CQC report explained · a nursing home
What the CQC found at Middlefield House Nursing Home
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
- Safe?
- Requires improvement
- People were protected from abuse, risks were assessed, medicines were managed safely and staffing had improved. However, some areas were not clean enough and infection control processes were not always effective.
- Effective?
- Good
- Staff had suitable training and supervision. People's health, nutrition, specialist diets and access to healthcare were well supported, and mental capacity and best-interest processes were followed.
- Caring?
- Good
- Staff were kind and respectful. They knew people's communication needs, supported their choices and encouraged privacy, dignity and independence.
- Responsive?
- Good
- Care was personalised and based on people's needs and preferences. People were supported with communication, activities, family relationships and community involvement.
- Well-led?
- Requires improvement
- There was a clear management structure and some useful audits. However, quality checks did not identify the cleanliness problems found by inspectors, so oversight was not consistently effective.
What inspectors found, February 2020
Middlefield House Nursing Home is rated Requires Improvement; inspectors found kind, effective and responsive care, but cleanliness checks did not always find problems and leadership needed strengthening.
This was an unannounced inspection on 21 and 27 January 2020. Inspectors spoke with people using the service, staff and relatives. They also observed care and checked care plans, medicines, recruitment files and management records.
The home was rated Good for Effective, Caring and Responsive. Staff knew people well, treated them kindly, supported their health and nutrition, and helped them make choices, communicate and take part in activities.
Safe and Well-led were rated Requires Improvement. Inspectors found dirt, debris, body fluids under toilet seats and missing hand towels in some areas on the first day. These issues were dealt with during the inspection, but existing checks had not found them.
Kind and respectful care
People received compassionate support from staff who understood how to communicate with them. Inspectors saw warm interactions and a calm atmosphere.
“The interactions between staff and people who used the service were warm and the atmosphere in the service was calm and happy.” from the report
Personalised support
Care plans gave clear guidance about people's complex needs, equipment, choices and independence. Inspectors saw staff following this guidance.
“People received personalised care from a staff group who had excellent knowledge of their individual needs.” from the report
Safer staffing and medicines
Staffing levels had improved since the previous inspection. Recruitment checks were in place, and medicines were stored, administered and recorded safely.
“People received their medicines safely from staff who had been completed training in the safe handling of medicines.” from the report
Improved mealtimes
Changes made after the previous inspection resulted in calmer and better organised mealtimes. Staff understood people's dietary needs and preferences.
“The staff team worked together to ensure the mealtime experience was well organised.” from the report
Cleanliness and infection control
needs fixingSome bathrooms, toilets and a bedroom were visibly dirty. Inspectors also found body fluids under toilet seats, a lack of hand towels and laundry equipment that was not cleaned regularly.
“The service did not always have robust processes in place to reduce the risks of the spread of infection at the service.” from the report
Quality checks missed problems
needs fixingThe home's audits did not identify the cleanliness issues found during the inspection. New monitoring arrangements were being introduced, but their effectiveness had not yet been established.
“Some of the quality monitoring processes in place at the service had not highlighted the issues we found around management of the cleanliness of the service.” from the report
- 01What new cleaning arrangements and infection-control audits have been put in place since the inspection?
- 02How do you check that bathrooms, toilets, bedrooms and laundry equipment are cleaned to the required standard every day?
- 03How will you show families that the new quality monitoring process is identifying and fixing problems?
- 04How do you support each person with their communication needs, choices, community activities and independence?
- 05What progress has been made since CQC said it would monitor improvements and return for a reinspection?
This was a planned, unannounced inspection covering all five key questions, and CQC looked at both the premises and the care provided. This explanation was written from the published report of 29 February 2020 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, March 2019
Requires Improvement; inspectors found kind care and safe medicines, but staffing and management weaknesses affected people's support.
This was an unannounced inspection on 02 January 2019. One inspector reviewed records, medicines, staff information and the premises. They observed care, spoke with staff and managers, received feedback from health professionals, and contacted relatives.
