We inspected the service on 21 November 2018. The inspection was unannounced. Milton House is a ‘care home’ for older people. 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. On the day of our inspection 23 people were using the service.

At our last inspection on 15 February 2016 we rated the service as good. At this inspection we found the evidence continued to support the rating of good. We were aware of a complaint being investigated by the local authority. While we did not look at the circumstances of the specific complaint, we did look at associated risks at the location.

People continued to receive a safe service where they were protected from avoidable harm, discrimination and abuse. Risks associated with people’s needs including the environment, had been assessed and planned for and these were monitored for any changes. There were sufficient staff to meet people’s needs and safe staff recruitment procedures were in place and used. People received their prescribed medicines safely and these were managed in line with best practice guidance. Staff knew what to do in the event of an accident and action was taken to reduce further risk.

People had their needs assessed and care and support was delivered in line with evidence based guidance. Staff received the training and support they required to meet people’s needs. People were supported with their nutritional needs. The staff worked well with external health care professionals, people were supported with their needs and accessed health services when required. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. The principles of the Mental Capacity Act (MCA) were followed.

People continued to receive care from staff who were kind, compassionate and treated them with dignity and respected their privacy. Staff had developed positive relationships with the people they supported, they understood people’s needs, preferences, and what was important to them. Staff knew how to comfort people when they were distressed and made sure that emotional support was provided.

People continued to receive a responsive service. People’s needs were assessed and planned for with the involvement of the person. Care plans were in place for each identified need. People received opportunities to pursue their interests and hobbies, and social activities were offered. There was a complaint procedure and action had been taken to learn and improve where this was possible.

The service continued to be ‘well led’. People and staff felt supported by and had confidence in the acting manager. There were systems in place to monitor the quality of service provision and these included seeking the views of people and staff. There was an open and transparent and person-centred culture at the service.

Further information is in the detailed findings below

The unannounced inspection took place on the 04 and 06 July 2016.

Milton House provides accommodation which offers personal care to older people and those living with dementia. There were twenty seven people using the service at the time of the inspection.

The service is required to have a registered manager. 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 home manager had been newly appointed in February 2016 and was in the process of registering as manager for the service with the Care Quality Commission.

The service is safe, clean and has effective infection control procedures however updating of the interior decoration is required to be more suitable for people living with dementia at the service.

An activities co-ordinator had been recruited in order to rectify the current lack of activities for people. People were provided support in a person centred way by staff who clearly displayed good knowledge of the people they supported.

Staff had good knowledge of their responsibilities and how to keep people safe. People’s rights were also protected because management and staff understood the framework of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Management applied such measures appropriately.

Effective support was delivered by staff. People’s safety was ensured whilst personal choice and wellbeing was promoted by the staff providing the care. As part of a robust recruitment process staff were recruited and employed upon completion of appropriate checks. There were sufficient staff to meet people’s individual needs. People’s medicines were managed safely by trained staff.

People had enough to eat and drink and staff understood and met their nutritional needs. Staff and managers ensured access to healthcare services were readily available to people and worked with a range of health professionals to maintain good health of the people.

Privacy and dignity was valued by staff and were observed to be respectful and compassionate towards people. Staff understood their roles in relation to encouraging people’s independence whilst mitigating potential risks.

The service was well led. Innovative plans were being developed to drive improvements of the services available to people. The service ran effectively using quality monitoring audits which the home manager and provider carried out to identify health needs and any improvements to the service. A complaints procedure was in place and had been used appropriately by management. Systems were in place to make sure that people’s views were gathered.

People told us that they were happy with the care and support provided at Milton House. People said, "I have no complaints the staff are nice and the food is good," and, "The staff have been wonderful." We saw that people's care needs were assessed and planned for with any risks associated with their care being minimised as far as possible.

The service was caring and responsive to people's changing needs. Staff sought support from other professionals or agencies when needed. Staff had a good knowledge of people's individual needs and offered them appropriate support. People had opportunities for activity and occupation.

People told us that they enjoyed the food provided at Milton House. We found that people's nutritional needs were assessed and monitored to ensure their on-going wellbeing.

We saw that the service had good infection control policies, procedures and practices in place. The service was kept clean and provided a hygienic place for people to live.

Staff were supported to be effective in their role through robust induction processes, good levels of training and on-going supervision.

People told us that any concerns they had were listened to and acted on. We found that any complaints made were investigated and responded to.

Overall we found Milton House to be an effective and well led service.

We found that people had access to good information about the service so that they knew what facilities they could expect and if the service would be suitable to meet their needs. People told us that they felt safe and comfortable living in Milton House. They told us that they could follow their own routines, were offered choices about their care, and that staff treated them kindly.

People told us that the staff who worked at the service were good. One person said, "All the staff who work here are friendly and good at what they do. I haven't had a bad one yet." We found that staff had adequate training to assist them in their role, but felt that this would be enhanced if they undertook good training in dementia care to ensure up to date and consistent practice. Staff had a good understanding of individual people's needs. People were treated respectfully and their individuality understood.

People told us that they were happy with the quality of the service provided. We found that the provider consulted with people and monitored the service to ensure that standards of quality and safety would be maintained.

People told us that they were happy living in Milton House. They liked the accommodation and found their rooms comfortable.

People told us that they were well cared for.

People praised the food and said that they were given choices about what and where they ate.

Everyone told us that the staff working at the home were very good and seemed well trained.

People living at Milton House told us that they were happy there. They said that the care and support that they received met their needs. They made comments such as “It’s lovely here, the staff are so kind,” “The staff are all lovely and they look after us well,” and “Everyone is always helpful.”

People said that they enjoyed the food and found their rooms comfortable.

Some people would like more activities to take place.