CQC report explained · a nursing home
What the CQC found at Milton Grange
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Good
- Inspectors found suitable risk assessments, safeguarding procedures, staffing checks, equipment checks and infection control arrangements. Medicine systems were in place, but the report identified many previous errors and one error during the visit.
- Effective?
- Good
- This focused inspection did not assess or rate Effective.
- Caring?
- Good
- This focused inspection did not assess or rate Caring.
- Responsive?
- Requires improvement
- Inspectors looked at how complaints were handled. They found the complaints policy had been updated, complaints were investigated on time, and learning was shared with staff.
- Well-led?
- Good
- Inspectors found regular audits, clearer care plans, a positive culture and managers who were visible and approachable. The rating improved from Requires Improvement.
What inspectors found, April 2021
Rated Good; inspectors found safer, kinder care and stronger management, but medicine errors remained a concern.
This was an announced focused inspection on 5 March 2021. Inspectors spoke with staff, residents and relatives, observed care, and checked care plans, medicine records, staffing files, complaints and other records.
The home was rated Good overall. Safe and Well-led improved from Requires Improvement to Good. Inspectors found better care plans, risk assessments, staffing checks, safeguarding arrangements and management oversight.
There had been 34 medicine errors and near misses in the previous year. Inspectors found one medicine error during the visit, which was dealt with straight away. The home later provided evidence of medicine audits and shared learning with staff.
Responsive was inspected but not rated. The report says complaints were recorded, investigated and answered within the policy timescale. Effective and Caring were not covered by this focused inspection.
Improved care records
Care plans and risk assessments had been improved. They included clearer information about people's needs, pain, wounds and rehabilitation goals.
“This had improved the quality of care records and risk assessments.” from the report
Safeguarding and staffing
People said they felt safe. Staff had safeguarding training, and inspectors found enough trained nursing and care staff on each shift.
“Sufficient trained nursing and care staff were available for every shift.” from the report
Complaints handled well
The complaints policy was updated and made available to people. Complaints were investigated within the stated timescale, with written responses and shared learning.
“Each complaint raised had been dealt with within the timeframe the policy stipulated.” from the report
Positive leadership
Inspectors found a visible manager, a supportive culture and a management structure that maintained oversight across the four units.
“This management structure was robust and ensured all aspects of the service were managed but with overall governance maintained by the registered manager.” from the report
Medicine errors
seriousThe report records 34 medicine errors and near misses in the previous 12 months. One error found during the inspection involved a medicine prescribed for one day being given for seven days.
“There had been a high number (34) medicine errors and near misses that occurred in the previous 12 months.” from the report
Audit missed an error
needs fixingAlthough medicine audits were carried out, the audit had not identified the error found during the inspection. The home investigated it afterwards and said it was a recording issue.
“This issue had not been identified during the medicine audit.” from the report
- 01What changes have been made since the 34 medicine errors and near misses were recorded?
- 02How do you now check that medicines are given for the correct length of time after someone is discharged from hospital?
- 03How will you show us that medicine audits identify and prevent recording errors?
- 04How will you assess and support my relative's rehabilitation goals, pain needs and risks such as falls or skin damage?
This was a focused inspection of Safe and Well-led, with infection prevention and control also checked; Responsive was inspected but not rated, and the other ratings were carried over from the previous comprehensive inspection. This explanation was written from the published report of 24 April 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.
What inspectors found, April 2020
Milton Grange was rated Requires Improvement; inspectors found kind, effective rehabilitation but gaps in care records, complaints handling and oversight.
Inspectors visited without notice on 20, 21 and 22 January 2020. They spoke with people, relatives, staff and professionals. They observed care and reviewed care plans, medicines records, complaints, incidents, audits, training and supervision records.
The home was safe in many respects. Staff understood safeguarding, staffing levels were sufficient, medicines were stored and given safely, and fire and equipment checks had been completed. However, some wound care records did not contain enough information, and increased pain and a worsening wound had not been properly monitored. This led to a breach of Regulation 12.
