CQC report explained · a residential care home
What the CQC found at Middleton
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
- Safe?
- Requires improvement
- Medicine records did not always match stocks, some entries were not checked and signed, and controlled drug procedures were not always followed. Other safety arrangements, including safeguarding, risk assessments, fire checks, recruitment and infection control, were generally in place.
- Effective?
- Good
- Staff had training and understood people's individual needs. People received support with nutrition and healthcare, although staff meetings and supervision had not been held regularly and some care records needed more detail.
- Caring?
- Good
- People were treated with kindness, dignity and respect. Staff knew people well, supported their independence and helped them make choices about their daily routines.
- Responsive?
- Good
- People followed activities and routines of their choice, maintained relationships and accessed the local community. Care files needed updating, and a new electronic care planning system was being introduced.
- Well-led?
- Requires improvement
- Audits did not identify all the medicine problems found by inspectors. Relatives were not always involved or kept informed, and there was no registered manager in post at the time of the inspection.
What inspectors found, February 2024
Middleton rated Requires Improvement; inspectors found kind, responsive care, but medicines were not always managed safely and management oversight was not effective.
Inspectors visited on 28 November and 7 December 2023. One inspector, a medicines specialist and an Expert by Experience looked around the home, observed care, spoke with people, relatives and staff, and reviewed medicines, care plans, recruitment and safety records.
The home was caring, effective and responsive. People were treated with respect, supported to make choices, helped to stay independent and supported to follow their interests. Staff understood people's needs and relatives generally felt people were safe and well cared for.
There were important problems with medicines. Records did not always match medicine stocks, some entries were not checked, and staff did not always refer to records before preparing medicines. The home also needed better care records, stronger audits and clearer involvement of people and relatives.
The overall rating was Requires Improvement. Safe and well-led were rated Requires Improvement, while effective, caring and responsive were rated Good. The previous overall rating was Good, published on 2 July 2018.
Kind and respectful support
Inspectors saw friendly interactions and found that staff knew people well. People were supported with dignity, privacy and independence.
“People's privacy, dignity and independence were respected and promoted.” from the report
Activities and relationships
People were supported to keep in touch with family and friends and to take part in activities, trips and routines they chose.
“People were supported to maintain relationships, follow their interests, and take part in activities that were relevant to them.” from the report
Staff skills and training
Staff had completed induction and relevant training, including training related to learning disabilities, autism and distress behaviours.
“The service made sure staff had the skills, knowledge, and experience to deliver effective care and support.” from the report
Safeguarding and general safety
Staff understood how to report concerns. Risk assessments, fire safety checks, recruitment checks and infection control arrangements were in place.
“People were safeguarded from abuse and avoidable harm.” from the report
Medicine safety
seriousMedicine records did not always match stocks, handwritten entries were not properly checked, and staff did not always use the medicine record before preparing medicines. Controlled drug records and guidance for as-needed medicines also had problems.
“People were supported to receive their medicines in a way that was not always safe.” from the report
Weak management checks
seriousThe home's audits did not identify all the medicine problems found during the inspection. Systems for checking and improving the service were not effective enough.
“Systems needed to be improved to evidence more effective management and oversight of the service for the purposes of continually evaluating and improving such services.” from the report
Care records and family involvement
needs fixingSome care records needed updating, and records did not always show who had been consulted. Relatives said they were not always involved in care planning or kept informed about the home.
“People and their relatives were not always included in discussion about the home and their care and support.” from the report
Management arrangements
needs fixingThere was no registered manager in post during the inspection. Management support was being provided and a new manager was to be appointed, but relatives were not always clear about who was responsible.
“At the time of our inspection there was no registered manager in post.” from the report
- 01What changes have been made to medicine records, controlled drug checks and as-needed medicine guidance since the inspection?
- 02Has a new registered manager been appointed, and who is currently responsible for the home?
- 03How will you make sure care plans are reviewed and kept up to date?
- 04How are people and relatives now involved in care planning and decisions about the home?
- 05How often are staff meetings and supervision sessions now held?
This was an inspection of the care home covering all five CQC questions, with particular checks on medicines, care plans, staffing, safety records and management systems. This explanation was written from the published report of 21 February 2024 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, June 2021
Heathcotes (Middleton) was inspected but not rated; inspectors found good COVID-19 precautions but identified problems with PPE bins and clinical waste.
This was a targeted inspection on 11 March 2021. Inspectors looked at infection prevention and control measures during the coronavirus pandemic, rather than the full range of care provided.
The home had daily temperature checks, staff symptom screening, appropriate use of PPE, good ventilation, and access to testing and vaccinations. People were also supported to keep in touch with family and friends by video call.
Inspectors found there were not enough bins for used PPE and that clinical waste was not managed well. The manager agreed to take action. The service was inspected but not rated, so this report does not give a Good, Requires Improvement or Inadequate rating.
Health checks
People and staff had daily temperature checks, and staff were screened for coronavirus symptoms.
“People using the service and staff had their temperature taken daily and staff were screened for symptoms of Covid-19.” from the report
Testing and vaccinations
The home took part in coronavirus testing and vaccination programmes for people and staff.
“The service was fully engaged with the Covid-19 testing and vaccination programmes.” from the report
Contact with families
People were supported to stay in contact with family and friends through video calls.
“People were supported to maintain contact with their families and friends through video calling.” from the report
Infection precautions
Inspectors found good ventilation and saw staff following government guidance on PPE.
“Staff were seen to be following the current government guidance in relation to the personal protective equipment (PPE) being used and there was good ventilation around the home” from the report
PPE disposal
needs fixingThere were not enough bins around the home for disposing of PPE. The manager agreed to take action to remedy this.
“We found that there were not enough bins around the home for disposing of PPE and that clinical waste was not managed well.” from the report
Some infection controls only partly assured
needs fixingInspectors were only somewhat assured that PPE was being used safely and effectively, and about safety through the home's layout and hygiene practices.
“We were somewhat assured that the provider was using PPE effectively and safely.” from the report
- 01What action was taken to provide enough bins for disposing of PPE?
- 02How is clinical waste now managed, and who checks that this is being done properly?
- 03What changes were made after inspectors were only somewhat assured about PPE use?
- 04How are the home's layout and hygiene practices checked now?
- 05How will people who want them be supported with coronavirus testing and vaccinations?
This was a targeted inspection of infection prevention and control during the coronavirus pandemic; it was not a full inspection of all five quality areas and the service was not rated. This explanation was written from the published report of 25 June 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 Middleton
4 rated inspections over 8 years: the service has held its Requires improvement rating throughout.
- February 2024Requires improvementcurrent ratingSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- June 2021Inspected but not ratedSafe: Inspected but not rated
- June 2018Goodstayed GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- February 2017Goodup from Requires improvementSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- November 2015Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- December 2014
Registered with the Care Quality Commission on 18 December 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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