This inspection took place on 24 July 2018 and was unannounced.
Middletown Grange 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.
Middletown Grange accommodates up to 60 people in one adapted building. At the time of the inspection, the home accommodated 56 people across two separate units, each of which have separate adapted facilities. One of the units specialises in providing care to people living with dementia.
There was no 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. The registered manager had left a week before our inspection. The provider had brought in two registered managers from their other homes to share management responsibilities whilst they were recruiting a new manager.
Before the inspection we had received concerns citing staff shortages and poor leadership and management of the home. A week prior to our inspection the registered manager had left. The provider implemented an action plan to ensure people’s safety which the management team were working through.
We found the provider had made some improvements in the last week to ensure people’s safety. However, they were still working through their action plans and there were still some areas to improve. We found the home did not have enough staff to meet people’s needs. The provider had taken action to rehire previously dismissed staff to ensure people were safe. The home continuously recruited staff to ensure people’s needs were met. The home had staff vacancies which were covered by regular agency staff. The home had robust recruitment procedures and conducted background checks to ensure staff were suitable for their roles.
Risks to people’s well-being were assessed and managed safely to help them maintain their independency. Staff were aware of people’s needs and followed guidance to keep them safe. However, some risk assessments were not always reviewed when people’s needs changed.
The environment on the dementia unit was not always clean. We found the unit had malodours both in people’s rooms and in communal areas. The management team told us the provider was in the process of refurbishing the whole home and reviewing the cleaning audits.
People had their needs assessed prior to living at Middletown Grange to ensure staff were able to meet people’s needs. However, the home had failed to ensure that the needs of people living in the dementia unit could be met as the staffing levels were not appropriately adjusted.
People were not always supported with hydration needs. We saw some people on the dementia unit did not have access to call bells and drinks. Staff provided people with regular refreshments, however, people were not supported to drink them.
The service did not always follow best practice in the end of life care. Low staffing levels impacted on how people received end of life care. People’s records were not always up to date.
People knew how to complain and some complaints were dealt with in line with the provider’s complaints policy. However, the concerns we had received prior to our inspection showed that some people’s concerns had not been addressed to their satisfaction.
The service was not always well-led. Historically, Middletown Grange had not had stable leadership. People, their relatives and staff were not happy with the way the service was run. The shortage of staff we identified had had a negative effect on general staff morale. Staff felt let down by the provider and not listened to.
The provider had a range of quality monitoring arrangements in place to monitor care and plan ongoing improvements. This included audits, surveys and regular health and safety checks. However, the systems in place had not identified some of the shortfalls found at our inspection.
People told us they felt safe living at Middletown Grange. Staff clearly understood how to safeguard people and protect their health and well-being. There were systems in place to manage people’s medicines. People received their medicine as prescribed.
Staff worked effectively with various local social and health care professionals. Referrals for specialist advice were submitted in a timely manner.
People were supported by staff that had the right skills and knowledge to fulfil their roles effectively. Staff support was through regular supervisions (one to one meetings with their line managers) and appraisals to help them meet the needs of the people they cared for.
People living at Middletown Grange were supported to meet their nutritional needs and maintain an enjoyable and varied diet. Meal times were considered social events. We observed a pleasant dining experience during our inspection.
People told us they were treated with respect and their dignity was maintained. People were supported to maintain their independence. The provider had an equality and diversity policy which stated their commitment to equal opportunities and diversity. Staff knew how to support people without breaching their rights.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.
People’s input was valued and they were encouraged to feedback on the quality of the service and make suggestions for improvements. The home had established links with the local communities which allowed people to maintain their relationships.
This is the first time the service has been rated Requires Improvement.
During this inspection we identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.