CQC report explained · a nursing home
What the CQC found at Mickley Hall
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Good
- People's risks were assessed and staff knew how to keep people safe. Medicines, equipment, staffing and infection control were managed safely, although one contradictory diet instruction was found and corrected during the inspection.
- Effective?
- Good
- People's needs and choices were assessed, and staff had suitable training and support. People received appropriate food, healthcare and help to make decisions.
- Caring?
- Good
- Inspectors saw a calm and friendly atmosphere. Staff treated people with kindness, dignity and respect, and supported their choices and independence.
- Responsive?
- Good
- Care plans were detailed, personalised and reviewed. People had access to activities, trips and communication support that reflected their individual needs and interests.
- Well-led?
- Requires improvement
- Management and quality checks had improved, and people and staff spoke positively about the changes. However, the home needed more time to show that the new systems were fully established and consistently effective.
What inspectors found, July 2022
Rated Good overall; care had improved greatly, but leadership and quality systems still needed more time to become consistent.
This was an unannounced follow-up inspection on 8 June 2022. Inspectors spoke with 10 people, 12 staff and other professionals. They reviewed care, medicine and staff records, as well as management checks.
The home had improved significantly since the previous inspection. People were found to be safe, treated with kindness, supported to make choices and offered care that met their needs. Medicines, staffing, infection control, activities and complaints handling were all improved.
The overall rating changed from Inadequate to Good. Safe, Effective, Caring and Responsive were all rated Good. Well-led was rated Requires Improvement because the new management and checking systems needed to be established over a longer period.
The home had been in Special Measures since November 2021. It is no longer rated Inadequate and is no longer in Special Measures. There were no current breaches of regulations at this inspection.
Major improvement
The home had made substantial progress since its previous inspection, when it was rated Inadequate and was in Special Measures.
“The service had significantly improved since the previous inspection.” from the report
Safe medicines
Medicines were stored, given and recorded safely. Staff handling medicines had training and checks of their competence.
“People received their medicines safely and as prescribed.” from the report
Kind and respectful care
People described staff as kind and caring. Inspectors saw staff listening, explaining care and protecting people's privacy and dignity.
“There was a friendly, calm and relaxed atmosphere at Mickley Hall.” from the report
Activities and choice
People could take part in group or one-to-one activities, including trips outside the home. Activities reflected people's interests and strengths.
“People had access to a range of activities.” from the report
Leadership still settling
needs fixingThere was no registered manager during the inspection. An interim manager was leading improvements, and a new manager was appointed the following day.
“At the time of our inspection there was not a registered manager in post.” from the report
Systems needed to become consistent
needs fixingThe new checks and management systems had improved, but the home had not yet shown that they were fully embedded over time.
“Although significant improvements had been made since the last inspection, further time was required to ensure that new systems were fully embedded, and consistency of improved practice was evidenced.” from the report
One unclear diet instruction
minorInspectors found contradictory information in one person's risk assessment about the dietary support needed. The manager corrected this before the inspection ended.
“We did find some contradictory information in one person's risk assessment about the support they needed with their diet.” from the report
- 01Who is now the registered manager, and how was the handover from the interim manager managed?
- 02How do you check that the new quality and safety systems are still being followed consistently?
- 03What staffing arrangements are now in place for nursing staff, including the use of agency staff?
- 04How are people's dietary risks checked so that care plans and risk assessments do not contain conflicting instructions?
- 05How are people and their relatives involved in reviewing care plans and choosing activities?
This was an unannounced follow-up inspection after the previous Inadequate rating; inspectors considered all five key questions and also checked infection prevention and control under Safe. This explanation was written from the published report of 22 July 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
Rated Inadequate and placed in special measures; inspectors found serious problems with safety, staffing, care records and management.
This was an unannounced inspection on 22 and 24 September 2021. Inspectors spoke with people, relatives, staff and visiting professionals. They reviewed care records, staff records, medicines, policies and the home's monitoring systems.
