Middleton Care Limited

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• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

We found the provider did not always follow the Mental Capacity Act (2005) in terms of assessing people’s capacity to make specific decisions and obtaining consent for the care they received. People's needs were assessed. They were able to express their choices and be involved in planning and reviewing care. We did not assess all the quality statements within this key question, as we did not identify concerns in the areas we judged as being met at our last inspection.

This service scored 67 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People felt involved in all aspects of the design of the care package and how it was delivered. They felt the assessment was thorough and captured their needs.

The registered manager stated people were fully involved in the assessment process and planning their own care. They stated this was also set out in the Service User Guide. The registered manager reported that any updates to people’s care needs were discussed at monthly staff meetings for the ‘zone’ they lived in, and care plans were reviewed at least 6 monthly with the person or their advocate by the registered manager. Staff told us there were effective systems in place to assess and monitor people's needs. One staff member told us, “I am given a lot of information about the needs and preferences of the service users. For new clients I am sent the information before I go to the first call so I have a knowledge of their needs and preferences and everything I need to know is also in the clients file that stays on their property.”

Assessments were produced although they did not always contain sufficient information. Medicines care plans did not always include sufficient detail to give staff all the information they needed to deliver medicines safely. For example, one support plan outlined that medicine needed to be given covertly but did not outline how these should be given (for example, whether in food or drink). The Medicines Risk Assessment for the same support plan said the person was always willing to take their medicine but it was given covertly so this was contradictory.

We did not look at Delivering evidence-based care and treatment during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at How staff, teams and services work together during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at Supporting people to live healthier lives during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at Monitoring and improving outcomes during this assessment. The score for this quality statement is based on the previous rating for Effective.

People and their families told us that staff asked for consent before completing care and this was recorded in their notes. People were given information about their rights around consent. People were encouraged to be involved in assessments and care planning. Where people had power of attorney arrangements, these were evidenced in care records.

The registered manager told us they understood their responsibilities to ensure people received support that they had consented to. A staff member told us, “I always ask before starting and during any task if it’s ok with them and during the task I check it’s ok for me to carry on and maintain their dignity as much as possible.”

The provider had a Mental Capacity Policy which referred to Best Interest decision-making where a person lacked capacity. However, this was not being followed in practice. There was no evidence of Best Interest decision-making for covert medicines and there was no written GP authorisation for administration of medicines covertly. During this assessment, the registered manager sought this from GP. We also found a person had capacity but a relative had signed their agreements and care plans. The provider had not recorded a rationale for this.