Middlefield House Nursing Home

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.

The provider's quality assurance systems were not always effective at monitoring and improving the service people received. They had not identified issues we found during our inspection, and parts of the service provision were not monitored. These included the mealtime experience, and whether support provided to people was in line with current best practice guidance. Records were not always kept up to date, and some had not been completed.

Staffing levels did not always meet people's needs. People had not always received personalised care due to staffing levels. Staff had not received supervision in line with the provider's policy. Staff training was not up to date.

In June 2017, The Care Quality Commission published 'Registering the Right Support'. This, along with associated good practice guidance, sets out the values and standards of support expected for services supporting people with a learning disability. At this inspection, we assessed the service in line with this guidance. The care service has not been developed and designed in line with the values that underpin ‘Registering the Right Support’. These values include choice, promotion of independence and inclusion, and people with learning disabilities and autism using the service can live as ordinary a life as any citizen.

People’s experience of using this service: As a larger care home catering for up to 18 people, Middlefield House does not meet current best practice guidance for supporting people to live as ordinary a life-style as possible. The Department of Health states that best practice is for people with a learning disability to live in 'small, local, community based settings.' The size, layout and staffing arrangements at Middlefield House meant that it did not feel or operate as people's own home. Staff wore uniforms and a large sign outside the service advertised the service. People who required support to learn or retain everyday living skills were not always provided with individualised support.

We have made a recommendation that the provider follow best practice for people with a learning disability to ensure the principles of choice, independence, inclusion and living as ordinary a life as any citizen are implemented throughout the service they provide.

The provider had systems in place to protect people from the risk of harm and staff knew how to keep people safe. Risk assessments were in place, which provided staff with guidance on how to maintain people's safety. The provider followed safe recruitment procedures and processes.

Staff knew people and their needs well. People were cared for by kind and caring staff. Relatives gave consistent, positive feedback about the service and said they were happy with the care their family member received.

Care plans were detailed and were developed in line with people's preferences. These were in accessible formats and included information from external healthcare professionals.

People's health was well managed and the service maintained positive links with healthcare professionals. Medicines were managed safely and people's dietary needs were met.

Some adaptations had been made to the premises to support people with their moving and handling needs. People had access to communal spaces which included a sensory room.

Complaints were managed in line with the provider's policy. People and their relatives were provided with information on how to complain.

Staff told us they were supported by management and felt able to raise concerns.

Rating at last inspection: Good (date published 3 June 2016)

Why we inspected: This was a planned inspection based on the rating at the last inspection.

Enforcement: We identified two breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014 around staffing and governance. Details of action we have asked the provider to take can be found at the end of this report.

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.

Middlefield House specialises in the care of people who have a learning disability. It provides accommodation for up to 18 people who require personal and nursing care. On the day of our inspection there were 17 people living at the home.

At the time of our inspection there was a registered manager 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.

On the day of our inspection we found that staff interacted well with people and people were cared for safely. The provider had systems and processes in place to safeguard people and staff knew how to keep people safe. Risk assessments were usually in place, where people received their medicines in food risk assessments had not been completed. Medicines were administered and stored safely. Accidents and incidents were monitored and recorded.

The provider acted in accordance with the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).If the location is a care home Care Quality Commission is required by law to monitor the operation of the DoLS, and to report on what we find.

We found that people’s health care needs were assessed, and care planned and delivered to meet those needs. People had access to other healthcare professionals such as a dietician and GP. Staff were kind and sensitive to people when they were providing support. Staff had a good understanding of people’s needs. People had access to leisure activities and excursions to local facilities.

People had their privacy and dignity considered. Staff were aware of people’s need for privacy and dignity.

People were supported to eat enough to keep them healthy. People had access to drinks during the day and had choices at mealtimes. Where people had special dietary requirements we saw that these were provided for.

There were sufficient staff available to care for people appropriately. Staff were provided with training on a variety of subjects to ensure that they had the skills to meet people’s needs.

Staff felt able to raise concerns and issues with management. We found relatives were clear about the process for raising concerns and were confident that they would be listened to. The provider recorded and monitored complaints.

Audits were carried out on a regular basis and action put in place to address any concerns and issues.

We looked at the care plans of three people, toured the building and looked at records which demonstrated how the provider was monitoring the quality of the service provided.

Relatives we spoke with told us they were involved in decision making about the care and support they received. One relative we spoke with told us, 'I think Middlefield House is absolutely brilliant. My family member is always happy and the care staff always consider our input which involves us as a family.' Another relative told us, 'All the staff are very friendly, very caring and always treat you with respect.'

We saw the food was prepared using fresh ingredients, was well presented and people were offered a variety of choices.

We saw Middlefield House was adapted to meet the needs of the people who lived there. The gardens around the house were accessible, well maintained and contained a patio area for service users and their families to use.

We saw there was an adequate number of staff to support people and extra staff were on duty to support people to go out on a trips out. One member of staff told us, 'I enjoy my job and I stay here because of the people'.

The provider had systems in place to monitor and assess the quality of the service.