The inspection took place on 30 August and 3 September 2018. It was unannounced on the first day and announced on the second day of inspection.

Milestone House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Milestone House is a respite and short stay service for up to seven adults with a learning disability and/ or autistic spectrum disorder in one adapted building. Many of the people also had a sensory or physical disability. It supports people in the Scarborough and Ryedale areas. At the time of inspection there were four people having respite stays and thirty people accessed the service for regular respite.

At the last inspection in February 2016 the service was rated good. At this inspection we found the service had not maintained this standard and rated it requires improvement.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

A registered manager was 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 had experienced a year of staffing shortages, which had meant the registered manager and staff had focused on providing day to day care.

One member of staff had been appointed and started work without an up to date DBS check in place to consider their suitability to working with vulnerable adults. We spoke with the registered manager and nominated individual about a gap in the provider’s recruitment policy and processes that had allowed this situation to occur.

Care records were not up to date and did not include details of all aspects of people’s needs. Risk assessments were not always in place to ensure people were supported safely and consistently with specific risks. Mental capacity assessments and best interest decisions had not been completed by the service to ensure staying at the service was in people’s best interests.

The registered manager and provider had not completed audits covering all aspects of the service to ensure quality and safety standards were being monitored and maintained.

These issues had not had an impact on people’s care and were a breach relating to the governance of the service. You can see what action we told the provider to take at the back of the full version of the report.

Medication was well-managed at the service. A booking in and out system helped ensure that the turnover of medication as people arrived to stay at the service and returned home was safely managed.

Staff understood people’s care needs and communication. They worked effectively with other services to ensure people received joined up care. Staff worked with relatives to improve their understanding of people and consider alternative ways of providing care to meet people’s support needs.

Staff were supported by team leaders and a registered manager. They received an induction to help them familiarise themselves with their role. Supervision and appraisals were used to encourage staff development and set appropriate targets for them to work towards.

Relatives and staff knew how to raise complaints and could approach the registered manager if they had any issues. Families gave positive examples of where issues had been rectified.

People received sufficient nutritional intake. Different dietary requirements were catered for.

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The inspection took place on the 3 February 2016 and was unannounced. We had made recommendations at our previous inspection and these had been considered and action taken. Milestone House provides respite services and short stays for up to seven adults with a learning disability and/or autistic spectrum disorder. Many of the people who used the service also had a sensory or physical disability. The service is situated in the village of Seamer close to shops, church, restaurants and public houses. There is a regular bus service from the village to the nearest town which is Scarborough.

There was a registered manager employed at this service. 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 had specialist equipment available which supported peoples safety. Ceiling hoists had been fitted in order that people were moved safely. Safety checks of the equipment had been carried out and it was maintained regularly.

There was a handyman at the service who carried out safety checks around the environment. These checks were clearly recorded. Assessments for the environment had been completed and any risks were clearly identified. There were risk assessments in place for individuals and we saw personal emergency evacuation plans in peoples files outlining the support they would require in the event of a fire. Staff were trained in fire safety and evacuation procedures and checks of fire fighting equipment had been carried out. Medicines were managed safely. An administration of medicines checklist had been introduced for staff to use in managing medicines. This had resulted in the elimination of medicine errors at this service.

Staff had followed safe infection control guidelines. There was personal protective equipment such as gloves available for staff in peoples rooms. When we looked around the service it was spotlessly clean and tidy. The laundry had a good dirty to clean flow ensuring that laundry did not become contaminated.

Accidents and incidents had been recorded and were discussed with staff at meetings or in supervision meetings.

Staff were recruited safely and had the skills and knowledge required to work with people who used Milestone House. When people started working at this service they had an induction and shadowed a more senior person until they were competent. They then went on to do further training which reflected the needs of people at the service and was appropriate to their role. Staff felt supported and we saw that supervision had been carried out albeit sporadically for some people.

Staff at Milestone House were skilled in communicating with people. They used their knowledge of the persons communication preferences and their body language to communicate along side more formal tools such as makaton. They worked within the principles of the mental Capacity Act 2005.