People were supported by trained staff and had access to health and social care professionals. Staff were kind, respectful and encouraged independence. Activities were available, but the complaints process was not clear or up to date, and some care plans lacked important personal details and guidance.
The overall rating was Requires Improvement. Effective and Caring were rated Good. Safe, Responsive and Well-led were rated Requires Improvement. This was a fall from the previous overall rating of Outstanding, published in February 2017.
Kind and respectful staff
Inspectors saw staff supporting people gently and respectfully. People were offered choices about daily care, privacy and socialising.
“Staff were kind to people and people were treated with dignity and respect.” from the report
Rehabilitation focus
The home helped people work towards returning home and encouraged independence in daily activities, exercises and personal care.
“People's rehabilitation at the service focussed on preparing them for independent living when they returned home.” from the report
Training and staffing
Staff had relevant training, a thorough induction and ongoing supervision. Inspectors found enough trained nursing and care staff on each shift.
“Staff training was up to date and a training plan showed us how training was managed and refresher training organised.” from the report
Safe medicines and recruitment
Medicines were stored and administered correctly during the inspection. Recruitment checks, including identity, references and DBS checks, had been completed.
“Medicine administration records (MAR) were completed correctly showing the date, time, quantity of medicines and the signature of the staff member administering.” from the report
Wound and pain records
seriousSome wound care plans contained very little information. A worsening wound and increased pain had not been properly assessed or monitored, and the report says this increased the risk of harm.
“Systems were not in place to demonstrate safe care and treatment was always provided.” from the report
Incomplete care plans
needs fixingSome care plans missed important personal details, consent forms or guidance about support needs. There was not an effective audit system to identify these gaps.
“The registered manager lacked oversight of these issues and there was no effective auditing of care plans.” from the report
End of life training
minorEnd of life training had been provided to a manager but was not routinely provided to all staff. No one at the inspection was receiving end of life care.
“A manager at the service had recently undergone end of life training but this was not routinely provided to all staff.” from the report
- 01What changes have you made to wound assessments, pain monitoring and treatment records since the inspection?
- 02How do you check that care plans include personal risks, consent, falls information, nutrition and washing and dressing needs?
- 03How can residents and relatives see the current complaints policy and make a complaint?
- 04How are complaints and minor concerns now recorded, investigated and reviewed for repeated patterns?
- 05What action has been taken in response to the Regulation 12 breach, and when was the latest follow-up inspection?
This was an unannounced inspection covering all five CQC questions, with records, observations and discussions with people, relatives, staff and professionals reviewed. This explanation was written from the published report of 1 April 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 Milton Grange
3 rated inspections over 4 years: the service has slipped, from Outstanding to Good.
- April 2021Goodcurrent ratingup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: Requires improvementWell-led: Good
- April 2020Requires improvementdown from OutstandingSafe: Requires improvementWell-led: Requires improvement
- February 2017OutstandingSafe: GoodEffective: GoodCaring: OutstandingResponsive: GoodWell-led: Outstanding
- June 2013
Report published without a new overall rating.
- June 2012
Report published without a new overall rating.
- October 2011
Report published without a new overall rating.
- December 2010
Registered with the Care Quality Commission on 15 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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19 live-in carers within about an hour of East Sussex
These are self-employed carers on PrimeCarers, the introductory agency that runs this directory. Each has a profile with their own rates and reviews from families, and you choose who to talk to.
Most charge £1,000 to £1,400 a week. 13 can care for a couple. 10 years' experience on average.
“When he point blank refused to go into hospital for a life saving blood transfusion she talked him through the situation and agreed to go in the ambulance with him and stayed until he was settled.”
“Una felt safe, secure and loved in her time with Debbie which is a gift that I am eternally grateful for.”
Every carer has had an enhanced DBS check in the last 18 months, ID and right-to-work checks and an online interview. Their skills and training are for you to check with them. Carers set their own rates, and who is free changes week to week.