CQC report explained · a residential care home
What the CQC found at Middleton Hall Retirement Village
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Good
- People were protected by safeguarding procedures, risk assessments, infection control measures and safe recruitment. However, records for topical medicines were not always complete.
- Effective?
- Good
- People's care plans, nutrition support and access to healthcare were effective. Some staff needed further knowledge about best interests decisions.
- Caring?
- Good
- This key question was not inspected during this focused inspection. No new rating was given.
- Responsive?
- Good
- This key question was not inspected during this focused inspection. No new rating was given.
- Well-led?
- Good
- The provider had improved its audits, spot checks, feedback systems and action planning. Staff and relatives described communication with managers positively.
What inspectors found, March 2021
Rated Good; inspectors found safe, kind care and major improvements, but medicines records and some staff knowledge still needed attention.
This was an unannounced focused inspection on 4 February 2021. Inspectors looked at Safe, Effective and Well-led. They spoke with people, relatives and staff, and reviewed care records, medicine records, staff files and management documents.
The home was rated Good overall and Good for Safe, Effective and Well-led. Inspectors found enough staff, safer recruitment, improved care plans and risk assessments, suitable infection control measures, and better systems for checking the quality of care.
There were still some issues. Records for creams and other topical medicines were not always completed. Some staff needed more knowledge about best interests decisions under the Mental Capacity Act. Inspectors made recommendations about both areas.
The previous rating was Requires Improvement, with multiple breaches. The provider had completed an action plan. At this inspection, the provider was no longer in breach of regulations and the overall rating improved to Good.
Personalised care planning
Care plans and risk assessments were regularly reviewed and gave staff detailed information about people's needs, choices and preferences.
“Care plans and risk assessments were up to date, comprehensive and personalised.” from the report
People felt safe
People said they felt safe and well cared for. Safeguarding concerns were recorded and investigated, and staff understood how to report them.
“People told us they felt safe and settled.” from the report
Food and drink support
Staff supported people with their nutrition and hydration needs. The home adapted food and used equipment to help people remain independent.
“People were assisted and supported to eat and drink and their nutrition and hydration needs were met.” from the report
Improved management checks
The provider had introduced regular audits and spot checks. Shortfalls were analysed and lessons were used to improve the service.
“Regular audits were completed along with a system of spot checks.” from the report
Topical medicine records
needs fixingRecords for creams and other topical preparations were not always completed. Guidance was also not always available, so inspectors could not be assured these medicines were used as prescribed.
“However, the records for topical preparations such as creams were not always completed and guidance was not always in place, therefore, we were not assured they were used as prescribed.” from the report
Best interests decisions
needs fixingSome staff had completed relevant training but did not yet have enough knowledge about best interests decisions. Inspectors recommended further training.
“Some staff required further knowledge in the area of best interests decisions.” from the report
Time for activities
minorStaff said there were enough staff to meet people's care and safety needs, but some said they did not always have enough time for social activities.
“Staff told us they would like more time to spend with residents to do activities.” from the report
- 01How do you now make sure records for creams and other topical medicines are completed every time?
- 02What extra training have staff received about best interests decisions?
- 03How do you make sure staff have enough time to provide activities and social interaction?
- 04What were the results of the latest audits and spot checks, and what actions followed?
- 05What are the current ratings and most recent inspection findings for Caring and Responsive?
This was a focused inspection of Safe, Effective and Well-led only; Caring and Responsive were not inspected and their previous ratings were used when calculating the overall rating. This explanation was written from the published report of 10 March 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.
What inspectors found, November 2019
Rated Requires Improvement; inspectors found kind and responsive care, but safety, consent and management checks were not reliable enough.
This was a planned inspection carried out over four days in August 2019. Inspectors spoke with people, relatives and staff, observed medicines being given, and reviewed care plans, medicine records, staff files and management records.
The home was caring and responsive. Staff treated people with kindness and respect, knew their preferences, welcomed families and offered many activities. People were supported to stay independent and take part in community life.
However, medicines, risk assessments and some safety checks were not always managed properly. Records about care, drinking, nutrition and mental capacity were sometimes incomplete or out of date. Staffing levels also caused concern, with some people waiting for help.
The overall rating was Requires Improvement. Safe, Effective and Well-led were rated Requires Improvement, while Caring and Responsive were rated Good. The home had deteriorated from Outstanding at the previous inspection in 2017.
