Middleton Manor Care Centre

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

Well-led – this means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture.

This is the first assessment for this for this service since a change to their registration. This key question has been rated inadequate. This meant there were widespread and significant shortfalls in leadership. Leaders and the culture they created did not assure the delivery of high-quality care.

The service was in breach of legal regulation in relation to governance at the service.

This service scored 36 (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 have a shared vision, strategy and culture based on transparency, equity, equality and human rights, diversity and inclusion, and engagement. They did not understand the challenges and the needs of people and their communities.

Although the provider had devised an action plan to address areas of concern, they did not have a clear strategy in place to make the necessary changes and ensure all staff were engaged in this.

We observed some practices to be more for the benefit of staff than people using the service. For example, staff encouraged people to spend their time in the lounge to make it easier to observe them.

A staff member told us, “I pride myself in delivering a high standard of person-centred quality care. I do not feel I am able to do this due to the culture and quality of staff within the home, particularly management and nurses.”

The provider did not have inclusive leaders at all levels who understood the context in which they delivered care, treatment and support, or who embodied the culture and values of their workforce and organisation. Leaders did not have the skills, knowledge, experience and credibility to lead effectively, and they did not do so with integrity, openness and honesty.

At the time of our assessment, a new management team had been in place for three months. During this time some issues had been identified but not acted upon and other areas of concern had not been recognised. For example, the managers daily walkaround had not picked up environmental risks. A relative told us, “The current leadership appears to be operating in a reactive, crisis-oriented manner, characterised by frequent discussion yet limited evidence of effective listening or decisive action.”

Some of the relatives we spoke with were not happy with the level of communication from the home. A relative told us, “Management is the main issue at the home, I now no longer know who is in charge, management has changed so much recently and there has been no information on it.”

People did not always feel they could speak up and that their voice would be heard.

Whilst the provider had policies in place for staff speaking up, the feedback we received indicated some staff did not feel confident to do so, or that appropriate action would be taken. A staff member told us, “Management don’t listen to us even if you try to communicate with them they do not respond to our calls, messages or emails, so whenever I have a problem I don’t know who to tell.” Another member of staff said, “I do not feel supported in my role. I feel vulnerable and concerned that the home is not safe. I have taken my concerns to management and these have been ignored.”

The provider did not always value diversity in their workforce. They did not always work towards an inclusive and fair culture by improving equality and equity for people who worked for them.

The provider had an equality and diversity policy in place, however, not all staff were up to date with training in this area.

The service employed a diverse range of staff. 1 member of staff had a sensory impairment and the provider had adaptations put in place to support them in their role. However, the mixed feedback we received from staff indicated they did not all have equal experiences within the workplace.

The provider did not have clear responsibilities, roles, systems of accountability and good governance. They did not act on the best information about risk, performance and outcomes, or share this securely with others when appropriate.

People were exposed to the risk of harm as the provider had failed to ensure an effective system was in place to monitor and improve the quality and safety of services provided. There was a lack of oversight of delegated tasks which resulted in a delay in safeguarding referrals being made.

Audits had not identified all of the issues we found at this assessment, some concerns were acknowledged but actions were not taken to rectify them. Action plans were not robust and did not drive improvement in a timely way.

The provider did not always understand their duty to collaborate and work in partnership, so services worked seamlessly for people. They did not always share information and learning with partners or collaborate for improvement.

Feedback from some professionals indicated that communication and responsiveness could be improved. The home was being monitored and supported by the local authority to ensure the correct procedures were in place to keep people safe.

The provider did not focus on continuous learning, innovation and improvement across the organisation and local system. They did not encourage creative ways of delivering equality of experience, outcome and quality of life for people. They did not actively contribute to safe, effective practice and research.

The provider’s audits had not been effective at implementing improvements in a timely way when issues had been identified. For example, recurring shortfalls had been found with infection control practices. Other concerns we identified during the assessment had not been picked up by internal audits meaning necessary improvements had not been made.

Records showed lessons were not always learned or shared with staff following accidents, incidents and safeguarding concerns.

A relative told us, "The current leadership appears to be operating in a reactive, firefighting mode, resulting in ongoing errors and compromised standards of care.”