Peoples dietary needs were assessed and there were detailed assessments in place outlining how staff should support them with eating and drinking. referrals to health professionals had been requested where necessary through peoples GP's.

Staff were caring and we witnessed many positive interactions between them and people who used the service. Relatives were confident of staffs ability to support their family member. People who used the service had detailed plans and risk assessments in place outlining what staff needed to do to support them. these were reviewed each time the person visited the service. People chose how they wanted to spend their time and this was supported by staff.

There was a quality assurance system in place at the service. Peoples views were gathered and used to improve the service.

This inspection took place on the 7 October 2014 and was unannounced. At our last inspection on 12 November 2013 we had not found any breaches of legal requirements.

Milestone House is located in a village outside the town of Scarborough. It is operated by North Yorkshire County Council. The service provides a respite and short stay service for up to seven people with learning disabilities, complex needs and autism between the ages of 18 -65 years. One of the seven beds at Milestone House is kept for emergency admissions. On the day of the inspection there were only two people resident until a third person arrived later in the day.

There was a registered manager at this service who had been registered with the Care Quality Commission since 2011. 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 safe. People told us that they felt safe staying at this service. Staff were recruited safely and they were trained appropriately.

Staff were clear about how to make an alert if they suspected that anyone was at risk of abuse. They had been trained in safeguarding procedures.

People who used the service were kept safe because safety checks were carried out within the environment and on equipment to ensure it was fit for purpose. Medicines were managed safely.

The service was not always effective because staff were not always clear about how to use the training they had received to best effect.

Staff followed the principles of the Mental Capacity Act 2005 by ensuring that where people could not make their own decisions the best interest decision making process was followed to ensure that people’s wishes were carried out, where possible.

People were given a healthy nutritious diet. Adaptations to cutlery and crockery were made where necessary, to aid people’s independence

Staff were caring and kind showing people respect.

Care plans were person centred and up to date. Risks had been identified and assessed to help to keep people safe.

When transitions between services were made it was done thoughtfully and with the full involvement of the person who used the service.

The service was not always well led. The registered manager had not provided documents requested by the Care Quality Commission.

There was an effective quality assurance system in place at this service.

Relatives we spoke with told us they had spent time at the home with the person who was going to receive respite care there so they could see what could be provided. This allowed people to ask questions and decide if this was the right place for them. We saw that people chose how they spent their time and consented to the care they received. A relative said “X has a way of explaining his needs. He gets his views known.” A person we spoke with said “I choose what to do.” We observed that people’s rights were protected.

People had individualised support plans and risk assessments in place which helped staff to understand and meet people's needs. A relative we spoke with said “They know X’s needs very well.”

Effective recruitment processes were in place. There were enough skilled and experienced staff in place to meet people’s needs, in a timely way.

There was an effective complaints system in place. Information about how to make a complaint was provided to people in a format that met their needs for example, large print. A relative said “The manager is brilliant. If I had any concerns I would raise them. Little niggles are always sorted out really quickly. I never have need to complain."

The quality of the service being provided was monitored by the management team. Any issues found were acted upon. This helped to ensure that people remained satisfied with the service they received.

People’s needs were assessed and their rights were respected by the staff. People made decisions for themselves about how they wanted to spend their time. We saw that staff treated people with dignity and respect. During our visit people could not tell us their views, however people had completed surveys which confirmed people's rights were being protected.

People had care plans and risk assessments in place which helped staff meet people's needs. Staff helped people to maintain their independence and make choices for themselves. One comment on a survey from a person using the service was ‘My needs are known and are met with a flexible approach.’ A relative commented ‘XX is happy to stay at Milestone House. They are calm and content.’

People could not tell us if they felt they were protected from abuse. However, staff were aware of the action they must take to protect people. One person had said on their survey ‘I feel very safe.’

We found that staff received training in a variety of subjects to help keep their skills up to date. A relative said on a survey ‘XX is fortunate to be looked after by such loving, caring and professional staff.’ Another comment on a survey was ‘The staff are good.’

People’s view were being sought about the quality of the service being provided. A person said on their survey ‘I think everything is very good. I would not change anything.’ We saw that the manager and staff wanted people to enjoy their stay.