Archived: Midfield Lodge

We found the following examples of good practice.

The service was only receiving essential visitors at the time of our inspection. Any person entering the building had their temperature taken, completed a health questionnaire and wore full personal protective equipment (PPE) including a face visor.

The service had a dedicated visiting room which had a purpose-built wall screen. Although visits had been paused at the time of our inspection, the service had a booking system in place so that relatives and friends could book appointments to visit when visits resume.

People were supported by staff in full PPE, whether that person was COVID-19 positive or negative. This is called barrier nursing. This is to protect both staff and people living in the service from spreading infection.

The manager told us that they had changed systems within the service to reduce the spread of infection. Staff entered through a back entrance immediately into a staff changing area where they changed into a clean laundered uniform.

The manager conducted a daily walkaround to check staff were wearing their PPE correctly. Spot checks on staff competencies were in place re the putting on and taking off of PPE, handwashing and hand hygiene.

The building was clean and free from clutter. During our inspection we observed staff cleaning communal areas. The rmanager told us that frequently touched areas were cleaned more often, and that staff used a fogging machine to support the cleaning of the building.

Nurses on duty told us that they were working collaboratively with the General Practitioner (GP) from the local surgery. The GP had been allocated to the service as a clinical lead, and they were well supported as a result.

People’s experience of using this service:

• People at this service were well cared for by dedicated staff. People benefited from good nursing care. Care planning was of good quality and regularly reviewed.

• People using the service were relaxed with staff and the way staff interacted with people had a positive effect on their well-being.

• People’s feedback was consistently positive about the care, support and staff. People particularly liked the home because of the caring staff employed. One person told us, “It’s very good here; the carers are very, very good.”

• People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

• Staff were well trained and supported by management. There were sufficient staff, but some people spoke of having to wait on occasion. Once activities staff are recruited as planned this will enhance people’s social needs. Particularly those supported in their rooms.

• The environment was being maintained with furniture, curtains and flooring being replaced. One boiler that effected some radiators was imminently to be repaired.

• We fed back areas for further development that included ensuring all areas of the service were clean, along with ensuring mobile heaters do not pose a scald risk. Signage could be better improved, and decoration of corridors would help people living with dementia navigate their way around.

Rating at last inspection: We rated Midfield Lodge as overall good and published our report on 18 August 2016.

Why we inspected: This was a scheduled inspection based on previous rating.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

During this unannounced inspection on 12 July 2016 there were 44 people receiving care from the service. The manager confirmed that the regulated activity, diagnostics and screening, was not provided at this service. We have therefore not assessed this during this occasion.

The last registered manager left in May 2016 when the current manager took up post. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The manager had applied to register with the CQC and their application was being processed.

Medicines were stored securely and people were supported to take oral medicines appropriately. However, this was not the case for administering and recording topical medicines and medicines prescribed to be given ‘when required’.

Although the service looked cleaned there were malodours in some areas of the service.

There were sufficient staff to meet people’s needs safely. However, people sometimes had to wait for their care to be provided. Staff were only employed after satisfactory pre-employment checks had been obtained. Staff knew the people they cared for well and understood, and met, their needs. Staff were trained, and well supported, by their managers. Systems were in place to ensure people’s safety was effectively managed. Staff were aware of the procedures for reporting concerns and of how to protect people from harm.

People’s health, care and nutritional needs were effectively met. People were provided with a balanced diet and staff were aware of people’s dietary needs.

There were formal systems in place to assess people’s capacity for decision making and applications had been made to the authorising agencies for people who needed these safeguards. Staff respected people choices and staff were aware of the key legal requirements of the MCA and DoLS. People were involved in every day decisions about their care.

People received care and support from staff who were kind, caring, friendly and respectful to the people they were caring for. Staff treated people with dignity and respect. There were limited opportunities for social engagement and occupation. However, the manager had taken action to improve this.

Care records provided staff with sufficient guidance to provide consistent care to each person. Changes to people’s care was kept under review to ensure the change was effective.

The manager was supported by a staff team that including registered nurses, care workers, and ancillary staff. The service was well run and staff, including the manager, were approachable. People and relatives were encouraged to provide feedback on the service in various ways both formally and informally. Concerns were thoroughly investigated and plans were actioned to bring about improvement in the service. The manager had clear plans for involving people, visitors, staff and the local community in developing and improving the service to benefit those receiving it.

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well led?

Below is a summary of what we found. The summary describes what people using the service and the staff told us, what we observed and the records we looked at. If you would like to see the evidence that supports the summary, please read the full report.

We used a number of different methods to help us understand the experiences of people using the service. Some of the people using the service had complex needs which meant they were not all able to tell us about their experiences. We observed care being provided and we spoke with 10 people who lived at the home. In addition, we spoke with four other people's relatives and nine staff members. We also looked at six people's care records and other documents relating to the management of the home.

At the time of our inspection on 19 September 2014, the provider was not carrying out the regulated activity 'Diagnostics and screening' at this service. This regulated activity was therefore not assessed on this occasion. There were 39 people resident in the home.

Is the service safe?

People told us they felt safe with the staff and trusted them. One person spoken to said that all staff were, 'Kind and gentle.' One person's relative, who had raised significant concerns with us during our last inspection in May 2014, told us, 'I think it is a safe home. [People living here] are well monitored with their food and personal care, and the social interaction has really improved.'

Information about the safeguarding of vulnerable adults was displayed clearly within the service. The manager and staff were aware of the correct procedures for reporting safeguarding concerns and had completed training in the safeguarding of people who may be at risk of abuse and neglect.

