Midway Supported Services Warwickshire

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 requires improvement. At this assessment the rating has changed to good. This meant people were safe and protected from avoidable harm.

The provider was previously in breach of the legal regulations in relation to safe care and treatment. Improvements were found at this assessment, and the provider was no longer in breach of these regulations.

This service scored 75 (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 had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

Effective systems were in place to monitor and review incidents and accidents. The acting manager and management team maintained oversight through detailed records, which were regularly analysed to identify patterns or emerging trends. Where trends were identified, such as people displaying distressing behaviour, the team worked collaboratively with staff and relevant health and social care professionals to better support individuals in managing these behaviours.

The management team demonstrated clear processes for sharing learning across the service, providing examples of how this had been incorporated into everyday practice to reduce the likelihood of similar incidents occurring in the future. For example, staff demonstrated a proactive and person-centred approach in supporting safe social media use. When concerns were identified about a person engaging in group chats where unkind or inappropriate comments were being shared, staff acted promptly to reduce risk. This included supporting the person to block harmful contacts and providing guidance on safe online interactions. The management team also ensured that relevant professionals were informed, promoting a coordinated and safeguarding-focused response. This approach demonstrates a strong awareness of digital risks, timely intervention, and effective partnership working to protect the individual’s wellbeing.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

People had hospital passports in place containing personalised information to support healthcare professionals in understanding their individual needs and preferences when accessing hospital services. Staff confirmed that any updates to this information were communicated during handovers to ensure continuity of care.

The provider worked collaboratively with people and healthcare professionals to establish and maintain safe systems of care. This included ensuring continuity when individuals moved between services, with relevant information shared appropriately to support safe and effective care delivery.

People’s needs, risks, and preferences were assessed prior to admission and regularly reviewed to ensure they remained accurate and reflective of current circumstances. Key information was shared with external healthcare services when required to promote consistent and appropriate support.

The service followed a structured transition process for people moving in. This included completing initial assessments, arranging transition visits, and offering overnight stays so individuals could experience the service, including meals and routines, before admission. Staff reported they felt well supported during this process and had access to the information needed to provide effective care.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. The provider shared concerns quickly and appropriately with the local authority safeguarding team and made relevant notifications to CQC.

At the last inspection, we found gaps in staff knowledge around the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS) practices. At this inspection, we found improvements had been made. The provider has now introduced a combined MCA/DoLS tracker, ensuring all related information is held centrally and can be effectively monitored. A new MCA/Best Interests assessment form has been introduced and rolled out across all services; the form includes guidance to support staff in completing it accurately.

In addition, a specific DoLS application process for supported living services has been implemented, enabling requests to the local authority for Court of Protection DoLS assessments and referrals, supported by submitted MCA evidence and clear tracking of communication and progress. To further embed good practice, the provider has delivered a manager away day focused on MCA and DoLS frameworks, as well as issuing detailed guidance through their internal communications documents such as managers bulletin and lessons learned bulletin, ensuring consistent understanding and application across services.

The provider demonstrated a strong commitment to safeguarding, ensuring concerns were shared promptly with relevant agencies so appropriate action could be taken to keep people safe. Staff received comprehensive safeguarding training and clearly understood their responsibilities, including how to recognise signs of abuse and report concerns to the local authority or police. Staff told us they felt confident that any concerns raised would be taken seriously and managed appropriately and gave examples of the actions they would take if they suspected abuse.

The management team responded to safeguarding concerns appropriately, ensuring incidents were recorded, investigated, and referred to the local authority where required, with notifications submitted to CQC in line with regulatory requirements. People and their relatives told us they felt safe and described staff as kind, caring, and competent in their roles.

The provider worked collaboratively with people and healthcare partners to understand what safety meant to them and how best to achieve this, balancing protection with people’s rights to live free from abuse, discrimination, and avoidable harm.

Observations during the inspection showed staff supporting people safely and respectfully. Reviews of safeguarding records confirmed that concerns were managed effectively, with clear documentation of actions taken and outcomes achieved.

The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

At the last inspection, we found the provider did not effectively engage with people to understand and manage risks. Although risks to individuals’ health and wellbeing had been assessed, improvements were needed in how safety concerns were managed and documented. For instance, some behaviour incident reports lacked sufficient detail to demonstrate how incidents had been handled to keep the person safe. In one example, medication was administered to an individual following an incident to help manage anxiety; however, this was not recorded, making it unclear whether the intervention was appropriate or effective.

At this inspection, we found improvements had been made. De-escalation strategies were used effectively, with PRN (when required) medication administered only as a last resort and in line with guidance. Clinical decision-making was appropriate, with management authorisation obtained before PRN medication was given. There was no use of physical intervention, reflecting a strong commitment to least restrictive practice.

Staff demonstrated a high level of compassion and person-centred care in supporting individuals through emotionally challenging experiences. For example, staff provided sensitive emotional support to a person during a significant bereavement period, including their first Christmas and New Year following a loss.

Care planning was responsive, with actions taken to review and improve support to better reflect people’s preferences. Staff provided care that was both safe and supportive, while encouraging individuals to take positive risks and participate in activities that mattered to them.

Each person had tailored risk assessments in place, covering areas such as choking, falls, safe access to the community, eating and drinking, personal care, potential risks to themselves or others, and mental health support. Personal emergency evacuation plans were also developed, clearly outlining the support each individual would need to leave the home safely in an emergency.

