We carried out a review of the data available to us about Middleton Hall Retirement Village 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 Middleton Hall Retirement Village, you can give feedback on this service.
Middleton Hall Retirement Village is a residential care service providing personal and nursing care to older people and people living with a dementia type illness. The service can support up to 90 people. At the time of our inspection the service was supporting 66 people.
Middleton Hall Retirement Village is set in substantial grounds and provides a range of accommodation and care packages. Not everyone who lives in Middleton Hall Retirement Village requires personal or nursing care. Within the grounds are bungalows and apartments for fully independent people, who have access to the on-site facilities. CQC only inspects where people receive personal care. Support is provided across four distinct areas, with each area having its own facilities. Middleton Court provides nursing care. Middleton Oaks provides care and support for people living with a dementia related condition and is divided into two inter-linked bungalows. Middleton Gardens provides residential care with a choice of care packages to meet people’s needs and preferences. Middleton Grove provides apartments for people who are largely independent but who may require some personal care support. At the time of our inspection, 14 people were living in Middleton Grove, 3 of whom required personal care.
People’s experience of using this service and what we found
Since the last inspection, improvements had been made regarding the administration and management of medicines. However, records for topical preparations were not always completed. We have made a recommendation about the management of some medicines.
Improvements had been made to people’s care plans and risk assessments. The provider had implemented a new electronic care plan system. The care plans and risk assessments were up to date, comprehensive and personalised.
People said they felt safe and well cared for. There were enough staff on duty to meet people’s needs and keep people safe. Staff were recruited safely. The home had robust safeguarding policies in place and staff understood their safeguarding responsibilities.
Since the last inspection improvements had been made with regard to assessments under the Mental Capacity Act. Some carers did not fully understand best interests decisions and we have made a recommendation about additional training in this area.
People were supported to eat and drink enough to maintain a balanced diet. Since the previous inspection, people had more choice about their food and drink and people had opportunities to give feedback. Staff were aware of individual residents’ nutritional needs.
People’s individual choices and preferences were recorded in their care plans. Staff had completed training in all core areas identified as mandatory by the provider and additional training was available on their online training system.
Since the last inspection, the provider had made improvements and had implemented and maintained effective procedures to review the quality of the service. The provider had a regular system of supervision, spot checks, and appraisals.
The provider encouraged and welcomed feedback from people and staff. Staff felt well supported by the management team and spoke positively about their roles. The provider’s visions and values were person-centred and focused on continuous improvement and providing good quality care.
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.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection and update
The last rating for this service was requires improvement (published 12 November 2019) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.
Why we inspected
We received an anonymous concern in relation to care, treatment and nutritional needs. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.
We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.
The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.
We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe, effective and well-led sections of this full report.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Middleton Hall Retirement Village on our website at www.cqc.org.uk.
Follow up
We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
Middleton Hall Retirement Village is a residential care home providing personal and nursing care to 73 older people and people living with dementia at the time of the inspection. The service can support up to 90 people.
Middleton Hall Retirement Village accommodates people across numerous areas within substantial grounds. Not all of the people who live within the wider retirement village are in receipt of support with their personal care. CQC only inspects those areas in which people are in receipt of personal care. The people who require this level of support live across four areas, each of which has separate adapted facilities. Middleton Court provides nursing care and Middleton Gardens provides residential support. Middleton Grove is home to a mixture of people who do not require any assistance with personal care and a small number of people who are receiving this additional support. Middleton Oaks provides care for up to 16 people living with a dementia. This is a separate building consisting of two linked bungalows designed to provide support in a family style setting where meals are prepared in a domestic kitchen.
People’s experience of using this service and what we found
Medicines were not always managed safely at the home. Risk assessments were not always in place and therefore staff did not have all the information necessary to minimise risk.
People and relatives felt there were not always sufficient staff on duty and sometimes people had to wait for assistance. We have made a recommendation about this.
People were not always supported to have maximum choice and control of their lives. Mental capacity assessments were not always correctly completed and records of best interest decisions were not always in place.
People were supported with eating and drinking but the choice and quality of food in Middleton Oaks was sometimes not of the same standard as other areas. Records were not always kept to ensure people were drinking enough to stay healthy.
Care records needed to be reviewed to ensure they were accurate and up to date. Whilst some care plans were very detailed others contained limited information about a person’s likes and dislikes.
Quality checks were in place but had not identified the issues we found. The registered manager and the wider management team were very quick to respond to our feedback and took steps to make improvements straight away.
People continued to receive care from kind and compassionate staff. Staff knew people well and provided support which met people’s needs. Family members were welcomed at the service at all times.
People had opportunity to take part in an incredibly varied programme of activities within the home in line with their personal preferences and there were good links with the local community. People were encouraged to be as independent as possible and were all able to enjoy the extensive grounds thanks to individual GPS tracking devices.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
The last rating for this service was outstanding (published 28 February 2017).
Why we inspected
This was a planned inspection based on the previous rating.
Enforcement
We have identified breaches in relation to safe care and treatment, consent and good governance at this inspection.
Please see the action we have told the provider to take at the end of this report.
