CQC report explained · a nursing home
What the CQC found at Milton House Nursing and Residential Home
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Good
- Risks, the environment, equipment, staffing and infection control were managed safely. Inspectors found that some guidance and audit checks for medicines were not complete, although no one was put at risk and the provider acted during the inspection.
- Effective?
- Good
- People’s needs, choices, dietary requirements and healthcare were supported well. Records about mental capacity and DoLS were not always clear.
- Caring?
- Good
- Staff treated people with kindness, dignity and respect. People and relatives were involved in care decisions and were positive about the support.
- Responsive?
- Good
- Care was personalised and reflected people’s needs and preferences. The home had improved its activities, including opportunities to attend community events, and had a complaints process.
- Well-led?
- Good
- Managers had clear responsibilities and used audits, feedback and action plans to improve the service. Staff, people and relatives were involved and staff felt supported.
What inspectors found, November 2022
Rated Good after improvements; inspectors found kind, personalised care, but some medicines and capacity records needed clearer management.
The unannounced inspection took place on 20 October 2022. Two inspectors, a medicines specialist and an Expert by Experience spoke with people, relatives, staff and managers. They reviewed care plans, medicine records, staff files and quality checks.
The home was rated Good in all five areas: Safe, Effective, Caring, Responsive and Well-led. Inspectors found people were safe, treated kindly, involved in their care and supported to follow their interests. Staff understood people’s needs and care plans reflected their preferences.
Some improvements were still needed. Records and audits for some medicines were not always complete, and some records about people’s mental capacity and DoLS applications were unclear. The provider acted during the inspection. The home had improved from Requires Improvement at the previous inspection in August 2021 and was no longer in breach of regulations.
Personalised care
Care plans reflected people’s needs and preferences. Staff knew people well and adapted care to suit them.
“Care plans had been developed which helped guide staff on how to provide, person centred care which reflected people's preferences.” from the report
Kind and respectful staff
Inspectors saw staff supporting people with kindness and concern. People and relatives spoke positively about the care.
“People were treated well and supported by kind and caring staff.” from the report
Improved management
The home had introduced audits, action plans and learning from incidents. The provider and managers checked the quality of care regularly.
“A series of audits had been developed to assess, monitor and improve the quality of the service.” from the report
Activities and community links
People were supported to maintain relationships and take part in activities linked to their interests and culture.
“People had the opportunity to take part in community events, such as local Harvest festival, and the service celebrated a variety of culturally diverse events, promoting inclusivity.” from the report
Medicine records and audits
needs fixingGuidance was not always recorded for medicines given when needed or for emollients. The medicine audit did not always identify missing guidance or recording errors for nutritional supplements.
“However, guidance was not always in place for 'when required' medication and emollients.” from the report
Mental capacity records
needs fixingSome records about people’s capacity and DoLS applications were unclear or contradictory. The provider was asked to review its recording process.
“People's capacity had been assessed, however, the records were not always clear.” from the report
- 01How do you now check that guidance is recorded for all medicines given when needed and for emollients?
- 02How do you make sure medicine audits identify missing guidance and recording errors for nutritional supplements?
- 03How are mental capacity assessments and DoLS information kept clear and consistent in each person’s care record?
- 04What activities are currently available, and how are they matched to my relative’s interests and preferences?
- 05How do you check that improvements made since the previous inspection continue to be followed?
This was an unannounced inspection that assessed all five key questions and included checks on infection prevention and control, medicines, care records, staffing and management systems. This explanation was written from the published report of 18 November 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, August 2021
Milton House Nursing and Residential Home was rated Requires Improvement; inspectors found kind care but serious weaknesses in safety, consent, staffing checks and management oversight.
This was the first inspection of the newly registered service. Inspectors visited on three dates, spoke with people, relatives and staff, and reviewed care records, medicines, recruitment files, training information and management checks. The inspection was prompted partly by concerns about staffing levels and care practices.
