Background to this inspection
Updated
29 February 2020
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.
Inspection team
The inspection team consisted of one inspector
Service and service type
Middlefield 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.
The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection
The inspection was unannounced.
What we did before the inspection
We reviewed information we had received about the service since the last inspection. This information helps support our inspections and we used all of this information to plan our inspection.
The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make.
During the inspection
We spoke with four people who used the service about their experience of the care provided. Some people who used the service had limited verbal communication. We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us. We spoke with ten members of staff including a housekeeper, a cook, three care staff, the registered nurse, the registered manager, the regional support manager and two company directors.
We reviewed a range of records. This included four people’s care records and multiple medication records. We looked at four staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures, were reviewed.
After the inspection
We spoke to three relatives to gain their views on the service provided for their family member.
Updated
29 February 2020
Middlefield House is a is a nursing home that provides personal and nursing care for up to 18 people with learning disabilities, autistic spectrum disorder or associated physical needs. At the time of this inspection, 17 people were using the service.
The service had been developed and designed before Registering the Right Support and other best practice guidance was introduced. The service was a large home, bigger than most domestic style properties. However, the size of the service having a negative impact on people was mitigated by the building design fitting into the residential area. There were deliberately no identifying signs or anything else outside to indicate it was a care home.
People’s experience of using this service and what we found
Although there was a clear management structure and communication strategies in place at the service, the quality monitoring processes in place did not always highlight issues around the environmental cleanliness that we found during our inspection. These issues were addressed during inspection, and the senior management team told us they had reviewed their quality monitoring processes in relation to infection prevention.
People were protected from abuse, as staff were aware of their role in safeguarding people and the provider worked closely with the local authority teams to manage any safeguarding issues.
The risks to people’s safety were assessed and managed safely using evidence-based assessment tools. People’s medicines were well managed and were stored safely.
People were supported by a group of staff who had been provided with effective training for their role. The numbers of staff reflected and met the needs of people at the service. There were safe recruitment processes in place.
People’s nutritional and health needs were well managed. They 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.
People received person centred care from a group of staff who knew their needs very well. There was a caring attitude towards people from the staff who supported them. We saw a number of positive interactions between staff and people at the service. Staff worked to maintain people’s privacy, dignity and encourage their independence.
The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.
The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion.
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 13th March 2019) and there were two 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 This was a planned inspection based on the previous rating.
Follow up We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.