We carried out a review of the data available to us about Milton Lodge on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Milton Lodge, you can give feedback on this service.
Milton Lodge is a care home which provides residential care for people who are living with a learning disability and may other needs such as mental health conditions.
Milton Lodge is a large home, bigger than most domestic style properties. It was registered for the support of up to 13 people. Twelve people were using the service. This is larger than current best practice guidance, Registering the Right Support. However. the size of the service having a negative impact on people was mitigated by the building design fitting into the residential area and the other large domestic homes of a similar size. There were deliberately no identifying signs, intercom, cameras, industrial bins or anything else outside to indicate it was a care home. Staff were also discouraged from wearing anything that suggested they were care staff when coming and going with people.
People’s experience of using this service and what we found
The registered manager and staff consistently demonstrated they valued and respected the people who used the service. The staff were passionate about supporting people to lead lives with meaning and develop the skills they needed to become more independent.
We found staff were committed to delivering a service which was person-centred. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests. The policies and systems in the service supported this practice.
Staff took steps to safeguard vulnerable adults and promoted their human rights. Incidents were dealt with appropriately and lessons were learnt, which helped to keep people safe. The registered manager ensured people's support needs were thoroughly assessed and potential risks were effectively mitigated. The staff team had received bespoke training from the local community forensic learning disability team around supporting people with complex needs and those who may have a history of offending. Staff promoted equality and diversity within the home.
Staff supported people to manage their healthcare needs and promoted their wellbeing. When necessary, external professionals were involved in individuals care. The staff supported people to eat varied appetising meals. Medicine was administered in a safe manner.
Thorough checks were completed prior to staff being employed to work at the service. Staff had received appropriate training and supervision. The registered manager had enabled staff to access a varied and extensive range of condition specific training. The staff had found the range of training they received assisted them to significantly improve people’s quality of life, support people who struggled to manage their impulse control and mitigate potential risks.
People’s voices were of paramount importance in the service. The registered manager understood how to investigate and resolve complaints.
The service was well run. Systems were in place, which effectively monitored how the service operated and ensured staff delivered appropriate care and treatment.
For more details, please see the full report which is on CQC website at www.cqc.org.uk
Rating at last inspection
Good (report published 27 April 2017).
Why we inspected
This was a planned inspection based on the rating at the last inspection.
Follow up
We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.
A previous inspection undertaken in January 2016 found breaches of Regulation 15 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in connection with maintenance of the premises and furnishings and unsuitable quality assurance systems.
After the inspection, the provider sent us an action plan to show how they would rectify these concerns and we returned to follow these up and check all regulations were now being met. We found the provider had made improvements to meet the Regulations.
Milton Lodge is registered to provide accommodation for up to 13 people who have a learning disability or mental health diagnosis. Some people may have come to the service from a hospital environment where they had been cared for under the Mental Health Act (MHA) 1983. At the time of the inspection there were 10 people living at the service with one vacancy to be filled in the coming few weeks.
The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.
Staff had received training in the safeguarding of vulnerable adults and were aware of what to do in the event of concerns. Suitable recruitment practices were in place for staff working with vulnerable adults and the provider ensured enough staff were available to meet the needs of the people who lived at Milton Lodge.
There were arrangements in place to manage the premises and equipment. Where any maintenance issues were identified, these were dealt with. Fire checks and drills were carried out in accordance with fire regulations.
Medicines were managed adequately and staff had received suitable training to support them administer people’s medicines in a safe manner.
Any risks had been identified and risk assessments put in place. The provider had a robust risk monitoring procedure and risk was reviewed regularly and when any issues arose. Where accidents had occurred, they were recorded and monitored by the registered manager.
People enjoyed the food available to them and confirmed this when asked. There was a range of nutritious meals and refreshments available throughout the day. We saw staff provided additional support to people with special dietary needs, for example, those with diabetes.
People were provided support to remain healthy and we saw evidence of this. Where necessary, arrangements were made for people to see GP’s and other healthcare professionals when they needed to and we saw copies of letters of attendance held on people’s care and support records. Healthcare professionals told us they had a good working relationship with staff at the service.
Care Quality Commission (CQC) is required by law to monitor the operations of the Mental Capacity Act 2005 (MCA) and to report on what we find. MCA is a law that protects and supports people who do not have the ability to make their own decisions and to ensure decisions are made in their ‘best interests’. We found the provider was complying with their legal requirements.
We observed that staff were kind and attentive in their interactions with people. Relatives and visiting professionals told us staff were caring and we observed that people displayed warmth and humour towards staff with whom they clearly enjoyed good relationships. The privacy and dignity of people was maintained. Advocates were used when this was required to support people.
People were asked their views of the service through regular ‘resident’ meetings and by completion of a survey used to gather their views periodically. A complaints procedure was in place. There had been no recent complaints and people were aware of how to complain if they needed to do so.
Regular staff meetings took place and staff felt supported to be able to share their views. We were told that morale within the team was good.
The provider had improved their quality assurance systems, with regular checks being made on care records, infection control and the management of medicines for example.
