CQC report explained · a residential care home
What the CQC found at Milton House
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Good
- People told inspectors they felt safe. Medicines were managed safely and there were enough staff, although some care files were not fully updated and the recommended masks were not being used during the visit.
- Effective?
- Good
- This question was not assessed during this focused inspection.
- Caring?
- Good
- This question was not assessed during this focused inspection.
- Responsive?
- Good
- This question was not assessed during this focused inspection.
- Well-led?
- Requires improvement
- Leadership and management were not consistent. The manager was not registered, the infection control policy needed updating and staff training for a specific health condition was not yet in place.
What inspectors found, November 2020
Milton House was rated Good overall; inspectors found safe care, but the home was not always well-led and was rated Requires Improvement for leadership.
This was an unannounced, focused inspection on 6 October 2020. Inspectors spoke with people living in the home, relatives and staff. They observed care and checked care records, medicine records, staffing information and management records.
The home was rated Good for Safe. People said they felt safe, medicines were recorded safely and there were enough staff. Inspectors found that some care files were not fully up to date, and staff were not using the recommended type of masks at the time of the visit. The correct masks were then ordered.
The home was rated Requires Improvement for Well-led. The manager was not registered, the infection control policy needed updating, and some staff training was not yet in place. The overall rating remained Good, but this focused inspection did not assess Effective, Caring or Responsive.
Safe medicines
Inspectors found completed medicines records, with no gaps or missed signatures. The records also explained how people preferred to take their medicines.
“Medication Administration Records (MAR) were completed and we did not find any gaps or missed signatures.” from the report
Enough consistent staff
Inspectors saw enough staff to meet people's needs. A consistent staff team meant agency staff were not needed.
“A consistent staff team meant agency staff were not required and the provider used a dependency tool to determine staffing levels at the service.” from the report
People felt safe
People told inspectors they felt safe. Safeguarding systems were in place and investigations had been completed.
“People told us they felt safe receiving their care from the service.” from the report
Communication with relatives
Relatives said the management team and staff kept them updated during restrictions on visiting.
“they told us the management team and staff had kept them updated.” from the report
PPE was not correct
needs fixingStaff were using type one masks when type two fluid-resistant masks were recommended for close personal contact. The home stopped staff using their own face coverings and ordered the correct masks after the inspection.
“It is recommended when in close personal contact with people type two masks which are fluid resistant are used.” from the report
Care files were not always up to date
needs fixingRisk assessments reflected current risks, but other parts of some care files had not been updated. Inspectors discussed this with the manager.
“other parts of the care file had not always been updated.” from the report
Management arrangements
needs fixingThe manager was not registered with the CQC, although the home's registration required a registered manager. The manager said they planned to apply again after further training.
“The provider had recruited a manager that was not yet registered.” from the report
Policy and training gaps
needs fixingThe infection control policy did not include COVID-19 and staff had not received training about one person's specific health condition. Training was later scheduled.
“The infection prevention control policy needed to be updated to include COVID 19 and the actions staff were currently taking to keep people safe.” from the report
- 01Are staff now using the correct fluid-resistant masks for close personal contact, and how is this checked?
- 02Have all care files been updated so that they accurately reflect each person's current risks and needs?
- 03What is the current position on the manager's CQC registration?
- 04Has staff training about the specific health condition identified in the report been completed?
- 05Has the infection control policy been updated to include COVID-19 and the measures used by staff?
This was a focused inspection of Safe and Well-led only; Effective, Caring and Responsive were not assessed and their ratings were not changed by this visit. This explanation was written from the published report of 20 November 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.
What inspectors found, January 2019
Rated Good; inspectors found safe, kind and personalised care, with some meal improvements still being made.
This was an unannounced, comprehensive inspection on 21 November 2018. Inspectors spoke with people living in the home, staff and a healthcare professional. They reviewed care records, medicines, complaints, audits and other records.
The home was rated Good in all five areas: Safe, Effective, Caring, Responsive and Well-led. Inspectors found people were protected from abuse, received their medicines safely and had enough suitable staff to meet their needs.
People were treated with kindness and respect. Their care plans included their needs and preferences, and they were supported with activities, healthcare, food and drink. The home had systems to monitor quality and respond to feedback.
The overall rating stayed Good, the same as at the previous inspection on 15 February 2016. Some work was under way to improve meals, care plan reviews and other parts of the service.
Safe medicines
Medicines were stored, administered and recorded safely. Staff who managed medicines had training and their competence was checked.
“People received their medicines as prescribed and staff managed people's medicines in a safe way.” from the report
Kind and respectful staff
Staff had positive relationships with people and supported them with warmth, dignity and respect.
“People were treated with kindness and compassion. People told us staff were kind.” from the report
Personalised care
Care planning included people's needs, preferences and life history. People were supported to choose activities and how they spent their time.
“People received personalised care that was responsive to their needs.” from the report
Support with decisions
People were involved in decisions where possible. Mental capacity and best-interest decisions were recorded and least restrictive approaches were used.
“Consent was sought before care and support was provided.” from the report
Quality monitoring
The home used audits, feedback and action plans to check the service and identify improvements.
“A quality monitoring audit had been carried out by an independent consultant.” from the report
Meals and mealtime experience
minorPeople gave mixed views about the meals. An audit had identified that the mealtime experience needed improvement, and changes were being made.
“We received mixed reviews about the meals provided.” from the report
Planned improvements not yet complete
minorThe acting manager was introducing new care plan review arrangements and planned a safety gate and improved care planning documents. Families should ask whether these changes have been completed.
“The acting manager told us they planned to introduce a new system for care plan review” from the report
- 01What changes have been made to the menu since inspectors received mixed views about meals?
- 02How do you now review care plans with people and their relatives every three months?
- 03Has the planned safety gate at the bottom of the staircase been fitted?
- 04Who is the registered manager now, and what happened with the acting manager's application to become registered?
- 05How do you check that staffing levels continue to meet each person's needs?
This was an unannounced comprehensive inspection covering all five key questions and the overall quality of the home. This explanation was written from the published report of 16 January 2019 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
3 rated inspections over 4 years: the service has held its Good rating throughout.
- November 2020Goodcurrent ratingstayed GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- January 2019Goodstayed GoodSafe: GoodWell-led: Good
- August 2016GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- November 2013
Report published without a new overall rating.
- January 2013
Report published without a new overall rating.
- September 2011
Report published without a new overall rating.
- April 2011
Report published without a new overall rating.
- January 2011
Registered with the Care Quality Commission on 20 January 2011.
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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