This inspection took place on 26 January 2017.

Milestone House is a service for up to 13 people who have learning and physical disabilities. The service is also provided to people who have Huntington’s disease. The home is set in a residential area in Deal. There is a drive and parking area at the front of the house.

There was a good sized secure garden with trees, plants and a large lawned area at the back of the home that people could spend time in and was wheelchair accessible. Accommodation was set across two floors and was wheelchair accessible. CCTV cameras were in operation in communal areas.

There was a spacious communal lounge, a small seating area and a dining room that people could spend time in. The home had specialised equipment including a spa bath, overhead hoists and a sensory room. One bedroom was on the first floor and could be accessed by a stair lift. All other bedrooms were on the ground floor.

The provider was also the registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 registered manager was not present at this inspection. A new manager had been employed to help run the home and develop the service.

At our last inspection in July 2015, the service was in breach of some of the regulations and was rated ‘Requires Improvement’. The provider sent us an action plan outlining how they would rectify those breaches. The manager and team had worked hard to update policies, the risk assessment processes and care planning to provide person centred care. At this inspection all the regulations were met and the manager had a clear plan to continue and maintain improvements.

The service had signed up to The Social Care Commitment. The Social Care Commitment is the adult social care sector's promise to provide people who need care and support with high quality services. There was a visible difference in the home since the last inspection. People were clearly benefiting from a more structured and well led service and staff carried themselves confidently. The improvements, staff training and staff support meetings were based on the principles of the Social Care Commitment and research of current best practice for people.

Staff, relatives and visiting professionals told us they thought the service was well led. The manager was experienced in supporting people with learning disabilities and health conditions like Huntingtons disease and working with other health and social care professionals to provide person centred care.

People were occupied with meaningful activities in the company of staff. There was a warm, friendly atmosphere and everyone looked calm and focused on what they were doing. A visiting professional told us, “I enjoy coming here, I look forward to it.”

Each person had a plan of care and support that had been written with them and their representative and gave a clear outline of what was important to them and what their preferences were. These were reviewed regularly and advice from other professionals was included.

People were supported to keep as well and healthy as possible. If people became unwell the staff responded promptly and made sure that people accessed the appropriate services as quickly as possible. Visiting health professionals including doctors, the community nutrition team and specialist nurses were involved in supporting people’s health and wellbeing. People received their medicines safely and when they needed them, by staff who were trained and competent.

People were supported to eat and drink healthily. There was a good variety of home cooked food and people were complimentary of the meals provided. Relatives told us that people were well fed and the food alwa

There were seven people living at the home and one person staying for respite at the time of the inspection. People were unable to talk to us directly about their experiences due to their complex needs, so we used a number of different methods to help us understand their experiences. We spoke with staff on duty, read records and observe some of the support people were given.

We observed that people were supported to do the things they liked to do each day like access the community and hobbies. People chose when to get up and when to go to bed, what they would like to eat and staff respected their choices.

People could choose how to spend their time at home and were provided with activities. They were helped to make choices with the use of pictures and staff support. We saw that each person was supported individually by a carer.

The home was clean and tidy and we saw that cleaning routines were in line with current guidelines. Infection control systems were followed and this protected people from the risk of acquiring an infection.

People were supported to be able to eat and drink sufficent amounts to meet their needs. The food provided was enjoyed by the people who used the service, staff and visitors. The menu was varied and nutritionally balanced.

The provider made regular checks of the service to make sure that people were getting the support they needed and the service was safe. These checks included asking relatives for their views.

We used a number of different methods to help us understand the experiences of people using the service, because the people using the service had complex needs which meant they were not able to tell us their experiences. These included observing the care and interactions between the people and staff. People expressed themselves

by using sounds, gestures, body language and pointing to objects and pictures. They indicated that the staff treated them with respect and that they felt reassured to be in their company. They indicated that they received the health and personal care they needed and that they were comfortable in their home

A carer (relative) said, ‘My daughter is very happy there. She comes home to us every four or five weeks and when we take her back to Milestone House she is as happy as anything and is really content. She knows the staff well’

All of the people who live in the service have special communication needs. They use a combination of words, sounds, signs and objects to express themselves. Staff assisted us to speak with people in a meaningful way.

People said that they were treated with kindness and respect. They said that they received the personal and medical care they needed and that they felt safe. They said that they liked their meals. People were relaxed in their manner and were confident about saying what they wanted.

Milestone House was inspected on 29 and 30 July 2015. The inspection was unannounced. The service provides accommodation for persons who require personal care for up to 13 people with learning disabilities and Huntington’s disease. At the time of the inspection there were 10 people using the service during the week and 11 people at weekends, as the service provided respite care.

There was a spacious communal lounge, a small seating area and a dining room that people could spend time in. There was a secure garden with trees, plants and a large lawned area at the back of the home that people could spend time in and was wheelchair accessible. One bedroom was on the first floor and all other bedrooms were on the ground floor and there was good wheelchair access. CCTV cameras were in operation in communal areas.

The provider was also the registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 safeguarding training and could identify different types of abuse and discrimination. Staff were unsure how to report abuse outside of the service, for example, to social services or to the Care Quality Commission. The safeguarding and whistleblowing polices had not been updated since 2009 and did not include all the information staff needed to raise concerns outside of the service if they felt they could not report to the provider.

The provider followed safe recruitment practices to make sure that staff employed were suitable to work with people. Assessments were carried out to make sure there were enough staff on duty with the right mix of skills, knowledge and experience on each shift to make sure people had support when they needed it. Some staff had not received the supervision they required to make sure people’s needs were met in ways that suited them best. Staff did not always receive the support they needed to carry out their roles and responsibilities effectively and safely.

Risks to some people were not consistently recognised and assessed. Action had not always been taken to make sure people were safe all of the time. Risk assessments that were in place were not consistently reviewed to make sure they were up to date and accurate. Accidents and incidents were not regularly reviewed to identify themes and patterns to prevent further accidents and action was not always taken to minimise risks.

Regular checks of emergency equipment and systems had been completed and the fire risk assessment had been regularly reviewed, but people did not have individual personal emergency evacuation plans (PEEPs).

People did not always have the support they needed to manage their health needs.

People did not know how to raise a concern. The complaints procedure had not been updated since 2009 and did not fully explain how to make a complaint to other agencies such as the local ombudsmen if people were not satisfied with the outcome of a complaint .

Systems were not in place to monitor the quality of service. As shortfalls with the service were not always identified, action had not been taken to address them. Support and care records were not checked as part of a quality assurance process and care plans did not include all the information for staff to meet people’s needs.

People and staff were not always actively involved in the development of the service. Whistle-blowers were not always protected as there was no system in place for them to raise concerns anonymously to the provider or outside agencies such as the local authority safeguarding team.

Staff understood their responsibilities under the Mental Capacity Act 2005. CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes.

Staff were aware of a recent Supreme Court Judgement which widened and clarified the definition of a deprivation of liberty. Senior staff understood when a DoLS application should be made and how to submit one. The service was meeting the requirements of the DoLS.

People were encouraged to follow a healthy diet. Staff knew people’s likes and dislikes and the menu was planned around this. Some people needed a high calorie diet and extra fluids due to their condition and staff made sure people had the nutrition and fluids they needed.

People’s medicines were stored and managed safely.

Staff knew people well. They described people’s life histories, personal preferences and hobbies. People were treated with respect and dignity. Staff spoke with and supported people in a caring and respectful manner. People’s diversity was recognised and supported. There were no restrictions on people having visitors.

People and their relatives were involved in the planning of their care and people were encouraged to maintain relationships with people who were important to them.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what actions we have asked the provider to take at the end of this report.