CQC report explained · a residential care home
What the CQC found at 20-22 Middlesex Road
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Good
- People were protected from abuse and avoidable harm, and risks were assessed and managed. However, some medicines did not have instructions for administration at specific times, and the wrong cleaning agent had been used for bodily fluids.
- Effective?
- Good
- This key question was not inspected during this focused inspection. Its previous rating was used when calculating the overall rating.
- Caring?
- Good
- This key question was not inspected during this focused inspection. Its previous rating was used when calculating the overall rating.
- Responsive?
- Good
- This key question was not inspected during this focused inspection. Its previous rating was used when calculating the overall rating.
- Well-led?
- Good
- The home had improved quality checks, oversight and systems for learning from accidents and incidents. However, people and relatives were not always involved meaningfully in care or in shaping improvements.
What inspectors found, October 2022
Avocet Trust - 20-22 Middlesex Road is rated Good; inspectors found safer, better-led care, but some medicine instructions and feedback systems needed attention.
This was an unannounced focused inspection. Inspectors visited on 14 July, 21 July and 9 September 2022, spoke with people, relatives, staff and health professionals, and checked care plans, medicine records and other documents.
The home was rated Good for Safe and Well-led. People were supported to access the community, received kind care, and had person-centred care plans. Staff understood how to manage risks, and systems for checking quality and learning from incidents had improved.
There were still some shortfalls. Instructions for medicines given at specific times were not always in place. People and relatives were not always involved meaningfully in shaping the service, and the home did not always use feedback to make improvements.
The rating improved from Requires Improvement at the previous inspection. The provider had completed an action plan, and inspectors found that the home was no longer in breach of the regulations identified previously.
Community access
People could use local shops and take part in community life. Inspectors found that the home was well integrated into its community.
“People were able to access their community and nearby shops and the home was integrated well within the community.” from the report
Kind and respectful care
Inspectors found that people received compassionate care and that staff respected their privacy and dignity.
“People received kind and compassionate care. Staff protected and respected people's privacy and dignity.” from the report
Staffing
There were enough staff to provide safe care. Relatives told inspectors they had no concerns about staffing.
“There were enough staff to ensure people received safe care. We observed staff providing support and engaging in a meaningful and positive way.” from the report
Better quality oversight
The home had introduced quality checks and recorded actions when issues were found. Accidents and incidents were reviewed to identify patterns and improve care.
“Audits were carried out by staff and reviewed by the registered manager. There was a clear record of actions taken when required.” from the report
Communication support
Communication passports helped staff understand and communicate with people effectively.
“Personalised communication passports guided and supported staff to communicate with people effectively” from the report
Medicine instructions
seriousSome people did not have clear instructions for medicines that had to be given at specific times. Inspectors said this could increase the risk of side effects or the medicine not working as intended.
“People did not always receive their medication as required.” from the report
Cleaning agent
needs fixingThe home was not using the correct cleaning product to remove bodily fluids. The manager acted immediately to obtain the correct products.
“The provider did not use the correct cleaning agent for the removal of bodily fluids.” from the report
Feedback and involvement
needs fixingPeople and relatives were not always involved meaningfully in care decisions or in shaping the service. Feedback was not always used to drive improvements.
“People and their relatives were not always involved in all aspects of their care in a meaningful way and their needs and preferences were not always considered.” from the report
- 01What checks are now in place to make sure every medicine has clear instructions for the time it must be given?
- 02How do you collect feedback from people and relatives, and how do you show what changed as a result?
- 03Has the correct cleaning agent for bodily fluids been put in place throughout the home, and how is its use checked?
- 04Has the minor decorating work identified by inspectors been completed?
This was a focused inspection of Safe and Well-led, including infection prevention and control; the other key question ratings carried over from the previous inspection. This explanation was written from the published report of 6 October 2022 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, November 2021
Avocet Trust - 20-22 Middlesex Road was rated Requires Improvement; inspectors found infection control, emergency cover and management weaknesses.
This was an unannounced focused inspection on 13 and 20 October 2021. One inspector spoke with people, relatives, staff and professionals, and reviewed care, medicine, staffing and management records.
The home was rated Requires Improvement overall. Safe and Well-led were both rated Requires Improvement. Inspectors found problems with COVID-19 precautions, fire safety checks, staff being away from the site, repairs, incident records and quality monitoring.
There were also positive findings. Care plans and risk assessments were person-centred, medicines were managed safely, and enough staff were employed overall to meet people's needs. The home had previously been rated Good in November 2017.
Person-centred planning
Care plans and risk assessments were developed around people's individual needs.
“Care plans and risk assessments were developed in a person centred way.” from the report
Medicines
Inspectors found that medicines were managed safely. Staff were trained, and guidance was available for medicines given when needed.
“Protocols were in place where people required 'as and when' medicine.” from the report
Recruitment and induction
Staff recruitment was described as safe, and new staff completed an induction before supporting people.
“Staff were recruited safely and attended a programme of induction before supporting people.” from the report
Staffing numbers
The home employed enough staff overall to meet people's needs, although staff deployment on site was a concern.
“Sufficient numbers of staff were employed to meet people's needs.” from the report
Infection control
seriousStaff did not always use PPE correctly. The home could not show a robust staff testing process, and cleaning arrangements and products were not always suitable.
“The failure to ensure good infection control processes were in place put people at risk of harm.” from the report
Emergency cover
seriousStaff were seen leaving the site, so remaining staff might not have been able to get help during an accident, incident or emergency.
“This meant that remaining staff may not be able to seek support in the event of an accident, incident or emergency.” from the report
Fire safety
seriousThe fire risk assessment was out of date, and some staff had not completed fire training, practice evacuations or drills.
“Some staff had not completed fire safety training, practice evacuations or fire drills.” from the report
Incident records
seriousAccidents and incidents were not always recorded or investigated properly. The provider did not regularly review them to learn lessons and prevent repeat problems.
“Accidents and incidents were not always properly recorded or investigated.” from the report
Quality monitoring
seriousThe home's checks did not identify problems found by inspectors. Where issues were found, actions were not always recorded or followed up.
“The providers systems in place to monitor the quality of the service was ineffective as concerns found during the inspection were not identified.” from the report
- 01What action has been taken to make sure staff wear PPE correctly and staff COVID-19 testing is properly recorded?
- 02How do you now make sure enough staff remain on site to respond to an accident, incident or emergency?
- 03Has the fire risk assessment been updated, and have all staff completed fire training and evacuation drills?
- 04How are accidents and incidents now recorded, reviewed and used to prevent similar events happening again?
- 05What quality checks and action plans are now in place, and how are people and their representatives asked for feedback?
This was a focused inspection of Safe and Well-led only; the other questions were not assessed and the previous overall rating had been Good in 2017. This explanation was written from the published report of 23 November 2021 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of 20-22 Middlesex Road
4 rated inspections over 7 years: the service has held its Good rating throughout.
- October 2022Goodcurrent ratingup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- November 2021Requires improvementSafe: Requires improvementWell-led: Requires improvement
- September 2020Inspected but not ratedSafe: Inspected but not rated
- November 2017Goodstayed GoodSafe: GoodWell-led: Good
- October 2015GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- February 2014
Registered with the Care Quality Commission on 3 February 2014.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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Most charge £1,020 to £1,350 a week. 12 can care for a couple. 8 years' experience on average.
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