Middleton Care Limited

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

People were protected from the risk of harm and abuse. There were sufficient staff in place to support people. People were supported by familiar staff who understood their needs. However, we found a breaches of the legal regulations in relation to medicines optimisation. People’s needs and preferences relating to medicines were assessed. People were encouraged to be involved in planning around their medicines, where their capabilities allowed. However, the medicines policy did not meet national best guidance and did not match the medicines practices carried out by staff. Medicines records were also not in line with best practice and contained errors. The provider did not have a robust audit process in place to identify errors nor act upon them. Guidance was not in place to support staff in the safe administration of ‘when required’. medicine. Staff competence in medicines management was checked through regular observations. We also found recruitment processes were not as robust as they should be and were often not done in line with best practice guidelines.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Learning culture during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

People and their relatives felt the care they received from Middleton Care Limited was safe. People told us they knew how to raise concerns or queries about their care. One person told us. “[Family member] is really frightened of falling and it gives him confidence to know that the carers are there and he feels safe and comfortable.”

Staff told us they felt confident about raising concerns if they needed to. They also told us they had never observed anything that required this. One person told us, “I would be confident using whistleblowing procedure but have never had to.”

The provider had a safeguarding policy in place and told us what they would do if they identified any safeguarding issues but reported this had never been the case.

Overall, people were satisfied that any risks to their well-being were understood and managed by staff during their visits. However, one person commented that when the person’s mobility needs had changed this was not updated in the care plans, which could lead to inconsistent or incorrect support. They said, “The care plan hasn't been reviewed for a while, she's only just started using the hoist. And her needs have changed. But the care plan and the red book hasn't been updated. I think it was done sometime last year.”

The provider stated: “Each service user has a personal care plan that sets out how their care needs will be met as well as their personal wishes and choices. We complete a detailed Care Plan and a Risk Assessment ensuring a lot of detail is included so that we have a clear picture of each individual service user.” Staff told us that they included people in managing risks by talking to them, letting them know what staff were are doing and getting them involved in their care. One staff member told us, “We provide person-centred care and encourage clients to take an active part in their care. I will always encourage a client to be independent wherever possible.”

Pre-assessment records included a generic risk assessment which included personal safety, mobility and the environment. However, individual potential risks were not always assessed or set out in care plans. For example, one person’s care plan indicated the person should be on a specialised diet advised by Speech and Language Therapist (SALT). However, it didn’t state what staff need to do to manage risk, for example, if they declined food or appeared to lose weight. Care records also stated that the person was bed bound and risk of falls so falls sensor and crash mat were put in place to manage this but there was no risk assessment with regards to potential pressure damage from being bed bound. Care records did not always evidence that people were included in reviews and their feedback had not always been captured in the documentation relating to their 6 monthly ‘Client Conversation’ meetings.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

Overall, people told us they felt there were enough staff and that they were cared for by a consistent group of staff. Some people told us at times they seemed a bit stretched and rushing off to another job but that they had the skills and knowledge to care for them safely.

Staff told us there were times when they were short staffed particularly around holiday times and when there were higher levels of sickness. They also acknowledged the difficulties with recruiting care staff in general. They said this could sometimes lead to longer working hours but acknowledged that overall, they have enough staff and work well as a team to cover. Staff told us they felt leaders work hard to keep staffing levels at acceptable levels and when things do get harder leaders always make sure staff know how appreciated they are and what they are doing to improve staffing levels.

Enough staff were employed to meet the needs of the people using the service. Staff had clear rotas and the rotas supported people to have a consistent team of staff who were familiar with them and their preferences. The service used an electronic staff rota system to ensure there were no missed or late calls and that consistent staff with the right training to provide care attend the call. Monthly meetings were held between seniors and each of the 3 zone teams to check on people's needs and check staff well-being. Recruitment checks were in place but not always robustly documented or complete. A review of recruitment records found gaps and contradictions, including full employment histories not being taken and there was some contradictory information in application forms. This left people using the service at risk of harm.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

Some people were independent in managing their medications. Those who required support felt their medicines were managed safely.

The management team stated senior staff carried out weekly checks of medicines containers to ensure people had correct and sufficient medicines. They acknowledged there was no managerial governance of medicines management including records. Staff told us they had training to administer medicines safely. They told us they were regularly supervised and regular training was in place to ensure they were doing this correctly. They also told us there was a care coordinator who visited people regularly to make checks.

The provider had a medicines policy in place but this was out of date and not robust enough. The medicines policy did not reflect the management of ‘when required’ medicines. For example, there were no protocols to describe when a person may need to be offered ‘when required’ pain relief and how they might present when they required this. Medicines Administration Records (MARS) were not always completed correctly and there was no record of whether issues were identified or acted upon. Records relating to the administration of topical medications did not always include directions for application, for example, how many times a day or only when required. The Medicines Risk Assessment and Agreement was only signed by the registered manager, not by the person receiving the medicines so it could not be considered an ‘Agreement’. There were no managerial audits of medicines by the provider. The provider started to take action to resolve this issue during the onsite visit