CQC report explained · a residential care home
What the CQC found at Middlewich
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
What inspectors found, October 2022
Manor Care Home - Middlewich was rated Good; inspectors found safer medicines and stronger management, but food choices and family updates still needed attention.
This was an unannounced, focused inspection on 15 August 2022. One inspector spoke with five residents, three relatives and 12 staff. They reviewed care records, medicines records, staff recruitment files and management records.
The home was rated Good for Safe, Effective and Well-led. Inspectors found that medicines were managed safely, staffing met people's needs, risks were assessed and infection control arrangements were suitable. People said they felt safe and that staff responded when they needed help.
The inspection followed a Requires Improvement rating in October 2021 and two previous breaches of regulations. The provider had made enough improvement and was no longer in breach. The overall rating changed to Good, but this visit did not assess Caring or Responsive.
Medicines managed safely
Medicines were stored correctly, staff had training and competency checks, and audits helped ensure prescriptions were available.
“Stock checks and audits ensured that prescribed medicines were always available to people.” from the report
Risks were reviewed
Risk assessments covered people's health needs and were kept up to date. Fire safety and other environmental checks were carried out.
“Assessments were reviewed and were up to date.” from the report
Stronger oversight
The new manager had introduced more effective audits and was using feedback to plan improvements.
“The provider now had effective systems in place to monitor, assess and improve the quality and safety of service being provided.” from the report
Mixed views about food
needs fixingSome people were unhappy with the quality or amount of food. The manager had created an action plan, but families should check what has changed.
“Comments about food was mixed. Some people were happy with the portions of food provided while others had expressed views to us and through surveys that the quality and amount of food differed.” from the report
Staff supervision had lapsed
needs fixingStaff supervision had stopped during management changes. The management team had recognised this and was working to restart support sessions.
“Staff supervision had lapsed due to management changes.” from the report
Relatives wanted better updates
minorSome relatives said they had not been kept informed about progress or important events. The manager had started meeting relatives to provide updates.
“Relatives had commented they had not felt kept up to date with progress or significant events affecting their relations.” from the report
Manager not yet registered
minorThere was no registered manager at the inspection. The manager had applied to complete registration with CQC.
“The manager had not yet registered with CQC but had applied to complete this process.” from the report
- 01What changes have been made to the quality, amount and variety of food since the inspection?
- 02How are staff supervision and support sessions now arranged and monitored?
- 03How will you keep relatives informed about progress and significant events?
- 04Has the manager's CQC registration application been completed?
- 05What were the results of the most recent resident, relative and staff surveys?
This was an unannounced focused inspection of Safe, Effective and Well-led, including infection control; Caring and Responsive were not inspected and their ratings carried over from the previous inspection. This explanation was written from the published report of 5 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, October 2021
Rated Requires Improvement; inspectors found unsafe medicines management and weak oversight, although staffing, cleanliness and kindness were strengths.
This was an unannounced focused inspection on 23 September 2021. One inspector and a medicines inspector visited the home, spoke with people, relatives and staff, and checked care, medicines, recruitment and management records.
The main problems were with medicines. Some medicines were out of stock, one person received the wrong dose of a blood thinner, and the morning medicines round was not finished until lunchtime. The systems used to check medicines and the quality of care were not effective enough.
There were also positive findings. People said they felt safe and that staff responded quickly to call bells. The home was clean, staff were kind and knowledgeable, and people and relatives were involved in care decisions. The overall rating fell from Good at the previous inspection to Requires Improvement.
Enough staff
People said there were enough staff, and inspectors saw staff around the home. Call bells were answered promptly, and recruitment checks were completed.
“During our inspection staff were visible around the home and any call bells were answered promptly.” from the report
Clean and hygienic
Inspectors found the home clean and hygienic. Staff followed infection prevention guidance and used protective equipment safely.
“The home was clean and hygienic. Enhanced cleaning schedules were in place and cleaning products had been reviewed and amended in response to COVID-19.” from the report
Kind and supportive staff
People appeared happy and comfortable. Relatives spoke positively about staff, who knew the people they supported.
“There was a caring and supportive culture amongst staff at the home. People appeared happy and comfortable.” from the report
People involved in care
People and relatives said staff involved them in decisions and kept them informed about changes to care.
“People and their relatives said staff involved them in decisions about their care and kept them updated about any changes.” from the report
Medicines were not always safe
seriousSome people missed medicines because they were out of stock. One person received the wrong blood thinner dose, and time-critical medicines were not always given on time.
“People did not receive their medicines safely and as prescribed. Some people had not been given their medicines because they were out of stock and one person had been given the wrong dose of a blood thinner.” from the report
Weak quality checks
seriousThe home's systems did not identify widespread medicines problems. Quality assurance records had not been properly maintained since the previous inspection.
“The provider did not have effective systems in place to monitor, assess and improve the quality and safety of service being provided.” from the report
Inconsistent records
needs fixingRecords about personal care were not always completed, and the mixture of electronic and paper records was confusing. Care plan reviews were also inconsistent.
“The quality and accuracy of record keeping at the home was inconsistent. For example, records relating to personal care were not always completed and there was a confusing mixture of electronic and paper-based records.” from the report
- 01How do you now make sure every person's medicines are in stock and given at the prescribed dose?
- 02How do you make sure time-critical medicines are given on time, and how are missed or late doses reviewed?
- 03What checks are now made on medicines fridge temperatures and medicines administration?
- 04What has changed in the quality assurance system since the inspection, and who checks that improvements are being maintained?
- 05How are personal care records kept complete and consistent across electronic and paper systems?
This was an unannounced focused inspection of Safe and Well-led only; the other key questions were not inspected and their previous ratings were carried over. This explanation was written from the published report of 23 October 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 Middlewich
7 rated inspections over 6 years: the service has held its Good rating throughout.
- October 2022Goodcurrent ratingup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- October 2021Requires improvementdown from GoodSafe: Requires improvementWell-led: Requires improvement
- January 2021Goodup from Requires improvementSafe: GoodEffective: GoodWell-led: Good
- November 2019Requires improvementstayed Requires improvementSafe: Requires improvementEffective: Requires improvementWell-led: Requires improvement
- April 2019Requires improvementstayed Requires improvementSafe: Requires improvementEffective: Requires improvementWell-led: Inadequate
- August 2018Requires improvementdown from GoodSafe: Requires improvementEffective: GoodCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- August 2016GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- July 2014
Report published without a new overall rating.
- June 2014
Report published without a new overall rating.
- December 2013
Report published without a new overall rating.
- February 2013
Report published without a new overall rating.
- November 2011
Report published without a new overall rating.
- December 2010
Registered with the Care Quality Commission on 14 December 2010.
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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