Middleton Manor Care Centre

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• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

Responsive – this means we looked for evidence that the provider met people’s needs.

This is the first assessment for this for this service since a change to their registration. This key question has been rated requires improvement. This meant people’s needs were not always met.

The service was in breach of legal regulation in relation to person-centred care.

This service scored 46 (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 make sure people were at the centre of their care and treatment choices and they did not work in partnership with people, to decide how to respond to any relevant changes in people’s needs.

Our observations showed a person-centred approach was not always followed by staff. People’s care plans were not accurate or fully reflective of their needs. 1 person’s care plan stated they used picture cards to help them communicate with staff, but staff were not all aware of this. A staff member told us “They can understand English, we just speak to them in English.” We observed staff telling this person to speak in English, even though this was not the person’s preferred language. We fed this back to management who told us that there were staff in the home who could communicate with this person in their first language and these staff should be involved in this person’s care. However, they were not always deployed to the area of the home where this person lived. The registered manager also told us the picture cards were no longer used as the person found them upsetting. This was not reflected in the care plans.

Activities were not always tailored to meet individual needs. At times people were encouraged to stay in lounge areas to make it easier for staff to observe them without consideration to their preference.

There was a lack of consistent staffing due to the recent high turnover of staff. This resulted in staff not always being familiar with the needs of the people they were supporting, ultimately impacting the delivery of person-centred care. A relative told us, “Without stable staffing, the opportunity to truly know and respond to each resident’s unique needs is lost.”

There were some shortfalls in how the provider understood the diverse health and care needs of people and their local communities, so care was not always joined-up, flexible or supportive of choice and continuity.

Care plans demonstrated people’s diverse needs and choices, however, we did not see evidence of this in practice. Although we requested evidence of how people’s religious needs were being met this was not provided.

There had been a high turnover of staff and people were not always getting consistent support from regular staff. There were staff in the home when we visited who did not know people well and directed us to other staff to answer queries about people’s care. The home was using both external agency staff and staff from an internal bank team.

Staff did not always have training to meet the needs of the service user group; several staff were new and still being introduced to the service and others had knowledge gaps around specialist training and skills needed for the people they supported.

Staff told us, “I am concerned that new staff are not offered adequate training to carry out their role safely, competently and in a caring manner. There is a great reliance on our internal bank team.”

A relative told us, “In the absence of staff continuity, the quality of care has deteriorated to a transactional level, lacking the personal relationships that foster genuine understanding of individual residents.”

The provider did not always supply appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

Information on the accessible information standard was available in the home with details of how to request information in other formats, however we found the home was not meeting 1 person’s communication needs and information was not always available to this person in a format they understood. We were told menus were available for this person in their first language but when we requested this, we were told that the menus had not yet been printed for the week. This meant the person had been without an accessible menu for 4 days.

The provider did not always make it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. Staff did not always involve people in decisions about their care or tell them what had changed as a result.

Management had recently sent satisfaction surveys to staff and relatives. The results from these surveys were mixed. Actions were taken in response to the survey results but over a month later we received similar feedback as part of our assessment. Actions were not always measurable or time specific.

The provider had recently placed feedback and suggestion boxes in reception so people’s views could be gathered on a more regular basis.

The provider had appointed a consultant to work in the home to speak with people, their relatives and staff to look for ways improvements could be made. This was an ongoing piece of work and more time was needed to see the results of this successfully implemented.

We received mixed feedback from people’s relatives about communication. A relative told us, “Communication is a bit of a problem. I know there has been a big changeover of staff and know there is a new manager. At the last relatives meeting, poor communication was the issue raised by all of the relatives there.” Another relative said, “[A consultant] has been brought in to help make improvements and I felt we were listened to at that meeting.”

The provider did not always make sure that people could access the care, support andtreatment they needed when they needed it.

People had equal access to care and support, however, we were not assured they always had this access when they needed it due to staff deployment.

Although the home was over 2 floors there was a lift available to ensure accessibility to all areas. Moving and handling equipment was available to ensure those people who required it could access care and support when they needed it.

Staff and leaders did not always actively listen to information about people who are most likely to experience inequality in experience or outcomes. This meant people’s care was not always tailored in response to this.

Due to the issues we found with systems, we could not be assured that people were meeting their outcomes or that these were being effectively monitored.

Staff had failed to ensure effective communication methods were used when people were struggling to understand. This included instances when menu options were not fully understood and when English was not a person’s first language.

Records did not always show how people, and their representatives where appropriate, were included in the development and review of their care plans. There was not always evidence to show they were consulted and listened to about their experiences to ensure their care plans were tailored and suited to their individual needs and preferences.

People were not always supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.

Although nobody was receiving end of life care at the time of our assessment, care plans documented people’s wishes and preferences, including cultural needs and traditions.

Staff did not have end of life training and whilst this knowledge was not required at the time of our visit, people’s circumstances may have changed at any point and staff had not been equipped with the skills to deal with this.