Middleton Fells

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. This is the first assessment for this newly registered service. This key question has been rated as requires improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety.

The service was in breach of legal regulation in relation to dignity and respect.

This service scored 56 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

Accident and incidents were recorded and continually monitored. Regular reviews of incidents showed where any lessons had been learned and used to inform strategies in place. Where lessons had been learned the sharing of these was done in staff handovers and meetings. Families and relevant others were informed of accidents and incidents, and the duty of candour was followed.

The provider worked with people and healthcare partners to design, establish and maintain safe systems of care, in which safety was always well managed and monitored. They made sure there was continuity of care, including when people moved between different services.

Thorough preadmission assessments were completed and transitions into the service were extremely well planned. Some relatives told us they had been involved in developing plans on admission to the home. One relative told us, “When [Relative] transitioned to Middleton Fells they did day visits and was introduced to their new accommodation. It went smoothly.” The planning also included professionals who were already involved in the care and treatment plans for people. Processes were in place to help ease transition to other services if needed such as emergency hospital admission information was available.

The provider did not always concentrate on improving people’s lives or protecting their rights to live in safety, free from abuse and discrimination. The provider did not always share concerns appropriately with the relevant agencies.

People can only be deprived of their liberty to receive care and treatment with appropriate legal authority. In care homes, this can be done through a procedure called the Deprivation of Liberty Safeguards (DoLS), which is part of the Mental Capacity Act 2005 (MCA). We checked whether the service was working within the principles of the MCA and how they managed DoLS within the service. We saw DoLS authorisations were applied for and recent DoLs reviews had been completed.

People’s liberty had been restricted in a variety of ways including the use of monitored seclusion over a number of hours day and night for 4 people. The use of seclusion had been an inherited practise from the previous provider and been used as part of the risk management of some individuals behaviours. The monitoring of one person’s secluded time included the constant use of CCTV. Under this provider where seclusion was being used, we did not see evidence of all lesser options of restriction having been considered.

The use of constant supervision and seclusion meant there was a lack of privacy and dignity. This was not in line with current best practice of Right Support, Right Care, Right Culture. The provider and staff were had commenced working with professionals and commissioners to consider a programme of seclusion reduction.

Staff had completed training in safeguarding awareness and in the MCA deprivation of liberties. However, we found not all incidents of safeguarding had been identified and shared with the local authority or us.

All relatives we spoke with told us they felt people in the home were safe.

The provider did not always work well to protect rights and dignity when assessing and managing risks. Staff provided care to meet people’s needs that was supportive and managed risks.

Seclusion was being used to manage known risks for 4 people. We did not see clear plans for reducing or ending the use of seclusion. Some records did not always have strategies identified to manage known risks. Some records for managing identified risks were seen not to be current and/or accurate. Positive risking taking was evidenced where appropriate for some people. We observed staff knew risks associated with people’s care and could explain how to manage them. We saw positive interactions by staff with people who could not easily express their needs or became distressed.

The provider did not always detect and control potential risks in the care environment. They did not always make sure facilities supported the delivery of safe and effective care.

Regular environment, safety checks and servicing was in place. There was an ongoing programme of upgrading and making improvements to the home. The décor of some individual living areas was lacking in being personalised and homely. We also observed an area of personal space being used as a communal kitchen by multiple staff.

Staff were adequately trained in fire and evacuation and the use of equipment. However, we were not fully reassured about the fire risk assessment being current and accurate and made a referral to the local fire and rescue safety team.

The provider made sure there were enough staff but how they were deployed meant at times some people were not consistently supported in line with their commissioned care. Staff were suitably qualified, skilled and experienced and received effective support and supervision.

The provider used a safe staffing risk assessment to make sure there were sufficient staff available. At the time of this assessment 2 people required 2:1 staffing during the day and 4 people 1:1 staffing. There were no separate ancillary staff employed for cleaning and cooking this was done by staff identified as providing direct support for people. This meant at times people were not in receipt of the level of staff support commissioned. One relative told us, “I would say there is enough staff.”

Staff had been recruited safely with the appropriate checks of suitability being made prior to their employment. Staff told us they felt they had received sufficient training to care for people safely. We noted for eLearning some topic areas still need to be completed by some staff. Staff told us they felt very supported by the registered manager and had regular supervisions. One relative told us, “Some staff are well trained, and some are not.”

The provider did not always identify, assess and managed the risk of infection.

The provider was working on an action plan following a local authority audit where a number of infection prevention concerns were found. We observed areas of the home were still not clean as noted in the audit. We found some fridges and mattresses were not clean and an area of someone’s living space. There were some damaged surfaces and furniture make cleaning difficult and could be a source for cross contamination.

There were no clear local procedures on managing cleaning, soiled laundry, the use and disposal of PPE and the management of the risk of cross contamination between staff doing personal care and then cooking. Communal food preparation was being done in an individual’s domestic kitchen. The provider has made a self-referral to the foods standard agency. Relatives told us when they visited the home they found it to be clean.

The provider made sure that medicines and treatments were administered and kept safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened.

Systems and processes to safely administer and store medicines were in place. Staff had completed medicines training and had their competency assessed. Medicine records were clear and concise in detailing peoples’ preferences for the administration of their medicines.