Middleton Park Lodge

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 good. 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.

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.

Systems were in place and had been designed to promote a culture of safety and learning; however, these were not always working robustly to improve practice and reduce risks.

We found individual incidents were analysed and actions taken. However, there was not a consistent analysis of trends and patterns. For example, several incidents of missed medication had occurred for people who were out of the home in activities, but a system had not been put in place to prevent this happening. Staff understood the importance of reporting safety concerns and told us the management team were supportive in dealing with any matters raised.

The service worked with healthcare professionals to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care and people were supported to be as independent as possible to access the services they required.

The provider completed thorough assessments before people were admitted to the service to ensure their needs were met.

We received feedback from 3 healthcare professionals working with the service. Their comments included,“I have had positive feedback from NHS hospital-based staff, that families have been happy with placements [at the home]. In one case, a person who went to the specialist dementia service at the home became more unwell with cancer and needed tomove to the general nursing service on the ground floor. The hospital nurse reported the family were very happy that a bed could be found for [person] to return there from hospital” and “I found [name of deputy manager] to be genuine, person centred and very caring towards these patients. [Deputy manager] also gave consideration to the safety of the people living on the [dementia unit], when making decisions regarding whether to offer a home to the people he assessed.”

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

There were safeguarding policies and procedures in place, and these were being followed. The registered manager worked with the local authority safeguarding team to ensure known risks were well managed and appropriately reported. Staff knew how to report abuse and neglect, and how to whistle blow if required. A staff member told us if they were aware of any type of safeguarding concern they would “report abuse immediately and document it and follow process.”

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

We found most people’s clinical risks were well assessed and risk managed. However, we found concerns about some people not being able to call for help when they were in their rooms because the call bells were either not in reach or they could not be used by people. For example, we found some people had a call bell on the wall but could not physically reach it. We also found examples of people who had variable ability to use a call bell, but one was not in place. We discussed our concerns with the registered manager and on our second visit we found these had been ordered and when we concluded the assessment the provider told us these were now in place.

Environmental risks were not always managed well. 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.

We found hazards in communal areas such as kettles and cookers accessible to people living with dementia; these areas were at times unsupervised by staff. We raised our concerns to the registered manager and after our visits we received evidence confirming environmental risk assessments were in place and had been reviewed to ensure safety in these areas.

Some people living at the home required staff to use a hoist to mobilise them. Although checks were being completed in line with requirements, we found one sling that was in use did not have a label and there was no evidence that had been checked. The provider did not have a list of equipment in place to ensure an appropriate oversight that all equipment being used had been checked and was safe to use. The registered manager took immediate action on these issues.

The provider did not always make sure there were enough staff who were safely deployed. They did not always work together well to provide safe care that met people’s individual needs.

People and staff shared mixed feedback regarding staffing levels and deployment. People told us, “Staff are so busy, from the crack of dawn until they go home. They never have enough staff;” and “I think they could do with more” and “There are lots of staff.” Relatives commented, “I think so [there is enough staff], I think everyone works very hard” and “It seems to be alright, there always seems to be staff around.”

Some staff told us they did not have time to spend with people. Their comments included, “At night we don’t have much time to spend with [people], it takes about 25 minutes to check on [people] every hour and by the time the documentation is done we start again, we might get 10 or 15 minutes to spare between the hours” and “I always advocate to see if we can have an increase in staffing levels at night considering the risk factor” and “It’s ok but it still needs more hands.” During our visits, we found examples where communal areas were unsupervised by staff and people required assistance. There were instances when the inspection team had to seek staff’s support due to people requiring it and being unable to call for staff's help.

The service had a dependency tool in place and rotas matched the number of staff indicated as required. We discussed our concerns about staffing with the registered manager and senior management who told us they would take action. We recommend the service reviews their staffing levels and staff deployment to ensure people always receive person centred care.

The service had a robust recruitment process to ensure positions were offered to suitable applicants. These included establishing their employment history and reference checks as well as Disclosure and Barring Service (DBS) checks. This protected people from receiving support from unsuitable staff.

There were policies and procedures in place around managing and controlling the risk of infections. However, during our visit we observed instances where communal areas were not always clean. We reported this to the management team.

People and relatives shared positive feedback about the cleanliness of the home. Their comments included, “Yes, it’s normally pretty good” and “Yes, I think so, the bed is clean [person’s] laundry comes back the same day.”

The provider was in breach of the legal regulation relating to safe care and treatment.​

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

Some people living at the home had swallowing difficulties and required their drinks to be thickened to manage the risk of chocking. On our first visit, we found same people were sharing thickeners that had been prescribed individually. Thickners were not always stored securely, and we found inconsistency in the recording of thickeners. The provider had not ensured checks had been completed on care staff who prepared people who required thickened drinks. We raised our concerns to the registered manager and after our visits we reviewed evidence confirming appropriate actions had been taken.

We found diabetic care plans did not always had sufficient detail to ensure people’s blood sugar target levels were known and action taken by staff when required. We found examples were people’s ‘as and when’ required medication to be administered in case of low blood sugars had not been administered in line with people’s requirements. We discussed these concerns with the management team who took immediate action.

There had been several incidents of people missing their medication due to being out of the home on trips. There were no arrangements in place to manage medication when people were outside the home. We discussed this with the management team who told us they would implement appropriate action to ensure people enjoyed their outings but also received their medication as required.

Regular medication audits were completed, but the issues found at this assessment had not been identified. Staff’s medication competencies were regularly completed.