Middleton Care Limited

Updated 8 September 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 14 August 2018. We gave the provider 24 hours’ notice of our visit to ensure people’s permission had been sought to speak with them.

We visited the office location on 14 August 2018 to see the provider and to review care records and policies and procedures. We spoke with people using the service, relatives and staff members the following day via telephone interviews.

The inspection was carried out by one adult social care inspector.

Before the inspection we reviewed other information we held about the service and the provider. This included previous inspection reports and statutory notifications we had received from the provider. Notifications are changes, event or incidents the provider is legally obliged to send to CQC within required timescales.

We also contacted the local authority commissioners for the service, the local authority safeguarding team and the clinical commissioning group (CCG). We also spoke with an occupational therapist, one of the local GP practices and a district nurse. Their views are reflected in our report.

At the time of our inspection visit there were 78 people who used the service. We also spoke with five people who used the service and three relatives. We spoke with the nominated individual, the registered manager, a director, the in-house trainer, two liaison officers and two care staff.

At the location’s office we viewed a range of records about how the service was managed. These included the care records of five people supported by the service, the recruitment records of two staff members, training records, and records in relation to the management of the service including a range of policies and procedures.

Updated 8 September 2018

We inspected Middleton Care Limited on 14 August 2018. This was an announced inspection so that people could be informed that we wished to speak with them in their own homes.

Middleton Care Limited is a domiciliary care agency. It provides personal care to people living in their own homes in Middleton in Teesdale and Barnard Castle. This area includes rural villages and remote areas in County Durham. Not everyone using Middleton Care Limited receives regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided. At the time of inspection 78 people were receiving a regulated activity.

We inspected the service in April 2016 and rated the service as Outstanding. At this inspection we found the service remained Outstanding.

Middleton Care Limited ensured people were at the heart of their care and support. People received a high standard of person centred care by the staff and management team who were reported to be exceptionally kind, caring and considerate.

The staff team clearly knew the people they supported including their likes, dislikes and interests and life history and the service ensured a small and consistent team who lived locally worked with each person.

We saw the staff team had gone above and beyond and worked in their own time, or gone out of their way for the benefit of people using the service, to ensure their care needs had been met and to ensure they were safe during adverse weather in a rurally remote area.

People, their relatives and the staff we spoke with, told us the service was extremely well-led and managed. The management team had expanded and we saw that care staff had been given the opportunity to achieve degree level qualifications in leadership and human resources so ensure the business continued to develop and grow. Other staff we spoke with told us of the training opportunities and of overcoming their own fears of information technology by supportive one to one training and coaching.

The service continued to develop strong relationships with partners in the local community. An inventive scheme had been developed between the GP surgery and local pharmacist which meant the service checked and collected people's medicines and delivered them to them at home each week. People and families told us this had helped them immensely and gave them reassurance.

To ensure high quality care and consistency continued to be delivered, the service completed regular monitoring, spot checks and formal audits of service provision. The management team also worked alongside staff to provide support and complete additional observations of practice.

Staff received high levels of support to enable them to provide outstanding care. In depth induction training was provided upon commencing employment, which included completion of the care certificate. Ongoing refresher training, regular supervision, team meetings and appraisals were also provided. Staff members were an integral part of the service and very much involved in feedback and decision making, and without exception told us they were proud to work for Middleton Care Limited.

People told us they felt safe as a result of the care and support they received. The service had comprehensive safeguarding policies and procedures in place. Recruitment procedures were robust. The staff we spoke with said they were given enough time to travel between calls and that they worked in small local teams to ensure consistent support for people.

The medicines policy and procedure had been reviewed and updated. People we spoke with were complimentary about the support they received to ensure medicines were taken when required and as prescribed. All staff administering medicines had received training and had their competency assessed.

There were general risk assessments and appropriate health and safety measures were in place. Accidents and incidents were recorded appropriately.

The service was working within the legal requirements of the Mental Capacity Act (2005) (MCA).

The service had developed training for staff on equality and diversity. The in house trainer told us, "I go through this policy individually as it's important we respect people's beliefs and views." People’s dignity and privacy was respected by staff, who demonstrated real empathy and compassion for people they supported. Throughout our inspection we witnessed a strong person led culture; staff were highly motivated and offered kind and compassionate care.

Staff were aware of confidentiality issues and were meticulous in ensuring the confidentiality procedures were followed. Documents were suitably stored in locked cabinets and computer systems were password protected.

Care plans outlined people’s likes and dislikes, background, hobbies and family dynamics and were regularly reviewed. People who used the service were supported to follow their own spiritual and religious beliefs and cultural practices as outlined in their plans of care. The service had also implemented a health and well-being policy to support staff with physical and mental health support.

The service sought feedback on a regular basis and the service had received many positive comments and compliments. People told us they knew how to make a complaint if they needed to and a clear process was in place that was discussed with people on commencement of the service.