People were generally treated kindly and staff provided compassionate care. Medicines were managed safely after immediate action was taken. However, inspectors found unsafe environmental arrangements, inconsistent infection control, gaps in staff recruitment checks, weak accident reviews and limited activities.
The home did not always record consent or follow the Mental Capacity Act when people could not make decisions for themselves. Training, care planning, food and fluid records, and quality checks also needed improvement. The overall rating and four of the five question ratings mean the home was not consistently meeting people's needs and there was limited assurance about safety.
Kind and compassionate care
Inspectors found that care staff built compassionate relationships and treated people with respect. People were offered choices and supported to maintain independence and relationships.
“Staff cared for the people living at the service through compassionate relationships.” from the report
Supportive staff culture
Staff felt supported by the manager and said they could ask for help when needed. Inspectors also found good relationships between staff and people.
“Staff felt supported by the registered manager and considered the service had the right vision and culture to improve the governance and recording.” from the report
Links with other services
The home worked with health and social care professionals and had links with local organisations to support people.
“The service had good links with the local community and key organisations, reflecting the needs and preferences of people in its care.” from the report
Unsafe environment and equipment
seriousFire doors were held open by furniture, communal areas were obstructed, and equipment was not clearly labelled for the right person. Inspectors found this exposed people to a risk of harm.
“We found automatic fire doors had been kept open by furniture which prevented them from closing in the event of a fire.” from the report
Infection control
seriousSome staff did not follow hand hygiene and clothing requirements, and visitors were not always screened robustly. Equipment that could have been contaminated was not covered by a clear cleaning system.
“Infection prevention and control systems were not robustly followed by all members of staff.” from the report
Consent and mental capacity
seriousThe home did not always record people's consent or complete mental capacity and best interest decisions. One restrictive practice lacked the appropriate legal authority.
“Mental capacity assessments and best interest decisions were not always considered and/or recorded where people lacked capacity to make specific decisions.” from the report
Recruitment and staff training
seriousSome staff files lacked important checks such as employment history, references or evidence of a DBS check. Induction, supervision and competency checks were also not robust.
“Some members of staff were recruited without a full employment history, reference or evidence of a Disclosure and Barring Service (DBS) check.” from the report
Limited activities
needs fixingThere was no daily or weekly activity plan and inspectors found a limited range of activities to reduce social isolation. The provider accepted that more work was needed.
“There was a limited range of activities to reduce social isolation.” from the report
Weak quality checks
seriousManagement audits did not identify problems with safety, care records, recruitment, incidents, food and fluid charts or call bell response times. This meant some actions were not resolved promptly.
“The checks of safety and quality of the service had not highlighted the issues we found during this inspection.” from the report
- 01What evidence can you show that the fire doors, communal areas and storage of equipment are now safe?
- 02How do you check that staff and visitors follow infection prevention and COVID-19 screening procedures every time?
- 03How are mental capacity assessments, best interest decisions, consent and any DoLS applications now recorded and reviewed?
- 04Have all staff and volunteers completed the required recruitment checks, induction, training and competency checks?
- 05What regular audits now check care plans, accidents, food and fluid records, call bell response times and infection control, and who reviews the results?
This was the first inspection of the newly registered service and covered all five key questions, including infection prevention and control; the previous provider's rating was Good in 2018. This explanation was written from the published report of 21 August 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 House Nursing and Residential Home
2 rated inspections over a year: the service has improved, from Requires improvement to Good.
- November 2022Goodcurrent ratingup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
Read what inspectors found at Milton House Nursing and Residential Home →
- August 2021Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
Read what inspectors found at Milton House Nursing and Residential Home →
- December 2019
Registered with the Care Quality Commission on 10 December 2019.
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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28 live-in carers within about an hour of North Yorkshire
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 £1,010 to £1,290 a week. 27 can care for a couple. 12 years' experience on average.
“Carla has been a god send with the implementation of bringing mum back home from respite care.”
“She was always 'just present enough': attentive, available, kind and engaging, but without ever over-stepping any boundary”
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