Follow up
We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
Middleton Hall Retirement Village comprises a range of accommodation and care options for older people. Within the grounds are bungalows and apartments for fully independent people who use the facilities on site. There is Middleton Court providing nursing care and the Family Living service providing care and support for people with dementia. Middleton Gardens provides residential care and Middleton Grove has self contained apartments for those people who wish to continue living independently but may have some care and support needs provided by staff.
At the time of our inspection the service was providing support to 74 older people.
There was 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.
People were actively encouraged to maintain as much independence as possible with a positive approach to risk taking in day to day life gaining positive results in people’s mental and physical health. Staff had also been responsible for encouraging and supporting people to explore new interests which they enjoyed.
The service had made positive changes to enhance their training, ensuring staff supported people to stay safe. They had developed interactive learning sessions which included role play where the management team “acted out” a wide variety of scenarios which helped staff reflect on their own practice to identify potentially abusive situations. The feedback from staff about this training was excellent. Staff told us it was thought provoking and really promoted discussions about their own practice and what could be seen as restrictive.
The service used state of the art GPS (global positioning system) technology to support people to independently explore the extensive grounds at Middleton Hall Retirement Village in a safe way.
The registered manager ensured that staff had a full understanding of people’s support needs and had the skills and knowledge to meet them. Staff training was innovative and staff were given the opportunity to explore and implement best practice approaches with excellent outcomes for people. The nursing team had researched oral health and had delivered training, implemented a new policy, screened all people and had a public information giving event with feedback from the NHS oral health lead that this work had been ‘outstanding’.
People’s independence was actively encouraged through a range of imaginative, person-centred approaches to activity-planning which the service called “Living Well”. The service provided innovative support to people to enable them to live fulfilled and meaningful lives.
All staff across the service including the estates and administration departments brought added value to the service by bringing their individual personal skills to the service. These included bird watching, technology, exercise and fitness. The service utilised these skills so their job satisfaction and motivation were visible to see.
The registered manager and staff team demonstrated commitment to providing the best possible care and opportunities for people. The close links with the local community meant the service provided support to local schools, churches and community groups via sharing their facilities and we saw people either independently or with support could access the community freely.
People were fully involved in staff recruitment and the service utilised an advanced tele-screening package which assessed candidates during practical and written exercises with people using the service, to assess key qualities such as attitude and skills matching. We saw this screening helped second interviewers target questions more specifically to areas they wished to pursue with candidates. This showed the service excelled at ensuring they had a robust recruitment process that focussed on selecting people with the best skills and attitudes.
We saw people, their families and friends were an integral part of the service, actively engaged in many areas; from meeting with the chefs to the planning and development of the new extension to the current ‘Family Living’ service. This was the service’s specific way of supporting people living with a dementia.
People were supported to maintain optimum physical and mental health by a team of staff across the Living Well and care service. People had access to bespoke sessions with qualified physical trainers, use of the gym, pool and spa facilities as well as the service promoting sessions to promote well-being such as new Mindfulness sessions and a raft of treatments such as a Nail Bar to help people feel positive in mind and body. People told us of the outcomes they experienced using this approach which for some people had been huge improvements in their physical health, for one person meaning despite their chronic condition, they had not had a hospital admission for over two years, something which has been a regular occurrence prior to moving to the service.
The registered provider demonstrated how they had sustained outstanding practice, development and improvement at the service. The leadership sought out creative ways to provide a personalised service and had achieved excellent results through exploring best practice both in the UK and abroad and implementing them at Middleton Hall Retirement Village. The staff team were highly motivated and were actively involved in and contributed to continuous improvements in care and running of the service.
Staffing ratios were excellent and responsive to people’s changing needs and preferences. This allowed for people to make full use of all of the facilities the service had to offer, to go out on trips, both as a group and individually, be supported to healthcare appointments and to experience unhurried and attentive care.
Without exception people and visitors we spoke with told us that staff were extremely caring. We were given lots of examples by people of when staff had gone the “extra mile” to show excellence in caring. We saw the service encouraged staff to share their interests and hobbies, for example one staff regularly brought in their trained Pets as Therapy (PAT) dog to visit the service which people enjoyed. All interactions between staff and people were caring and respectful, with staff being patient, kind and compassionate. Feedback from relatives showed end of life care was undertaken with extreme care and compassion by staff. We saw staff had created beautiful hand crafted ‘Memories’ books for the relatives of people who had passed away. This showed the service cared for people and their families even after death with love and support.
The service excelled at promoting choice and in catering to hotel quality standard whilst ensuring people’s nutritional needs were met. The chef and catering team showed they listened to people’s views and provided a service that enabled people to enjoy a wide variety of food in settings such as the Orangery café, the restaurant and quieter dining rooms which meant people could enjoy meals, drinks and snacks with family and visitors.
For those people at risk in relation to nutrition, the service had attained accreditation with the national Focus on Undernutrition (FoU) programme and the records the service developed in relation to supporting nutrition had been highlighted by the FoU programme as an example of best practice to share with other care services.
Staff at the service had excellent links with healthcare services and people told us they were involved in decisions about their healthcare. People gave us examples about how their health had improved since being at the service.