The home was not always safe, effective, caring or responsive. Staffing levels meant people sometimes waited for help at mealtimes and did not always receive personalised support. Staff training and supervision were not up to date. Records, premises checks and quality monitoring were also not consistently reliable.
There were positive findings. Staff knew people well and were described as kind. Care plans were detailed, medicines were managed safely, and links with health professionals were positive. Relatives gave consistently positive feedback.
The overall rating and all five areas were Requires Improvement. This was a fall from Good at the previous inspection, published on 3 June 2016. The provider was required to send CQC a report explaining how it would improve.
Kind and respectful staff
Inspectors saw staff explain things calmly and patiently. Relatives gave consistently positive feedback about how their family members were treated.
“People were observed to be content and happy in staff presence.” from the report
Safe medicines
Medicines were administered by nursing staff, competency checks had been completed, and records showed medicines were given as prescribed.
“Medication administration records confirmed people had received their medicines as prescribed.” from the report
Good health support
The home worked with GPs, dieticians and occupational therapists. People had health checks, health action plans and hospital passports.
“People were supported to maintain good health.” from the report
Detailed care information
Care plans included people's preferences, communication methods and advice from health professionals. They were available in accessible formats.
“Care plans were detailed and were developed in line with people's preferences.” from the report
Too few staff at busy times
seriousPeople sometimes waited for help at meals. Limited staffing also reduced people's opportunities for personalised support and independence.
“Staffing levels did not ensure that people's needs were met in a timely way.” from the report
Training and supervision gaps
needs fixingSome staff training was overdue or incomplete. Staff supervision had not taken place as often as the provider's policy required.
“Staff training was not up to date.” from the report
Weak quality checks and records
seriousThe home's systems had not found issues with mealtimes, maintenance and care records. Some records were incomplete, difficult to navigate or not reviewed promptly.
“The provider's quality assurance systems were not always effective at monitoring and improving the service people received.” from the report
Limited independence and ordinary living
needs fixingThe size, layout and staffing arrangements did not fully support choice, independence and inclusion. People could not access the main kitchen to develop cooking and everyday living skills.
“The premises of the service were not purpose built.” from the report
Food choices were not always offered
needs fixingAt one lunchtime, a broken oven and staffing pressures meant people were not offered a choice. One person received an alternative, but others who could not communicate were not offered one.
“People were not provided with a choice.” from the report
- 01How many staff will be on duty at breakfast and lunch, and how will you prevent people waiting for help?
- 02How will you provide personalised one-to-one support when people stay at the home?
- 03Which staff training and supervision sessions are now complete, and how are overdue sessions monitored?
- 04What has changed in the quality checks for mealtimes, care records, fire drills and building maintenance?
- 05How will people be supported to make choices, develop everyday skills and live as ordinary a life as possible?
This was an unannounced comprehensive inspection covering all five CQC questions, with the overall rating and each question rated Requires Improvement. This explanation was written from the published report of 14 March 2019 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 Middlefield House Nursing Home
3 rated inspections over 4 years: the service has slipped, from Good to Requires improvement.
- February 2020Requires improvementcurrent ratingstayed Requires improvementSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
Read what inspectors found at Middlefield House Nursing Home →
- March 2019Requires improvementdown from GoodSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
Read what inspectors found at Middlefield House Nursing Home →
- June 2016GoodSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- July 2013
Report published without a new overall rating.
- May 2012
Report published without a new overall rating.
- January 2011
Registered with the Care Quality Commission on 20 January 2011.
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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9 live-in carers within about an hour of Lincolnshire
These are self-employed carers on PrimeCarers, the introductory agency that runs this directory. Each has a profile with their own rates and reviews from families, and you choose who to talk to.
8 can care for a couple. 10 years' experience on average.
“Martin was more than a carer, he managed the home and became my uncle's best friend, enriching his life during his last few years.”
“Magda was always positive and proactive about trying new things to keep dad busy. She also introduced new ideas for keeping dad healthy.”
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