The provider had displayed their rating within the service and also on their website as legally required.
Milton Lodge is registered to provide accommodation for up to 13 people who have a learning disability or mental health diagnosis. Some people have come to the service from a hospital environment where they had been cared for under the Mental Health Act (MHA) 1983. At the time of the inspection there were 11 people living at the service.
The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.
The service was not well maintained and did not have a planned programme of redecoration, repair and renewal in place. We found a number of areas that needed to be addressed.
The provider’s arrangements to regularly check the quality and safety of people’s care needed to be improved. There were some systems in place to monitor the quality of the service, which included audits and feedback from people using the service. These were being updated by the provider as current processes were not robust. A new infection control audit was about to be implemented.
People’s medicines were given to them when they needed them although we have made recommendations about the safe management and storage of medicines which also takes into account people's privacy and dignity.
People were happy living at the service and they were protected from the risk of harm or abuse. People received safe care from a consistent staff team, who were properly recruited and fully understood people’s care and safety needs. Sufficient staff were consistently provided.
Staff understood risks to people’s safety from their health conditions, their environment and from people’s behaviours that may challenge others and followed suitable procedures to mitigate this.
Emergency contingency plans were in place for staff to follow in the event of emergencies in the service. Regular checks were made on fire alarms and other equipment. The Fire and Rescue Service recently confirmed they were satisfactory arrangements for fire safety at the service.
People were supported to maintain and improve their health and nutritional needs. Staff received the training they needed and they fully understood people’s health conditions and related care needs. People accessed external health professionals when they needed to and staff sought and followed their instructions for people’s care when required.
Care Quality Commission (CQC) is required by law to monitor the operations of the Mental Capacity Act 2005 (MCA) and to report on what we find. MCA is a law that protects and supports people who do not have the ability to make their own decisions and to ensure decisions are made in their ‘best interests’. We found the provider was complying with their legal requirements.
People received care and support from caring staff who knew them well and treated them with respect. Staff communicated well with people and promoted their rights, dignity and privacy when they provided care. People and their relatives were informed and involved in their care and daily living arrangements. Staff at the service helped to provide a voice for and represent people’s views about their care when this was required.
People were supported to participate in how the service was run and had access to relevant recreational activities and to the local community. The service routinely sought, listened and responded to people’s experiences and concerns or complaints made about the service.
Staff understood their roles and responsibilities and they were appropriately supported to share their views or raise any concerns about people’s care.
We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This related to the premises and good governance. You can see what action we told the provider to take at the back of the full version of this report.
This inspection took place on 5 and 6 November 2014 and was announced. A previous inspection was undertaken on 5 July 2013 and found there were no breaches of legal requirements.
Milton Lodge is registered to provide accommodation for up to 13 men who have a learning disability or mental health issues. People come to the service from a hospital environment where they have been cared for under the Mental Health Act 1983. At the time of the inspection there were 13 people using the service.
The home had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.
We saw there were procedures in place to keep people safe and staff understood what action to take if abuse was suspected. Staff were suitably trained and experienced for their role. They told us the quality of training was good. Staff were trained in safe working practices and more specific areas suitable for their role.
We saw there was enough staff on duty to meet people’s needs. There were recruitment procedures in place and suitable checks were completed before staff started working at the service. There was a system in place to manage medicines safely.
CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. DoLS are part of the Mental Capacity Act 2005. They aim to make sure that people are looked after in a way that does not inappropriately restrict their freedom. The registered manager was aware of the Supreme Court judgement which had redefined the definition regarding what constituted a deprivation of liberty. We saw that mental capacity assessments were in place for each person and best interests meetings were held to ensure that all actions taken were in the best interests of people in line with legislation.
Staff knew people well and had a good understanding of their needs. They were respectful to people and were patient when supporting them. We saw staff enabled people to make decisions for themselves whenever possible.
People who used the service had an individual activities plan based on goals. People chose what activities they wished to engage in and when they liked to do them. People were supported to access the local community. There was a complaints procedure in place and people were provided with a copy in case they had any concerns about the service.
The registered manager monitored the quality of care. Surveys were carried out annually for people who lived at the service. Audits were also carried out for areas such as health and safety, infection control and fire safety.
Regular meetings were held with staff and these meetings were recorded. Staff felt supported in their role by the registered manager. However, we saw the registered provider did not always respond promptly to requests for repairs to be made and for equipment to be replaced.
Records including care plans and risk assessments were complete and kept securely. Records could only be changed by staff by hand which meant it was time consuming for staff when changes needed to be made.
People told us their consent was obtained before care was delivered and staff acted in accordance with their wishes. We found that people's care needs were assessed and their care and treatment was planned.
We looked at how the home managed medicines and found there were appropriate arrangements in place for the safe administration, recording, obtaining, handling, storage and disposal of medicines.
We found the provider had a structured staff selection and recruitment policy in place which aimed to ensure staff were suitably skilled, experienced and qualified to deliver care safely.
There was a structured complaints policy and procedure in place and people said they would happily complain to staff or the manager if necessary.