People were placed at the heart of the service by strong, caring leadership which promoted an open culture. The service was recognised by schemes which reward quality practice, for example, achieving Investors in People Gold Award. The management team respected, supported and listened to staff at all levels to improve the quality of service. There were a number of champions within the staff team who each took enthusiastic responsibility to improve the quality of service in their chosen area.
The service acted on staff and people’s views and regularly consulted with them about how to improve. Communication at all levels was clear and encouraged mutual respect. The senior management team understood the service’s strengths, where improvements were needed and had plans in place to achieve these with timescales in place.
There were robust systems and processes in place to protect people from the risk of harm. Thorough checks of the buildings, grounds and maintenance systems were undertaken to ensure health and safety for people and staff was maintained. We saw accidents and incidents were closely monitored by the registered manager.
Records and conversations with the registered manager, people and relatives showed us that people were listened to and complaints or concerns were taken seriously and responded to appropriately
Staff had received training in the Mental Capacity Act 2005 (MCA) to make sure they understood how to protect people’s rights. There was clear guidance in relation to the MCA and people were asked for their consent before staff carried out any care or treatment and care records also showed how the service sought written consent. CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We saw the registered manager; registered provider and staff ensured that people were supported in w
The inspection visit took place on the 17th and 24th November 2014 the first day was unannounced.
We last inspected Middleton Hall in 2013 and found the service was not in breach of any regulations at that time.
The service provides accommodation for up to 77 older people. Middleton Hall is on the outskirts of Middleton St. George. The home is situated in extensive grounds and gardens that are accessible to the people living there.
The home provides a range of accommodation options. People have the choice of residential care apartments, studios and more traditional bedrooms, depending on their level of need.
There is a manager in post who is registered with CQC. 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.
There were policies and procedures in place in relation to the Mental Capacity Act and Deprivations of Liberty Safeguards (DoLS). The manager had made several urgent applications prior to our visit and following advice had carried out capacity assessments on all people using the service. Following this action they had commenced making applications where this was necessary. This meant people were safeguarded. We found the location to be meeting the requirements of the Deprivation of Liberty Safeguards.
People told us they felt safe at Middleton Hall and that staff were always kind towards them. We saw people being given choices and encouraged to take part in all aspects of day to day life at the home, from helping to set the table for lunch to looking after the service’s two chickens. Activities were based on people’s individual needs and focussed on a model called “Living Well” a holistic approach to mental and physical well-being.
Relatives told us they were provided with information about their relative and involved with the care planning and review process.
We saw that staff were recruited safely and were given appropriate training before they commenced employment. There were sufficient staff on duty to meet the needs of the people and the staff team were supportive of the managers and each other. Retention of staff at this service was good.
In the residential and family living service we saw people’s care plans were personalised and had been well assessed. The care plans in the nursing unit were based on a very medical model of care which meant they were not written from the point of view of the person. Both the registered manager and nurse in charge stated they were aware of this and had plans in place to review all the care files in this unit.
Staff told us they felt listened to and were able to talk to the managers and relatives and people who lived at the service also confirmed the management were approachable and accessible. There was a robust quality assurance programme in place that identified areas for improvement and people were actively involved in the day to day and long term planning of how the service was delivered.
People had access to different dining experiences at this service and people were very positive about the quality of food provided.
We saw medicines were administered safely but improvements were required to make sure records were completed correctly and guidance was in place for as required medicines.
All the staff we spoke with knew the needs of the people they were caring for well and interacted with people very positively. One relative we spoke with praised the staff team highly saying, 'They are all so kind and respectful'. We saw that care plans had become much more person centred since our previous visit and the way in which people wanted their care and support to be provided was clearly recorded.
People had lots of choice over menus and dining areas in which to eat, and we also saw that people had their nutritional needs assessed regularly. People told us the food was 'excellent'.
There were sufficient staff on duty to support people for their care needs. We saw staff were recruited safely and appropriate checks were obtained and induction training provided. One person told us, 'There's loads going on, there is a trip out tomorrow and I am going out to the pub for a meal tonight.'
We saw the provider had a quality monitoring process in place to check the quality of the service, which included seeking the views of people and their relatives. There was also a system for reporting and acknowledging complaints which was well publicised around the service.
People told us they were satisfied with the service. One person said, 'It's a very good service. We chose it because we have discerning taste and wanted the best.' Another person said, 'I was in an assisted living flat but my needs changed so I moved across to the residential unit because I needed a bit more care. It's good that we can stay on the same site so we can still use all the facilities.'
A relative told us, 'The quality of care is excellent.' We also spoke to one visiting health care professional who told us that the home gave 'superb care' and 'the organisation was very good'.
One person told us, 'I feel safe and well looked after here.' A regular visitor told us, 'I have no concerns, my relative is well looked after. There are always plenty of staff on and managers around to supervise them.' Another person told us, 'Staff are very caring. Someone fell the other day and they came running from all directions in a shot.'
People told us they felt included in influencing the service. One person said, 'Everything is very good. We get the opportunity to comment on the service at our meetings.' Another person commented, 'We are asked for our views and the manager seems to take note because changes are made if necessary.'