Care was delivered safely by staff who demonstrated a strong understanding of risk identification and management. For example, one staff member explained how they supported individuals experiencing distress by recognising early warning signs and behavioural changes, avoiding known triggers, and using reassurance and distraction techniques to reduce anxiety and maintain safety.

One relative told us, “I think staff understand [name of person] and can calm them down when they are unsettled’.

The provider detected and controlled potential risks in people’s homes.

The provider identified and managed potential risks within the care environment, ensuring that equipment, facilities, and technology supported the safe delivery of care.

The premises were designed and maintained to meet people’s individual needs. People had access to their own bedrooms and were encouraged to personalise them with their belongings, helping to create a comfortable and homely environment.

The provider also ensured the environment and equipment were safe and well maintained through regular servicing and safety checks. These included checks of fire alarm systems, portable electrical appliances, gas safety, and window restrictors. Routine fire drills were carried out, and each person had a personal emergency evacuation plan (PEEP) in place, clearly outlining the support they would need to leave the building safely in an emergency.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

People and their relatives consistently told us there were enough staff to meet their needs. One relative told us, “[Name of person] has been with the organisation for some time, they are safe and have the right number of staff’. Our observations supported this, with sufficient staff on duty to provide safe and attentive care. Staff were not rushed and had time to engage with people in a calm and respectful manner. One staff member confirmed, “I find there are enough staff on duty, and we always try to keep the same staff supporting people,” which helped ensure continuity of care.

Staffing levels were planned in line with people’s individual needs, with additional support built into rotas where required for activities or healthcare appointments. The provider ensured staff were suitably qualified, skilled, and experienced, and that they worked effectively together to deliver safe, person-centred care.

Robust recruitment procedures were followed, with all necessary pre-employment checks completed before staff started work. These included verification of employment history, right to work checks, references, and Disclosure and Barring Service (DBS) checks to support safer recruitment decisions.

Staff received a structured induction aligned with the Care Certificate, which included shadowing experienced colleagues. One staff member told us they felt confident supporting people following their induction and appreciated the option to extend it if needed. Ongoing training covered mandatory and role-specific topics, such as mental health awareness, managing behaviours of distress, and Oliver McGowan training to support people with a learning disability and autistic people. Staff were further supported through regular supervision, appraisals, and monthly team meetings, enabling them to maintain and develop the knowledge and skills required to meet people’s needs effectively.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

The service was clean, well maintained, and free from unpleasant odours. Regular cleaning schedules were in place, and staff had access to appropriate personal protective equipment (PPE) when required. Records of infection prevention and control audits showed that cleanliness and hygiene were consistently monitored. Training records also confirmed that staff had received up-to-date training in infection prevention and control. One relative told us, “The home is safe and very clean and well organised’.

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened.

At the last inspection we found, several handwritten Medication Administration Record (MAR) charts had not been checked and countersigned by two staff members, meaning potential errors may not have been identified. We also found examples where medicines were recorded on MAR charts without clear information on the dose or instructions for administration, which could place people at risk of receiving incorrect medication. While ‘as required’ (PRN) medication protocols were in place, they did not always provide clear guidance, with some missing essential details such as the appropriate dose.

At this inspection, we found that improvements had been made. Medicines documentation was more person-centred and providing clear guidance for staff. Medication recording was generally of a good standard and demonstrated overall competent practice. For example, one person has an up-to-date medication risk assessment in place, outlining detailed control measures for staff to follow. The person’s medication support plan was comprehensive and person-centred, focusing on ensuring the individual’s comfort during administration and supporting effective staff monitoring. These documents were consistent with the MAR charts reviewed.

PRN protocols were detailed and contained the necessary information. For example, one person’s Lorazepam protocol, supported staff to recognise when administration was appropriate by outlining warning signs and expected outcomes. These protocols had been appropriately signed and countersigned in line with other management records.

However, we did find some inconsistences with medication competency assessments. For example, some had identical timings recorded across multiple staff records. We also identified some discrepancies in dates across records, which could affect confidence in their accuracy. This suggests staff and countersigners may benefit from reminders to check and verify dates, and to ensure records are completed contemporaneously. We raised this with the management team, and they confirmed additional checks would be implemented in relation to the accuracy of dates on records.

The provider ensured that medicines and treatments were managed safely and were tailored to meet people’s individual needs, capacities, and preferences. Individuals were involved in planning their care, including any changes to their treatment or medication.

People received their medicines in a safe manner and in line with prescribed guidance. Medications were administered by trained staff who had completed competency assessments. The management team carried out regular audits of medication practices to ensure they remained safe and effective. Where concerns were identified, action plans were put in place and followed through to completion.

The service also supported the aims of the Stopping Over Medication of People with a Learning Disability, Autism or Both (STOMP) programme, an NHS England initiative focused on reducing the inappropriate use of psychotropic medicines and aligned with the NHS Long Term Plan.

When medication errors did occur, these were investigated promptly. Records demonstrated that learning from incidents was clearly documented, and staff involved received further competency assessments and refresher training to improve practice.

People and their relatives told us they had no concerns regarding medicines administration, and feedback indicated confidence in how medicines were managed within the service. One relative told us, “‘[name of person] has medication for their mental health, and I think it’s given safely”.