Kind and respectful staff
People were supported in a dignified and patient way. Staff knew people well, valued their backgrounds and involved them in decisions.
“People were supported in a dignified and patient way.” from the report
Activities and independence
People could choose from many activities, use the grounds and maintain links with the local community. The home used GPS devices to help some people enjoy the grounds safely.
“People had opportunity to take part in an incredibly varied programme of activities within the home in line with their personal preferences” from the report
Family involvement
Families were welcome at any time and could spend time with residents in different areas of the home. People were also supported to keep in touch with relatives who lived further away.
“Families were able to visit at any time and were welcomed into the service.” from the report
Clean environment
Inspectors found the areas they looked at to be very clean, with protective equipment available to help prevent infection.
“All areas of the building were immaculately clean.” from the report
Quick response to feedback
The management team listened to the inspectors and made changes during and after the inspection. It also provided evidence of changes and further plans.
“The registered manager and the wider management team were very quick to respond to our feedback and took steps to make improvements straight away.” from the report
Medicine safety
seriousMedicine records were not always complete or accurate. Guidance and records for variable doses, as-needed medicines, self-administration and medicine patches were sometimes missing or unclear.
“Medicines were not always managed safely.” from the report
Risk management and safety checks
seriousSome risks were not fully assessed or regularly reviewed. Inspectors found incorrect mattress settings, water temperatures above the safe limit and insufficient guidance about catheter care.
“Risk had not always been fully assessed or reviewed regularly.” from the report
Staffing levels
needs fixingSome people said there were not enough staff and that they sometimes waited for help, particularly at night or at weekends. One nurse usually covered the whole service, and only one staff member worked at night in one area.
“Some people were happy with staff levels, but others told us there was not enough staff and at times they had to wait for assistance” from the report
Consent and mental capacity
seriousMental capacity assessments were not always completed when restrictions were used, such as bedrails. Best interest decisions were not always recorded.
“Where people lacked capacity to consent to restrictions an MCA assessment had not always been completed” from the report
Care and nutrition records
needs fixingSome care plans did not contain enough detail about people's preferences or current needs. Records of fluid intake and some dietary requirements were not always complete.
“Care records needed to be reviewed to ensure they were accurate and up to date.” from the report
Weak management checks
seriousAudits and quality checks had not identified the problems found by inspectors. Some audits were not dated, and identified errors were not always followed up.
“Systems to review the quality of the service were not effective.” from the report
- 01What changes have you made to medicine records, including variable doses, as-needed medicines, self-administration and medicine patches?
- 02How many staff and nurses are now on duty in each area at night and at weekends?
- 03How do you check that risk assessments, mattress settings, water temperatures and catheter care guidance are current and safe?
- 04How are mental capacity assessments and best interest decisions recorded when restrictions such as bedrails are used?
- 05How do you make sure care plans are updated promptly and include each person's preferences, fluid needs and dietary requirements?
This was a planned inspection covering all five key questions; the previous ratings from 2017 were considered and all five ratings were changed at this inspection. This explanation was written from the published report of 13 November 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 Middleton Hall Retirement Village
4 rated inspections over 6 years: the service has held its Good rating throughout.
- March 2021Goodcurrent ratingup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
Read what inspectors found at Middleton Hall Retirement Village →
- November 2019Requires improvementdown from OutstandingSafe: Requires improvementEffective: Requires improvementWell-led: Requires improvement
Read what inspectors found at Middleton Hall Retirement Village →
- March 2017Outstandingup from GoodSafe: OutstandingEffective: OutstandingCaring: OutstandingResponsive: OutstandingWell-led: Outstanding
- February 2015GoodSafe: GoodEffective: GoodCaring: GoodResponsive: OutstandingWell-led: Requires improvement
- January 2014
Report published without a new overall rating.
- October 2012
Report published without a new overall rating.
- January 2011
Registered with the Care Quality Commission on 13 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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36 live-in carers within about an hour of Darlington
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.
Most charge £970 to £1,230 a week. 35 can care for a couple. 11 years' experience on average.
“Petty introduced herself to Mum every time she was caring for her and responded very quickly to Mum if she was distressed in the night.”
Every carer has had an enhanced DBS check in the last 18 months, ID and right-to-work checks and an online interview. Their skills and training are for you to check with them. Carers set their own rates, and who is free changes week to week.