We carried out a review of the data available to us about Midland Care Home on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Midland Care Home, you can give feedback on this service.
Midland Care Home is a residential care home providing personal and nursing care to up to 66 people. The service provides support to people with dementia, people with an eating disorder, people detained under the mental health act, people with mental health needs, people with limited mobility and blind people or partially sighted people or visually impaired. At the time of our inspection there were 46 people using the service.
Midland Care Home was purpose built. The service has communal areas, assisted toilets, bathing facilities, and bedrooms with en-suite facilities sited over three floors, known as Sunflower, Daisy and Lily. There is an accessible garden.
People’s experience of using this service and what we found
People’s safety was underpinned by the provider’s policies and processes. Potential risks to people were assessed and measures put in place to reduce these. Lessons were learnt and improvements made through the analysis of reports of accidents and incidents. People were supported by sufficient numbers of staff who had undergone a robust recruitment process and had undertaken training in topics to promote their safety. Medicine systems were managed safely. People lived in an environment which was well maintained and clean, with safe infection control and prevention measures.
People’s health and wellbeing needs were assessed, and their health and welfare monitored by staff. Staff liaised effectively with health care professionals to achieve good outcomes for people. Staff had the knowledge and experience to meet people’s needs. Staff were supported by ongoing assessment of their competence to fulfil their role and responsibilities. People’s dietary needs were met.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.
Family members were complimentary about the quality of care provided to their relatives. They spoke of the kind, caring and the compassionate approach of staff, and were confident that their relative’s privacy and dignity was promoted.
People’s needs were recorded in personalised care plans, considering all aspects of their care, including protected characteristics as defined by the Equality Act. Opportunities were available for people to engage in a range of activities within the home and local community, which included observance of their religious beliefs.
Family members were complimentary about the registered manager and management team and were kept informed of key events affecting their relative. Systems, processes and effective governance and management meant the provider kept under review the quality of the service provided. Staff were supported and monitored to enable them to deliver good quality care. The registered manager and management team worked effectively with partner agencies to achieve good quality outcomes for people.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection and update
The last rating for this service was requires improvement (published 16 February 2021).
At our last inspection we recommended that audits were reviewed to ensure all areas for the safety and quality of the service were monitored. At this inspection we found the registered manager and senior leadership had a good overview of audits carried out to monitor the safety and quality of the service.
Why we inspected
The inspection was prompted in part due to safeguarding concerns received and a review of information we held about this service, which included the CQC rating history.
We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.
Follow up
We will continue to monitor information we receive about the service, which will help inform when we next inspect.
Midland Care Home is a care home, providing personal and nursing care to 17 people aged 65 and over at the time of the inspection. The service can support up to 66 people.
The home is set out over 3 floors. Each floor can be accessed via a lift and has a communal dining and lounge area. At the time of the inspection only the ground floor was in use.
People’s experience of using this service and what we found
Risks to people required further review and improvement to ensure risks were consistently monitored and mitigated. Systems and processes required some further development to ensure effective oversight of all aspects of the safety and quality of the service. We have made recommendation for this to be actioned.
The provider and management team were open and honest when things went wrong and there was evidence of lessons learned.
Care was person centred, people were encouraged to be involved and make their own decisions and choices as much as possible. Family members were involved in developing care plans and were kept up to date with changes for their relative.
The provider and management team had started a regular program of staff and resident meetings to seek feedback and a supervision schedule for staff had been implemented. Staff suggestions were listened to and acted upon. The provider and management team were reviewing staffing numbers as a result of staff feedback.
Medicines were managed safely.
The home was clean and well maintained, extra infection control measures to mitigate the risks of COVID-19 were in place. Appropriate PPE was available to staff and used as per government guidance.
People were protected from the risk of abuse by staff who had been recruited safely. Staff were trained in recognising the signs of abuse and how to report it.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection (and update)
The last rating for this service was inadequate (published 19 August 2020) and there were multiple breaches of regulation. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.
