CQC report explained · a nursing home
What the CQC found at Milton Court Care Home
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
- Safe?
- Good
- Inspectors found enough staff to keep people safe, appropriate risk assessments, safe medicines management and effective infection control. People were protected from abuse and staff recruitment checks were robust.
- Effective?
- Good
- This key question was not inspected during this visit. Its previous rating was carried forward when calculating the overall rating.
- Caring?
- Requires improvement
- This key question was not inspected during this visit. Its previous rating was carried forward when calculating the overall rating.
- Responsive?
- Requires improvement
- Care was not always personalised. People did not always have enough opportunities to follow their interests, and some people staying in bed were at increased risk of loneliness and social isolation. Communication needs were not always met.
- Well-led?
- Requires improvement
- Management checks did not always identify problems with care plans and activities. Inspectors also found a mixed culture, although people, relatives and staff described positive changes under the new manager.
What inspectors found, July 2023
Milton Court Care Home is Rated Requires Improvement; inspectors found safe care but person-centred support and management checks were not reliable enough.
This was an unannounced inspection on 31 May 2023. Inspectors spoke with people, relatives and staff, and reviewed care records, medicines records, staff recruitment files and management documents.
The home was rated Good for Safe. Inspectors found enough staff to keep people safe, suitable risk assessments, safe medicines processes and good infection control. People were protected from abuse and staff followed the Mental Capacity Act.
Responsive and Well-led were both rated Requires Improvement. Care records did not always describe people's personal needs, interests or distress clearly. Some people, especially those staying in bed, had too few opportunities for meaningful activity and social contact. Communication support was also not always available.
The overall rating stayed Requires Improvement. This was the third consecutive inspection with that rating. The provider breached Regulation 9 on person-centred care, and CQC recommended a review of the provider's governance systems.
Safety and staffing
Inspectors found enough staff to keep people safe. People, relatives and staff said staffing levels had improved.
“There were enough staff to keep people safe.” from the report
Medicines
Medicines were administered, stored and disposed of safely. Staff had training and regular checks of their competence.
“Medicines were administered, stored, and disposed of safely.” from the report
Protection from harm
Risk assessments covered areas including falls, malnutrition, skin condition and diabetes. Safeguarding concerns were referred appropriately and promptly.
“People were protected from the risk of harm and abuse.” from the report
Learning from incidents
The home reviewed accidents, infections, falls and pressure sores, and shared learning with staff to reduce the chance of problems happening again.
“These were analysed for themes and trends and learning was shared with the wider team to reduce risk of reoccurrence.” from the report
Positive changes in leadership
Inspectors found that people, relatives and staff were positive about changes introduced by the new manager. The manager was supported by deputy managers and the provider.
“People staff and relatives were positive about the changes they were already introducing.” from the report
Care was not always personalised
seriousCare plans lacked personal details, including information about people's life histories, social needs and how to support distress. This was a breach of Regulation 9.
“Peoples care was not always personalised. Care plans lacked personal detail.” from the report
Too little meaningful activity
needs fixingSome people had limited opportunities to do things they enjoyed. People staying in bed had particularly few activities and were at increased risk of social isolation.
“There were limited choices and opportunities for people who remained in bed to participate in activities.” from the report
Communication support
seriousCommunication boards had been removed during the COVID-19 pandemic and had not been reinstated for one person who needed them. This left the person unable to communicate effectively.
“This meant the person was left unable to communicate effectively, placing them at risk.” from the report
Management checks
needs fixingAudits did not identify problems with care planning and activities. CQC recommended that the provider review its governance systems.
“Systems to assess and monitor the service were not always effective.” from the report
Mixed staff culture
needs fixingInspectors saw some positive interactions, but also found that some staff were dismissive of people's needs. Person-centred care was not consistent.
“There was a mixed culture within the service and people did not always receive person centred care.” from the report
- 01How are you rewriting care plans so they include each person's life history, interests, social needs and ways to respond if they become distressed?
