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Middleton Hall Retirement Village Requires improvement

Reports


Inspection carried out on 6 August 2019

During a routine inspection

About the service

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.

Inspection carried out on 10 January 2017

During a routine inspection

The inspection was carried out on 10, 11 and 13 January 2017 and was unannounced. At the last inspection carried out on 17 and 24 November 2014 the provider was meeting all the regulations that were assessed.

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 t

Inspection carried out on 17 and 24 November 2014

During a routine inspection

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.

Inspection carried out on 5 December 2013

During a routine inspection

We spoke with eight people from 72 living at the service.

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.

Inspection carried out on 18 September 2012

During a routine inspection

People told us �The staff care for us. One person said, �This is a nice place to be, people are nice.� One visitor told us, �I think the staff attitude is very good. Whenever I come (to the care home) staff are attentive and caring.�

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.�

Reports under our old system of regulation (including those from before CQC was created)