This service has been in Special Measures since 19 August 2020 During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.
Why we inspected
We carried out an unannounced focussed inspection of this service on 29 June 2020. Breaches of safe care and treatment and good governance were found. The provider was issued with a warning notice after the last inspection to tell them they needed to improve and by when to improve.
We undertook this focused inspection to check they had complied with the warning notice, to check the quality and safety of the service and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions safe and Well-led which contain those requirements.
The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from inadequate to requires improvement. This is based on the findings at this inspection.
We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Midland Care Home on our website at www.cqc.org.uk.
Midland Care Home is a nursing home that is registered to provide care for up to 66 older people. There were 20 people living at the service at the time of the inspection, some of whom were living with dementia.
People’s experience of using this service and what we found
Risks to people were not consistently mitigated, the provider and registered manager had not maintained effective oversight in this area. Lessons had not consistently been learnt when things went wrong.
Medicine administration was not consistently safe. Nursing competency checks were not regularly completed. Medicines were stored and disposed of safely.
We were not reassured of good infection control practice. Management oversight in this area required improvement.
The provider and management team were committed to improving the service and were working with other organisations and privately sourced support to drive improvement. However, professional partnership working was not always effective as professional advice was not consistently followed to mitigate risk.
Staff support and supervision was inconsistent.
The provider and management team were open and transparent with people and their relatives and reported incidents to the local authority and Care Quality Commission.
People were protected from the risk of abuse. Staff were recruited safely.
For more information, please read the detailed findings section of this report. If you are reading this as a separate summary, the full report can be found on the Care Quality Commission (CQC) website at www.cqc.org.uk
Rating at last inspection and update
The last rating for this service was Requires Improvement (published 11 December 2019). The service is now inadequate.
Not enough improvement had been made at this inspection and the provider was still in breach of regulations.
Why we inspected
We undertook this focused inspection to check if the provider had made improvements and if they were now meeting the legal requirements. This report only covers our findings in relation to the key questions Safe and Well-Led.
We used the ratings from our last comprehensive inspection for the key questions not inspected this time to calculate the overall rating.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Midland Care Home on our website at www.cqc.org.uk.
Enforcement
We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so
We have found breaches in relation to the safety and managerial oversight of the service at this inspection. Please see the action we have told the provider to take at the end of this report.
The overall rating for this service is inadequate and the service is therefore in special measures. This means we will keep the service under review and will re-inspect within six months of the date we published this report to check for significant improvements.
If the registered provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question, we will take action in line with our enforcement procedures. This usually means we will start processes that will prevent the provider from continuing to operate the service.
For adult social care services, the maximum time for being in special measures will usually be 12 months. If the service has shown improvements when we inspect it, and it is no longer rated inadequate for any of the five key questions, it will no longer be in special measures.
What happens next?
We will meet with the provider to discuss how they will make improvements. We will work with the local authority to monitor progress until we carry out our next inspection.
People’s experience of using this service:
The provider had made many improvements to the safety and well-being of people living at Midland Care Home. However, the management team had not been in post long enough to make all the improvements required.
The main areas that required improvement related to the management oversight of staff following care plans, the accuracy of care records, environmental checks, complaints and seeking people’s feedback. Further clinical supervision was required to oversee the monitoring of people’s health and end of life care. All of these were included in the provider’s action plans; the management team continued to take action to improve all these areas.
The management team had been responsive to feedback from health professionals and commissioners, however, the provider had not been pro-active in identifying the issues raised themselves. The provider’s audit systems were not robust enough to monitor, assess and improve the safety and quality of the service in all areas.
People were cared for by staff who knew them and their preferences. Staff had been employed to engage people in activities that interested them, but these could be improved upon to include all people’s interests, hobbies and engagement with their local community.
Staff received training in safeguarding vulnerable adults. They demonstrated they understood their responsibilities to protect people from the risks of harm and abuse.
