Middleton Manor Care Centre

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• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

This is the first assessment for this service since a change to their registration. This key question has been rated requires improvement. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

This service scored 50 (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 did not always make sure people’s care and treatment were effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them.

People had holistic needs assessments which fed in to care plans and risk assessments. However, care plans and risk assessments were not always reflective of current needs or risks. Relatives told us they did not always feel involved in the assessment and planning of people’s care and treatment. A relative told us, “There has been no involvement in any reviews or planning since the new management team took over.”

The provider did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them.

Needs were assessed in-line with good practice guidance and recognised standards; however, people were not always involved in choices about their care and treatment and care plans were not always effectively followed or updated when people’s needs changed.

People were not always supported to eat meals of their choosing and did not always have enough support. This led to meals being left uneaten and placed people at risk of poor nutritional intake. Staff were not recording when prescribed thickeners were used and we could not be assured people had appropriate drinks. This placed people at risk of choking and dehydration.

We observed that people were not always given the appropriate support to make choices about their meals. People had not been involved in developing the menus and several expressed not knowing what the food on offer was. We were told further work was planned to tailor menus around the likes and choices of people in the home.

Kitchen staff were aware of people’s special dietary requirements and food was prepared in line with this. This included meeting peoples religious and cultural requirements and modified textures for those people who had swallowing difficulties or were at risk of choking.

The provider did not always work well across teams and services to support people.

We saw some examples of the service contacting external teams appropriately, however we could not be assured this was happening consistently due to lack of clear record keeping.

We received mixed feedback from relatives about how the provider managed the involvement of appropriate healthcare professionals when needed. A relative told us, “[My family member] has had a couple of issues where the community matron needed to come out and also last year SALT (speech and language therapy) were called out due to issues with their swallowing. I have been kept informed and talked through this by the senior floor staff each time.” However, another relative said, “Due to the lack of communication recently I’m not aware of the level of contact [with healthcare professionals] that is currently in place.”

The provider did not always support people to manage their health and wellbeing, so people could not always maximise their independence, choice and control. Staff did not always support people to live healthier lives, or where possible, reduce their future needs for care and support.

We observed that several people in the home had long, dirty, finger or toenails. We requested information on when these people last saw the chiropodist. The registered manager told us people had been visited by the chiropodist recently but records of this were not provided when requested.

We also observed 1 person we spoke with had very dirty teeth. We reviewed the records for this person and found oral hygiene and teeth cleaning was not happening on a daily basis with no explanation why.

We received mixed feedback from relatives. A relative told us, “We have recently contacted the GP who liaised with the home and there has been a change made to [my family member’s] medicines. We’re happy with how all that was managed.” However other comments included, “I’m never sure if they are sorting appointments for things like the optician or chiropodist.” And “I have had no offers of assistance when I have taken my [relative] to hospital or dental appointments.”

The provider did not always routinely monitor people’s care and treatment to continuously improve it. They did not always ensure that outcomes were positive and

consistent, or that they met both clinical expectations and the expectations of people themselves.

Some relatives told us they did not have recent input into their family member’s care and outcomes. We received mixed feedback from relatives, including people having limited social outcomes. A relative told us, “There have been no trips out or regularly organised sessions to my knowledge (apart from the hairdresser and chiropody). I believe this is a considerable failure of the home.” Another relative said, “It would be nice, to have more staff so that the levels of social interaction and activities could be higher.”

Due to the issues we found with systems in areas such as medicines, accidents, incidents and staffing, we could not be assured that people were experiencing positive or consistent outcomes or that these were being effectively monitored.

The provider did not always tell people about their rights around consent and did not always respect their rights when delivering care and treatment.

We reviewed the mental capacity assessments being undertaken in the home. Whilst some had been completed appropriately, not all capacity assessments for the use of bedrails had been completed in-line with best practice. Families had not always been involved in decisions. We also saw no evidence of Best Interest decisions around the use of covert medicines (where medicines are administered hidden in food or drinks).

A relative told us, “As far as possible [my relative is involved in decision making], they’re at a stage where this is very difficult but they do generally ask them and even if they can't answer they are good at following the gist, this is better with staff who know them better, so how effective this is can depend a little on who is on shift.”

DoLS applications had been submitted to the local authority for authorisation when needed.