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.

At our last assessment we rated this key question inadequate. At this assessment the rating has remained 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 provider was previously in breach of the legal regulation in relation to good governance. Improvements were not found at this assessment, and the provider remained in breach of this regulation.

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 following our last assessment, they did not have a clear strategy in place to make the necessary changes and ensure all staff were engaged in this. As a result, many of the concerns had not been addressed and the provider continued to be in breach of regulation. As a result, people continued to be put at risk.

The high turnover of staff, including at management level meant there had not been opportunity to develop a strong united team with a shared approach to improving care delivery.

New practices implemented by the management team had a negative impact on the culture of the service. For example, informing staff they would face disciplinary procedure for failing to use more than the stipulated number of continence products per person. Some staff told us they were unhappy with this approach. One staff member told us, “Some of us don't think it's right so we're just not doing it. They are checking though, counting the pads.” Another staff member said, “We are afraid of the disciplinary - this will compromise the care of our residents."

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.

Shortfalls and areas of concern highlighted to the management team were not actioned appropriately or in a timely way. Shortfalls in mattress checks had been flagged as an issue in December by an external professional, but this was still an issue when we visited. We highlighted some concerns to the management team on the first day of our assessment and requested changes be made. When we returned 9 days later, not all improvements hadn’t been made and there was limited insight from management around why this was not acceptable.

Leaders did not have in-depth knowledge of the people they were supporting. There had been an unstable management team and a lack of ownership in relation to improvements that were required. A relative described, "...constant change, so reinforcing standards at a weekend is a challenge.”

We received mixed feedback from staff regarding management support. A member of staff told us, “We have a very supportive deputy manager, he always gives a listening ear and is ready to support when needed.” However, not all staff felt supported or confident in the leadership of the home. Another staff member told us, “Staff morale is low because we don’t get to talk to each other or management together and say how we are feeling. We only get told off when things go wrong. Management blame the staff…”

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

The provider was not always open and transparent. They had failed to display the Inadequate rating from our last assessment on their website which they are legally required to do. Within the home, the previous providers old ‘good’ rating was still on display which was misleading. A relative we spoke with told us they had not been told the home was in special measures and had only recently discovered this.

Whilst the provider had policies in place for staff to speak up, we received mixed feedback from staff in this area. Whilst some staff reported improvements in this area under the new management team, other staff did not feel they could openly speak up. They told us they didn’t feel listened to and were not given the opportunity to provide feedback.

Relatives told us they did not feel they were listened to when raising concerns. A relative told us, “We as a family have had numerous complaints…The usual response would be to either fob us off with a ‘we are trying to improve things’ or totally blame agency staff.”

The provider valued diversity in their workforce. They worked 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. Staff told us they were able to adapt their working day to accommodate religious practices, for example taking later breaks to accommodate fast-breaking during Ramadan.

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.

Concerns remained at this assessment with regards to the providers lack of effective governance systems and processes to monitor and improve the service. Shortfalls and concerns identified at the previous assessment remained at this assessment. Action plans that had been put in place to drive improvements were not effective.

Audits were either ineffective or not sufficient. They failed to identify the issues we found during our assessment and the provider remained in breach of regulations.

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.

The home was in organisational safeguarding and was being monitored and supported by the local authority. This was to ensure the correct procedures were in place to keep people safe. Professionals continued to raise concerns about communication and the responsiveness of the management team and reported very little improvements in the service.

Following our last assessment, there had been regular input from a number of external stakeholders who had been working to support improvement at the home, but they told us their feedback was not always acted on. Some of the concerns professionals had raised were still apparent during our assessment.

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.

Lessons had not been learnt and shortfalls we found at our last assessment remained at this assessment. Audits continued to be ineffective and action plan implemented were either not fully followed or were not sufficient to address all areas of concern.