The provider had improved the independence for people living with dementia and those with Gujarati as their first language, by introducing signage in pictures and in English and Gujarati.
People received food and drink that met their preferences and cultural needs. Staff ensured people’s dietary needs were met.
People received their prescribed medicines as planned. Staff followed infection prevention procedures.
People and their relatives had been involved in planning their care.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.
We made a recommendation relating to the skill mix of nursing staff.
Rating at last inspection:
The last rating for this service was Inadequate (published 23 May 2019) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found some improvements had been made and the provider continued to be in breach of two regulations.
Why we inspected:
This was a planned inspection based on the previous rating.
Enforcement:
We have identified two breaches in relation to the management oversight of people’s care plans, care records, the environment, complaints and audits at this inspection.
Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.
Follow up: We will continue to monitor the service and work with partner agencies. The provider will be instructed to provide action plans and reports.
This service has been in Special Measures since 15 April 2019. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
People’s experience of using this service:
• People were not protected from the risks of abuse as not all staff had received training in safeguarding and staff had failed or report incidents to the manager. The manager did not recognise when to report allegations of abuse or the significance of unexplained injuries and poor moving and handling; they had not alerted the relevant authorities.
• There were not enough staff employed to provide people’s care; there was a high use of agency nursing and care staff. Staff were not deployed to ensure people received all of their planned care, and ensure that people had appropriate supervision. People’s dignity was not always maintained as their personal care was not always carried out regularly or at the planned intervals.
• The provider relied on agency staff, but did not ensure they had a suitable induction to the service, employment checks, training and competencies required to carry out their roles. Both agency and permanent staff had not always received the training and supervision they required to provide safe care.
• Staff did not always have information about people’s needs as people’s risk assessments and care plans did not always reflected their current needs. Staff did not always receive all the information they required to meet people’s care safely.
• People did not always receive their prescribed medicines as they were not in stock. People’s medicine records did not have all the information required to enable agency staff to give medicines safely.
• Staff did not consistently ensure people were offered and supported to eat their meals. People were at risk of losing weight and dehydration.
• People living with dementia had access to other people’s rooms; there were no safeguards in place to prevent them accessing maintenance materials or substances that are hazardous to health. People were at risk of acquiring infections as cleanliness in the home was poor, particularly on the first floor where people lived with advanced dementia.
• People were not supported to express their views about their care or be involved in creating their care plans. People and their relatives had not been asked for their feedback. People did not have any involvement in the running of the home.
• People’s verbal complaints were not recorded or responded to. The manager did not always follow the provider’s complaints procedure; complaints were not always reviewed or concluded in writing.
• People had not always had the opportunity to express their preferences or wishes for their end of life care. People’s care plans did not record people’s wishes.
• • The provider failed to have sufficient oversight of the home as there were failings in the quality and safety of the care. The provider has no previous experience of nursing homes.
• There had been failings in recognising when people were unwell and seeking prompt medical attention. A clinical lead had recently been employed to improve the clinical safety, however, the provider had not given them all the resources they required to implement all safety measures. There was insufficient management or a clinical oversight at night, evenings and weekends.
• The provider did not have systems to assess, monitor, evaluate and make changes to improve the service. The provider failed to have systems in place to evaluate the quality and effectiveness of deployment of staff.
• The provider was working within the principles of the MCA, they identified people who required a Deprivation of Liberty Safeguards (DoLS) assessment and made the appropriate applications.
Rating at last inspection: Requires Improvement published 5 December 2018.
Why we inspected: This inspection was brought forward due to information of concern relating to staff’s ability to recognise when people were unwell, and people being admitted to hospital with sepsis.
Enforcement: The provider was in breach of nine regulations of the Health and Social Care Act 2008 (Regulated activities) Regulations 2014and one regulation of Care Quality Commission (Registration) Regulations 2009. Full information about CQC’s regulatory response to the more serious concerns found in inspections and appeals is added to reports after any concerns found in inspections and appeals have been concluded.
