Middleton Manor Care Centre

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. At our last assessment we rated this key question inadequate. At this assessment the rating has changed to requires improvement.

This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

The provider was previously in breach of the legal regulation in relation to people’s safe care and treatment including medicines management, managing risks to people and the environment, infection prevention and control. They were also in breach of the legal regulation in relation to safe staffing. Improvements were not found at this assessment, and the provider remained in breach of these regulations.

The provider was previously in breach of the legal regulation in relation to safeguarding. Improvements were found at this assessment and the provider was no longer in breach of this regulation.

This service scored 44 (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 have a proactive and positive culture of safety based on openness and honesty. They did not always listen to concerns about safety and did not always investigate or report safety events. Lessons were not always learned to continually identify and embed good practice.

The provider was unable to demonstrate that lessons had been learned in relation to fire safety, despite this being a previously identified concern. For example, fire drill records were incomplete, and repeated issues were noted regarding staff knowledge and responsiveness. Despite these recurring concerns, the actions taken to improve fire safety practice had not been sufficient.

There were systems in place to analyse accidents and incidents, to look for patterns or trends. However, oversight was not always effective. We found some incidents had not been recorded accurately or in full.

Incidents were recorded, but appropriate follow-up action was not always taken in order to ensure lessons were learned and any potential risks were minimised. For example, care plans and risk assessments were not always reviewed and updated.

We received mixed feedback from staff about learning from incidents. A member of staff told us, “Learning is shared through our daily handovers and staff briefings.” However, another staff member said, “Learning from accident and incidents isn’t even a thing in the home, if there’s a fall or anything the nurses will do the paperwork and that’s the last we hear from it unless we hear that a safeguarding has been put in place.”

The provider did not always work well with people and healthcare partners to establish and maintain safe systems of care. They did not always manage or monitor people’s safety. They did not always make sure there was continuity of care, including when people moved between different services.

Care records continued to be regularly reviewed but still did not always reflect people’s current needs, recent incidents or measures to manage risk.

We found examples of staff making appropriate referrals to external professionals. However, referrals were not then followed up and therefore the necessary input from specialist teams was potentially delayed as a result. This included referrals to the occupational therapist and falls team.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

Safeguarding systems had improved and incidents were investigated, reported to the Local Authority and, where applicable, the Care Quality Commission.

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. DoLS applications were submitted to the local authority for authorisation when needed. There was a condition on one person’s authorisation, and we could not see any records to evidence this was being met. The provider agreed that this needed more work and added prompts for staff to the electronic system.

We had positive feedback from a visiting professional who told us, “Safeguarding seems to be being positively handled.” Most relatives told us they felt people were safe. A relative told us, “[My family member] is safe, they’re very careful with them, using correct moving and handling techniques”

People we spoke with told us they felt safe. One person said, “I’m very safe because I feel at ease 24 hours a day.”

The provider did not work well with people to understand and manage risks. Staff did not provide care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

People’s risk management remained a concern within the service, as the provider did not consistently identify, manage, or mitigate risks effectively. Some agency staff did not have access to the electronic care planning system and relevant information about people’s needs and level of support they required. Care plans and risk assessments contain inaccurate information and were not always followed by staff. This resulted in people not being appropriately supported in areas such as eating. We had feedback from relatives that food was not always cut into manageable ‘bite-sized’ pieces and people were left unattended attempting to eat food whilst lying down.

Concerns remained regarding thickening powders which are used to thicken drinks to prevent choking. We found four containers of thickening powder in a dining area accessible to people and not securely locked away.

We receive mixed feedback from relatives. Some felt risks were well managed, but others raised concerns. For example, a relative told us, “I do not worry about [my family member’s] wellbeing and safety at Middleton Manor whereas that wasn’t the case at their previous home.” Another relative said “I don’t feel my [relative] is safe. She is not checked on enough.”

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

Mattresses were not being checked correctly which resulted in the ongoing use of mattresses no longer fit for purpose.

The home was in need of repair and redecoration in a number of areas. We found damaged flooring which posed a trip hazard and crumbling plaster on a person’s bedroom wall where damage had been caused alongside their bed.

There was a programme of safety checks in the home including water temperatures, equipment, lighting, alarm bells, bedrails and these had all been completed as planned.

The provider did not always make sure there were enough qualified, skilled and experienced staff. They did not always make sure staff received effective support,supervision and development. They did not always work together well to provide safe care that met people’s individual needs.

The provider had been using agency staff regularly to ensure staffing levels were safe. The agency staff identity was not always appropriately checked when they arrived for their first shit and inductions were not always provided in a timely way. We observed two agency staff entering the building without being asked to sign in and one agency staff member supporting people before they had completed their induction.

Staff medicines competency checks had not been completed by an appropriately trained and competent person and therefore we could not be assured staff were competent in this area.

Permanent Staff were recruited safely, and appropriate checks were carried out to ensure they were suitable to work with vulnerable people.

The provider did not appropriately assess or manage the risk of infection. They did not detect and control the risk of it spreading or share concerns with appropriate agencies promptly.

Infection, prevention and control (IPC) concerns remained at this assessment. The provider completed monthly infection prevention and control audits which reflected that standards were regularly not fully met. Despite this, the provider had failed to put sufficient measures in place to address the issues.

Four mattresses were found to be stained and malodourous at this assessment despite this being highlighted to the provider previously by other professionals.

We observed many areas of the home were in need of a deep clean, with areas of malodour in people’s bedrooms, bathrooms and in a communal corridor. A staff member told us, “The cleaning in the home needs a massive improvement and more cleaning staff are needed.”

Concern regarding clinical waste bins in bathrooms and toilets not always have bags in them remained at this assessment. We gave feedback to the provider at the end of our first day on site but found this was still not resolved when we returned for a second day.

In relation to the cleanliness of the home, one person told us, “Everything is alright, but there can be issues with cleanliness of rooms.” A relative said, “I’m sorry about the smell in the room, but the home tells me they are in the process of replacing the carpet for a hard floor.”

The service did not make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. People were not involved in planning.

We continued to have concerns that the process for disposal of medicines was not robust as the disposal records did not correlate to the refused codes on the medicines administration records. In addition, disposal of controlled drugs (medicines liable to misuse) continued to be inaccurately recorded and therefore could not be accounted for.

The home had introduced processes to improve the oversight of doses of paracetamol to ensure enough time between administration, but further work was needed to ensure this was embedded into practice.

Thickening powders continued to be inappropriately managed. One person did not have any thickener available. Another person did not have any of their own prescribed thickener in use despite records stating they had been given thickened drinks.

Medicine care plans and ‘as and when required’ medicines protocols were not always accurate or updated in a timely manner when changes occurred. This placed people at increased risk of not receiving medicines at the correct doses.

The home had been provided with additional medicine support from other professionals. Where audits had been completed and shortfalls found, action had been taken to address this. However, some of the medicines shortfalls found at the last assessment remained at this assessment.

We received mainly positive feedback from people and their relatives about how medicines were managed. A person told us, “I get my medication on time and it’s part of my routine.” A relative said, “No major concerns about meds but we had a safeguarding issue which seems to have been resolved satisfactorily.”