CQC report explained · a nursing home
What the CQC found at Middletown Grange
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Good
- Inspectors found enough staff to meet people's needs, safe recruitment, appropriate risk management and medicines given as prescribed. They also found that previous staffing improvements meant the home was no longer in breach.
- Effective?
- Good
- People were supported to eat and drink enough, maintain their health and receive suitable training and care planning. Staff followed people's choices and worked with other health and social care professionals.
- Caring?
- Good
- People said staff were caring. Inspectors observed polite and respectful interactions, and found that people were supported with privacy, dignity, choice and independence.
- Responsive?
- Good
- Care plans reflected people's needs, preferences and routines. People had access to activities, trips and community links, and complaints were recorded, investigated and answered under the home's policy.
- Well-led?
- Good
- Inspectors found a clear management structure, effective quality checks and a culture of learning. Records were up to date and the home was no longer in breach of the previous good governance regulation.
What inspectors found, August 2019
Rated Good; inspectors found safe, kind and personalised care, with clear improvements since the previous inspection.
This was an unannounced planned inspection on 23 July 2019. Inspectors reviewed information held by the CQC, spoke with people, relatives, staff and health professionals, and examined care, medicines, recruitment and management records.
The home was rated Good in all five areas: Safe, Effective, Caring, Responsive and Well-led. Inspectors found enough staff, safe medicines systems, clean surroundings and staff who knew people's needs and preferences.
People were supported with food, drink, healthcare and activities. Staff treated people with kindness, respected their choices and supported their dignity and independence.
The previous rating was Requires Improvement, with breaches relating to staffing and good governance. The report says improvements had been made and the home was no longer in breach of regulations.
Staffing improved
Inspectors found enough staff to meet people's needs, and people were attended to promptly. The home used the same agency staff where possible to support consistency.
“There were enough staff to meet people's needs. We saw people were attended to in a timely manner and staff were not rushed.” from the report
Kind and respectful care
Staff knew people well and supported them in a calm and respectful way. Inspectors saw staff protect people's privacy and dignity.
“We observed staff talking to people in a polite and respectful manner.” from the report
Personalised support and activities
Care plans included people's routines, choices and preferences. The home offered activities, outings, entertainment and links with local schools and community groups.
“People received care and support specific to their needs, preferences and routines.” from the report
Management improvements
The report says management systems, staffing and records had improved since the previous inspection. The home used audits and reflective meetings to monitor and improve care.
“People's records were up to date and reviewed whenever their needs changed. This was a significant improvement from the last inspection.” from the report
Inspectors raised no specific concerns in this report.
- 01How many agency staff are currently being used, and how is consistency of care maintained while recruitment continues?
- 02What checks are now used to prevent medicines recording errors, following the previous problems?
- 03How often are care plans and risk assessments reviewed when a person's needs change?
- 04How would the home support my relative if they needed end of life care?
- 05How are residents and relatives' feedback about food, activities and care acted on?
This was an unannounced planned inspection covering all five CQC key questions, the premises and the care provided. This explanation was written from the published report of 3 August 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.
What inspectors found, September 2018
Requires Improvement; inspectors found kind staff and safe medicines, but serious staffing, record-keeping and leadership problems.
Inspectors visited the home without notice on 24 July 2018. They spoke with 22 people, 10 relatives and staff, checked care and medicines records, observed care, and reviewed the home’s management systems.
The home did not have enough staff to meet people’s needs, especially on the dementia unit. Some people did not have drinks or call bells within reach. Records were not always up to date, some risks were not reviewed after people’s needs changed, and the dementia unit had unpleasant smells.
There were also concerns about end of life care, activities and complaints. Staff were often kind and respectful, medicines were managed safely, and meals were enjoyable. However, all five areas were rated Requires Improvement. This was the first time the home received this rating.
Safe medicines
People received their medicines as prescribed. Records of medicines given were accurate.
“People received their medicines as prescribed and the home had safe medicine storage systems in place.” from the report
Kind and respectful care
Inspectors saw warmth and affection from staff. People were treated with dignity and supported to remain independent.
“Throughout our inspection, we observed many caring interactions between staff and the people they were supporting.” from the report
Good meals
Meals were varied and suitable for people’s needs. Mealtimes were social, relaxed and enjoyable.
“This was an enjoyable, social event where most people attended.” from the report
Skilled staff
Staff had relevant training, knowledge and experience. They received supervision and appraisals.
“People received effective care from staff who were knowledgeable and skilled in their practice.” from the report
Partnership working
The home worked with health and social care professionals and made timely referrals when specialist advice was needed.
“The service worked closely in partnership with the safeguarding team and multidisciplinary teams to support safe care provision.” from the report
Not enough staff
seriousStaffing levels were not enough for people who needed two staff for personal care. People on the dementia unit spent periods without staff support.
“We found the home did not have enough staff to meet people's needs.” from the report
Out-of-date records
needs fixingSome care plans contained conflicting information, including dietary instructions and resuscitation decisions. This could mean staff did not have the right information to provide care.
“However, some of the care plans were difficult to follow resulting in conflicting information.” from the report
Weak leadership
needs fixingThere was no registered manager, and people, relatives and staff were unhappy about how the home was run. Staff morale had been affected.
“The service was not well run.” from the report
Poor monitoring
needs fixingQuality checks had not found some of the problems inspectors identified. There were no audits of staffing levels or people’s experiences and views.
“The provider's quality assurance systems were not always effective.” from the report
End of life care
seriousEnd of life plans had not always been discussed with people or their representatives. Staff shortages meant staff did not always have enough time to support people at the end of life.
“It was clear staff shortage impacted on how staff delivered end of life care.” from the report
- 01What are the current staffing levels on the dementia unit, and how do you check they are enough for people who need two staff?
- 02How do you make sure people always have access to drinks and call bells, and are supported to drink when needed?
- 03How do you check that care plans, dietary instructions and resuscitation decisions are current and do not conflict?
- 04Who is currently responsible for managing the home, and when will a new registered manager be in place?
- 05How do you make sure people’s end of life wishes are discussed, recorded and followed?
This was an unannounced inspection covering all five areas of the service, including accommodation and nursing or personal care. This explanation was written from the published report of 7 September 2018 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 Middletown Grange
6 rated inspections over 4 years: the service has improved, from Requires improvement to Good.
- August 2019Goodcurrent ratingup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- September 2018Requires improvementdown from GoodSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- May 2017Goodup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- March 2016Requires improvementstayed Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- September 2015Requires improvementstayed Requires improvementSafe: Requires improvementEffective: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- June 2015Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- June 2014
Report published without a new overall rating.
- January 2014
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.
- February 2011
Registered with the Care Quality Commission on 15 February 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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