The overall rating was Inadequate. Safe and well-led were rated Inadequate. Effective, caring and responsive were rated Requires Improvement. Inspectors found risks were not always properly assessed, staffing was not always enough, infection control rules were not always followed, and care records were often incomplete or out of date.
There were some positive findings. People said they felt safe, medicines were managed safely, food was appetising, and many staff interactions were kind. However, the home had not made enough improvement since its previous Requires Improvement rating in May 2020. The home was placed in special measures and CQC said it would re-inspect and monitor progress.
People felt safe
People told inspectors they felt safe and well looked after. Safeguarding systems and staff training were in place.
“People told us they felt safe and well looked after.” from the report
Medicines
Medicines were stored properly and people received them when they should. Staff who gave medicines had training and regular competency checks.
“Medicines were stored properly and there were appropriate arrangements in place for the management of controlled drugs” from the report
Kind staff interactions
Inspectors saw many positive interactions. Staff generally understood people's needs and treated them with dignity and respect.
“Most interactions we observed were kind, caring, positive and appropriate.” from the report
Food
People said the food was good. Inspectors found meals looked plentiful and appetising, and people's dietary needs were recorded.
“The meals provided looked plentiful and appetising.” from the report
Risks were not managed consistently
seriousSome risk assessments and care plans did not match. Emergency evacuation information was out of date, and risks linked to a person's choice about a modified diet had not been fully assessed.
“This placed people at risk of harm.” from the report
Too few staff at times
seriousPeople sometimes missed showers and could not choose when to go to bed because staffing was not sufficient. Staff also raised concerns about low numbers, especially in the afternoons and at weekends.
“We found no evidence that people had been harmed however the provider had not taken appropriate steps to ensure staffing levels and the deployment of staff were sufficient to always meet people's needs.” from the report
Care plans were not reliable
seriousCare plans were not always accurate, current or detailed enough to guide staff. People and relatives were not involved consistently in care reviews.
“These shortfalls meant people were at risk of receiving unsuitable or inconsistent care because staff did not always have clear guidance about how to support people's individual needs.” from the report
Limited activities and choice
needs fixingSome people had little stimulation or conversation, and records did not show what activities they had taken part in. People did not always have a choice about when they got up or went to bed.
“We observed people sat in their room all day with little stimulation or conversation.” from the report
Training gaps
needs fixingSome staff training had lapsed, including practical moving and handling. The home could not show that nursing staff had completed required specialist clinical training.
“There was no evidence nursing staff had been provided with specialist clinical training they required.” from the report
Consent processes
seriousPeople's capacity was not always assessed and best-interest decisions were not always recorded. This meant the home did not consistently show that people's rights were protected.
“Processes were not always followed correctly to ensure that people's rights were upheld, and decisions were made in the best interest of people who lacked mental capacity.” from the report
- 01How many staff are currently on each shift, especially in the afternoons, at weekends and overnight?
- 02How do you make sure risk assessments, care plans and emergency evacuation plans are accurate and updated?
- 03What specialist clinical training have nursing staff completed, and how are staff training gaps being checked?
- 04How are residents involved in care reviews and decisions about meals, activities, getting up and going to bed?
- 05What action has been taken in response to the warning notices and the home's placement in special measures?
This was a planned inspection based on the previous rating, covering all five key questions and infection prevention and control measures, with records reviewed for three people. This explanation was written from the published report of 17 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 Mickley Hall
7 rated inspections over 7 years: the service has improved, from Requires improvement to Good.
- July 2022Goodcurrent ratingup from InadequateSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- November 2021Inadequatedown from Requires improvementSafe: InadequateEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Inadequate
- May 2020Requires improvementdown from GoodSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Inadequate
- April 2019Goodup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- April 2018Requires improvementstayed Requires improvementSafe: InadequateEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- November 2017Requires improvementstayed Requires improvementSafe: Requires improvementEffective: GoodCaring: Requires improvementResponsive: GoodWell-led: Requires improvement
- November 2015Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- July 2019
Registered with the Care Quality Commission on 31 July 2019.
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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