.
This was a planned inspection after the previous Requires Improvement rating. One inspector visited on 22 October and 13 November 2019. They spoke with people, staff and relatives, and checked care records, medicines, training, audits and other documents.
The home provided respite and short stays for up to seven people with a learning disability and autistic spectrum disorder. Inspectors found caring, effective and responsive support. Staff knew people well, respected their choices and helped them continue with familiar activities and day centres.
However, some risks were not properly assessed or reviewed. One person's medicines and food supplements were not stored safely. The home also had weak quality monitoring, incomplete or inconsistent records, and safety checks that did not cover some higher-risk areas.
The overall rating remained Requires Improvement, as did Safe and Well-led. Effective, Caring and Responsive were rated Good. The home had been rated Requires Improvement at the previous inspection and had not made enough improvement, so it had this rating for two inspections in a row.
Kind, person-centred staff
Staff knew people's preferences, communication styles and personal histories. They supported people with dignity, choice and independence.
“Staff knew people's preferences and used this knowledge to care for people in a way they liked.” from the report
Skilled support
Inspectors found staff competent and suitably trained. People received support with their health, food and other needs.
“Staff were competent, knowledgeable and skilled. They received appropriate training, supervision and support to fulfil their roles effectively.” from the report
Good communication and relationships
People and relatives described positive relationships with staff and management. Staff understood how to communicate with people who did not use speech.
“Staff understood how to communicate with people who were not able or chose not to verbally communicate their needs.” from the report
Safeguarding awareness
Staff had received safeguarding training and understood what to do to protect people from abuse.
“Effective safeguarding systems were in place. Staff had a good understanding of what to do to protect people; they had received safeguarding training.” from the report
Medicines not stored safely
seriousOne person's medicines and food supplements were not stored properly during their visit. The manager said a new medicines cupboard had been purchased after the inspection.
“suitable arrangements had not been made to ensure one person's medicines and food supplements were stored properly when they visited.” from the report
Risk checks were incomplete
seriousSome risk assessments were missing, incomplete or not reviewed after changes or incidents. Checks also missed risks linked to windows and bed rails.
“Risk assessments were not always in place, completed properly or reviewed in response to changing needs, including following incidents.” from the report
Weak quality monitoring
seriousAudits and action plans did not reliably identify or resolve problems. Some actions were marked complete even though issues remained, leading to a continuing legal breach.
“Some actions on audits were signed off as completed when there were still outstanding issues.” from the report
Infection control shortfall
needs fixingThe cover on a shower trolley was split and difficult to clean. Inspectors recommended that the provider review infection prevention and control guidance.
“The soft cover for the shower trolley was split making it difficult to clean properly.” from the report
Records did not always guide care
needs fixingCare plans and records were sometimes inconsistent or lacked enough detail about people's changing needs, goals and outcomes. This could make support less consistent.
“People's care plans did not always contain sufficiently detailed guidance and updated to ensure staff provided safe, consistent care.” from the report
- 01How have you fixed the medicines storage problem, and how do you now check that medicines and food supplements are stored safely?
- 02Which risk assessments have been updated since the inspection, particularly for falls from windows, bed rails and incidents?
- 03How do you make sure audit actions are completed before they are signed off?
- 04How are care plans kept up to date with each person's changing needs, goals and personal outcomes?
- 05What has been done to improve infection control and replace the split shower trolley cover?
This was a planned inspection that considered all five CQC questions, including the premises and care provided, and the ratings for all five questions were reviewed. This explanation was written from the published report of 8 January 2020 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of Milestone House
5 rated inspections over 7 years: the service has improved, from Requires improvement to Good.
- August 2022Goodcurrent ratingup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- January 2020Requires improvementstayed Requires improvementSafe: Requires improvementWell-led: Requires improvement
- October 2018Requires improvementdown from GoodSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- April 2016Goodup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- March 2015Requires improvementSafe: GoodEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Requires improvement
- December 2013
Report published without a new overall rating.
- October 2012
Report published without a new overall rating.
- December 2010
Registered with the Care Quality Commission on 1 December 2010.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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