Archived: Middle Path

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question good. At this assessment the rating has remained good. This meant people were safe and protected from avoidable harm.

People were well cared for and protected from abuse and neglect. Staff had a good understanding of safeguarding and how to raise any concerns they may have.

Risks were identified and were generally well managed. Medicines were managed safely.

There were enough experienced staff to care for people properly. Staff were well trained and well supported. People were supported by staff who had been recruited safely.

Some improvements were needed in respect of developing additional specific support plans and in people’s decision making and when others were making decisions for people.It was unclear if people lacked capacity to make some decisions or when certain restrictions were in place. Relatives had made some decisions about their family member without legal authority to do so. If the person lacked capacity, these should have been ‘best interest’ decisions.

This service scored 72 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Learning culture during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

We had received concerns that people may not have always been cared for in a safe way.

We found staff supported people to live active lives while protecting their right to live in safety, free from abuse, avoidable harm and neglect. Some improvements were needed in respect of people’s decision making and when others were making decisions for people.

People were able to express to us they felt safe and were very happy living at the home. Relatives told us Middle Path was a safe place for their family members to live. One relative said, “We do feel the home is a safe place for [name] to live. On the whole we believe staff are kind, patient and respectful.” Another relative told us, “[Name’s] very happy in every sense of the word. That’s his home and he loves it there.”

Staff knew the signs of abuse to look out for and told us they would report these to the manager to ensure action was taken to keep people safe. One staff member said, “My job is to ensure people are safe. If a colleague was jeopardising that, I would not hesitate to report [my concerns].” There were appropriate policies and procedures in place to protect people from the risk of abuse.

Safeguarding concerns were reported to the local authority safeguarding team and the provider knew what actions were needed to keep people safe. We discussed a recent safeguarding concern with the manager where there had been a delay in reporting to the local authority. It was acknowledged this concern should have been reported sooner.

Staff understood the principles of the Mental Capacity Act 2005 (MCA) (a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves), but improvements were needed and were ongoing when we visited.

We saw staff supported people to make as many of their own decisions as possible. However, it was unclear if people lacked capacity to make some decisions, such as what to spend their money on or when certain restrictions were in place. We read in people’s care records that relatives had made some decisions about their family member without legal authority to do so. If the person lacked capacity, these should have been ‘best interest’ decisions approached, decided and recorded in line with legislation. This was discussed with the home manager who agreed this was an area for improvement and they had already made some progress in this area and would continue to do so.

Where needed, appropriate legal authorisations were in place to deprive a person of their liberty. any conditions related to deprivation of liberty authorisations were being met.

We had received concerns that risks were not always well managed for people.

We found staff worked with people to understand and manage risks. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

People had individual risk assessments in place as part of their care plan. These covered areas such as their medicines, personal care needs, nutrition and travelling in vehicles.

Relatives told us they felt care was provided in a safe way, and staff responded quickly if there was a change in a person’s care needs.

The management team was adding to and improving risk assessments for people to ensure all areas of risk had been covered. For example, 1 person had recently left the home without staff support. This incident had been taken seriously and an ‘emergency staff meeting’ had been held to discuss this. It was clearly stated in this meeting “We [all staff] need to work together to keep the people we support safe.” The person’s risk assessment had been updated to reflect this increased risk and other safety measures put in place to prevent this happening again.

Staff received training and support in supporting people with a learning disability, and autistic people who had, or may be at risk of developing, behaviours of distress. The service worked with other professionals, supporting this approach, and helped to make sure people were consistently supported when they were distressed.

Where people communicated their needs or feelings through their behaviour the manager wanted to ensure a positive behaviour support plan was in place. One person had a plan, and additional plans were being developed for the other 3 people who lived in the home with the support of relevant professionals.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

We had received concerns that people did not always receive the support they needed and staff were not well supported.

We found the provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide care and support which met people’s individual needs.

People were able to confirm they liked the staff who supported them. Two people said “Yes” when we asked if they liked staff. We saw many examples of kind, patient and compassionate care and support being provided when we visited.

People’s relatives spoke highly of staff, both in relation to the care they provided and their caring nature. One relative told us, “[Name’s] got a very close relationship with all the staff. I never hear anything negative from him. His key worker [name] is lovely.”

Staffing had been focused upon by the manager and staff rotas redesigned to ensure each person had their allocated support hours provided. One staff member said, “It is a positive move as we will make sure everyone gets their one to one.”

All 4 social care professionals were very complimentary about the staff team. One told us, “Staff are kind, friendly and approachable and treat the residents with respect. The home has a friendly and homely feeling about it.” Another said, “From my observation, the care provided is of an excellent standard, with staff displaying warmth, compassion, and professionalism in all they do. It is evident that the team is committed to fostering a safe, supportive, and nurturing environment.”

Staff told us they were well trained, and staff support had improved since the new manager had started work. One staff member said, “Supervisions are regular now, but not in the past. [The manager] is trying hard to regularly have face to face supervisions, his door is always open. Team meetings are regular and good.”

Records confirmed staff were provided with comprehensive training such as health and safety practices, safeguarding vulnerable people from abuse and how to care for autistic people or people who required support with their mental health. Staff training was audited. Where staff needed to complete training or required a refresher, this was organised for them.

Formal supervision meetings with staff and regular staff meetings were held. Records of staff meetings showed these were now well attended, covered a range of topics and staff were encouraged to raise any issue they wished to discuss. Staff were also provided with individual meetings such as when they needed additional support. Clear records were kept of these meetings.

People were supported by staff who had been recruited safely. Appropriate checks were carried out on all new staff to ensure they were of good character and safe to support vulnerable people.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

We had received concerns that people’s medicines were not always managed in a safe and effective way.

People we spoke with were happy with the support they received with their medicines. Relatives said medicines were managed safely and their family member was well supported with their medicines. One relative said, “No issues with medication.”

Staff made sure that medicines were safe and met people’s needs. There were systems and processes in place for the safe management of people’s medicines, including safe storage. Staff received training in administering medicines and their practice and competence was assessed.

The provider understood and implemented the principles of STOMP (stopping over-medication of people with a learning disability, autism or both) and made sure people's medicines were reviewed by prescribers in line with these principles.