Follow up: We will continue to monitor the service and work with partner agencies. The provider will be instructed to provide action plans and reports.
The overall rating for this service is 'Inadequate' and the service is therefore in 'special measures'.
Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months.
The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.
This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action.
Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.
For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.
For more details, please see the full report which is on the CQC website at www.cqc.org.
Midland Care Home is a ‘care home’ with nursing. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
Midland Care Home can accommodate up to 66 people in one purpose built building. It provides a service to older people, some of whom have nursing or dementia related care needs. At the time of this inspection 59 people were living in the service.
The registered manager left the service in July 2018. A new manager had taken up post in July 2018 and at the time of the inspection were undergoing the necessary checks to register with the Commission. A registered manager is a person who has registered with the CQC to manage the service. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.
People felt safe and protected from harm and able to raise any concerns regarding their safety. Staff understood how to keep people safe. The service safely supported people with the administration of medicines. However, the safeguarding and whistleblowing policy required the contact details of the local safeguarding authority included, to support staff to raise any abuse concerns with external agencies.
Safe recruitment procedures were carried out by the service. There was sufficient staff available, but there was the high reliance on using external agency staff. The manager was working towards recruiting more permanent staff to reduce the need to use external agency staff.
Risk assessments addressed the potential risks present for each person. Monitoring records were used to evidence when staff provided care for people at risk of developing pressure sores and at risk of poor nutrition and hydration. However, they lacked sufficient detail to evidence the actual care being provided.
People could not be assured personal information about them was treated confidentially. As files containing personal information were not securely stored away.
People were provided with nutritious meals, but the quality and variety of meals raised some areas of dissatisfaction. In addition, staff did not always ensure meals were presented appropriately.
Relatives raised concerns that staff had not always respected people’s personal clothing. Following the inspection, the provider confirmed the laundry process had recently been reviewed in August and a new laundry system had been put in place. They felt that the concerns raised at the time of the inspection may have been in relation to historic practice. We have made a recommendation that the provider further reviews the laundry processes to ensure people have their own clothing returned to them and their clothing is appropriately cared for.
Arrangements were in place to make sure the premises were kept clean and hygienic so that people were protected from infections that could affect both staff and people using services. Regular checks to the safety of the environment took place.
Systems were in place to question accidents and incidents to learn from them and mitigate the risk of any repeat incidents. The manager took timely action to address areas identified for improvement.
People had their needs assessed before moving into the service. The service worked and communicated with other agencies and staff to enable effective care and support was provided when moving between different services.
People's consent was gained before any care was provided and the requirements of the Mental Capacity Act 2005 and the deprivation of liberty safeguards were met.
Most people and relatives told us the staff were kind, friendly and patient. However, some people said the care they received from some staff was not always very caring. The manager had met with individual staff to review their performance. They had also reviewed agency staff to ensure only staff with the right qualities were used to work at the service.
A complaints procedure was in place. Some complaints that had been received prior to the new manager taking up post needed reviewing and closure. Following the inspection, the provider confirmed the outstanding complaints had been addressed and they were awaiting a response from one of the complainants before it could be concluded and closed.
People were encouraged to express their views and make choices. Their needs were assessed, and people felt they had control regarding decisions about their care. If people were unable to make decisions for themselves and had no relatives to support them the provider had the contact details of independent advocate to support them.
People spoke positively about the activities provided at the service. People’s spiritual needs were met. People were supported at the end of their life to have a comfortable, dignified and pain-free death.
The provider and manager had carried out audits of all aspects of the service, and knew what areas needed improving and this was work in progress. People, staff and relatives felt positive about the changes being made to the service. The manager was open and transparent in sharing information with the health and social care professionals involved with the service.
The feedback from commissioners involved with the service indicated they had confidence in the new manager to continue to make positive changes to the service. The manager had kept the Commission informed of events at the service through submitting statutory notifications.