There were enough qualified, skilled and experienced staff to meet people's needs. One person told us, 'There's been lots of changes in staff, but they all seem to know what I need.' The provider used a tool to work out how many staff were needed which was based on people's levels of dependency in key areas of need. We found for the majority of the time the required staffing levels were met.

Is the service effective?

People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. Care plans were regularly reviewed and reflected people's current needs. One relative told us, 'There have been lots of improvements since your last inspection. There are some fabulous carers and I think my [family member's] needs are well met now.'

Is the service caring?

People using the service made positive comments about the staff. One person said 'They look after me so well, I can't fault them.' Another person said, 'They always come when I pull my call bell, I couldn't wish to be in a better place.'

People's privacy, dignity and independence were respected. During our inspection people who used the service were seen and heard to be given a variety of choices. One member of staff came into a person's bedroom and asked how they were feeling and what they would like for lunch. After the member of staff left the room, the person using the service said, 'That wasn't put on for you, they always speak to me like that and come into my room regularly.'

Is the service responsive?

People's views and experiences were taken into account in the way the service was provided and delivered in relation to their care. One person told us, 'Staff are very good. I can get up and go to bed when I want to, I choose to get up at 10am and that's when staff help me to get up'. We saw that people and their relatives were given opportunities to express their views about the running of the home, both informally on a day to day basis, and more formally through meetings. People had an opportunity to join in a range of activities within the home. People's needs were regularly re-assessed and their care records updated to show the changes to their needs.

Is the service well led?

All the staff members that we spoke with commented positively on the increased support that they had received since the current manager and deputy manager had started working in the home. One member of staff said, '[The manager and deputy manager] listen and check up on us now. They are very much for the residents.'

People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard. Staff described positive training experiences and relayed how this had helped them to improve the care they provide to people.

There were effective systems in place to regularly assess and monitor the quality of service that people received. We saw that areas noted for improvement were followed up in the next audit to ensure improvement had occurred. People, their relatives, and staff, told us they were confident that they were listened to and appropriate action was taken. One person's relative said, '[The manager and deputy manager are both approachable. I feel they listen and take on board what I say.'

We found that the provider was compliant with the regulations in all the areas we assessed. If you wish to see the evidence supporting our summary please read the full report.

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well led?

Below is a summary of what we found.

Is the service safe?

People we spoke with told us that they felt safe, and their relatives said they had never seen or heard anything that gave them any concern. They said the staff were all very kind and caring.

Some of the staff were able to demonstrate that they were clear about their responsibilities to report any abuse and they knew there was a telephone number for the local authority's safeguarding team on the office board.

Staff told us, and training records confirmed, that the majority of staff had undertaken training in how to protect people from abuse. However, some of the staff we spoke with were not clear about reporting concerns, nor to whom they should report outside the service.

We found that the provider was not meeting their legal responsibility to report all allegations of abuse to the Care Quality Commission.

This meant that the provider did not have a sufficiently robust system in place to ensure that people were kept safe from abuse and harm.

Is the service effective?

An assessment of each person's needs was carried out by staff and a care plan developed to meet those needs. However, we found that care plans were difficult to follow and in some instances gave staff contradictory information and guidance about people's needs. Relatives told us that the care delivered to people by the staff had not always followed the care plan: in one example this had put the person at serious risk.

One person told us they were happy with the care they received. However, there were not always enough staff for people to be offered care and support in the way they wanted it. Some people did not receive personal care until after lunch. Other people could not always be assisted to get out of bed as there was a limited number of recliner chairs available, which people had to share.

Records of care given to people were poor so that it was not always possible to tell whether care had been given or not.

This meant that the service provided was not effective.

Is the service caring?

People and their relatives told us that staff were hard-working, caring and kind. During our observations of the interactions between people who lived at the home and the staff, we saw that staff were attentive and spoke very respectfully to people. However, staff were very busy. One member of staff that we spoke with said, 'We're doing our best, and we're doing a good job, but we're just so tired.'

Several people, and some of the staff we spoke with, said staff never had time to stop and chat. Staff were not given the support and guidance they needed so that they could do their job properly, in the way they wanted to.

Is the service responsive?

Some of the staff we spoke with were not clear about people's individual needs. For example, they could not tell us who was diabetic and how each person's diabetes was managed. They did not know whether another person should have been on a high protein diet.

Is the service well-led?

There was no registered manager at this service at the time of our inspection, and the acting manager was on leave. We were told that there had been seven managers since the last registered manager left in February 2013.

All the relatives we spoke with, and some of the staff, said the main issue was the lack of leadership. They described the last 15 months as a period of 'instability'. The provider had a system in place to monitor the quality of the service being provided. However, we found that a number of issues we identified had already been identified in at least two quality assurance reports. The action plan that had been put in place had failed to address the issues.

This meant that the service was not well led.

Care records we looked at provided staff with the information they required to meet people's needs. However, we found that the files were bulky and staff needed to read through lots of information which was especially daunting if you were a new member of staff.

Staff were clear about the procedure to follow if they had any concerns in relation to an allegation of abuse or concerns about the care and support being provided.

Staff felt they were well supported by the management team and had received regular supervision and appropriate training to meet people needs and ensure they remain up to date with best practice in care and support.

We found that there were audits in place which looked at where improvements could be made to provide a quality service for people living at Midfield Lodge.

Since our last visit there had been significant improvement in staffing levels and in the recording and administration of people's medication. There had been some improvement in involving people and their advocates in decisions about their care; however the manager recognised that this was still an area for further development. Overall we considered that the provider had taken sufficient action to address the outstanding concerns from our previous inspection.