- 02What activities are available for people who stay in bed, and how do you check that these activities match their wishes?
- 03Have communication boards or other communication aids been reinstated for people who need them?
- 04How are management audits now checking care plans, activities and staff engagement?
- 05What progress has been made since the new manager started, and how will you show that improvements are lasting?
This was an unannounced focused inspection that assessed Safe, Responsive and Well-led; the other key question ratings were not inspected and were carried forward from the previous inspection. This explanation was written from the published report of 8 July 2023 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, December 2021
Milton Court Care Home was rated Requires Improvement; inspectors found kind care and safe medicines, but staffing shortages affected timely care and activities.
This was an unannounced inspection on 9 and 10 November 2021. Inspectors spoke with 26 people, 17 care staff and other workers. They reviewed care records, medicines records, recruitment information and audits.
Staffing levels were not always met because of shortages. This affected how quickly people received care and limited some activities. One unit had been closed so staff could be concentrated elsewhere, and recruitment was continuing.
Inspectors found that medicines were stored and given safely, the home was clean, infection control was effective, and staff were kind and respectful. The overall rating was Requires Improvement. Safe, Responsive and Well-led were also rated Requires Improvement. Effective and Caring were not inspected during this visit, so earlier ratings for those areas were used in the overall calculation.
Safe medicines
Medicines were stored and administered safely. Records were accurate, and staff were trained to give medicines safely.
“Medicines were stored and administered safely. Medicine administration records (MAR) were accurately completed, and details around people's specific needs with medicines, were documented and reviewed.” from the report
Kind and respectful care
Inspectors saw positive relationships between staff and people. Feedback about staff was generally good, although some people said care could be delayed.
“Staff treated people with kindness, dignity and respect. We observed positive interactions between people and staff, and feedback from people about staff relationships were good.” from the report
Safe recruitment and training
Recruitment checks were carried out before staff started work. Staff received induction and training for their roles.
“The provider had safe staff recruitment checks in place. This meant that checks were carried out before employment to make sure staff had the right character and experience for the role.” from the report
Staffing shortages
needs fixingThe planned staffing levels were not always met. People and staff said this could lead to delays and affect the quality and timeliness of care.
“We found no evidence that people had been harmed, however, people and staff spoke of the impact on the quality and timeliness of care delivery.” from the report
Reduced activities and access outside
needs fixingActivities took place but were limited at times because of staff shortages. Some people had waited months for support to go outside.
“An activities programme was in place, but participation was at times negatively affected by low staffing levels.” from the report
Mixed management support
needs fixingStaff gave mixed feedback about morale and whether they could approach the registered manager with problems. Some staff felt rushed and unable to give people enough time.
“There were mixed responses regarding staff morale and support within the service.” from the report
- 01How are you making sure every shift has the planned number of staff, and how will you respond when a shift is short?
- 02What has changed since the inspection to reduce waiting times for call bells and personal care?
- 03How will people who need two staff members be supported to go outside and take part in activities?
- 04How can staff raise concerns with the registered manager, and how are you checking staff morale?
- 05What progress has been made with recruitment and the reopening of the closed unit?
This was a focused inspection of Safe, Responsive and Well-led; Effective and Caring were not inspected and their previous ratings were used. This explanation was written from the published report of 9 December 2021 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 Milton Court Care Home
4 rated inspections over 6 years: the service has slipped, from Good to Requires improvement.
- July 2023Requires improvementcurrent ratingstayed Requires improvementSafe: GoodEffective: GoodCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- December 2021Requires improvementstayed Requires improvementSafe: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- June 2021Requires improvementSafe: Requires improvementWell-led: Requires improvement
- April 2021Inspected but not ratedSafe: Inspected but not rated
- December 2017GoodSafe: GoodResponsive: GoodWell-led: Good
- December 2016
Registered with the Care Quality Commission on 9 December 2016.
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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