Middleton Hall Retirement Village

Updated 10 March 2021

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection team consisted of two inspectors, a Pharmacy inspector, and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

Middleton Hall Retirement Village is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority, the County Durham Infection Control team and professionals who work with the service.

The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.

During the inspection

We spoke with six people who used the service about their experience of the care provided. We spoke with 22 members of staff including three directors, the registered manager, service managers, a deputy manager, nurses, senior care workers, care workers, the chef, kitchen assistants, a housekeeper and a hostess.

We reviewed a range of records. This included nine people’s care records and multiple medicine records. We looked at four staff files in relation to recruitment and supervision of staff. A variety of records relating to the management of the service, including policies and procedures were reviewed.

After the inspection

We continued to seek clarification from the provider to validate evidence found. We requested additional documents and policies to be sent to us electronically. We spoke with 11 relatives on the telephone on 5 February 2021. We collected additional documents from the service on 9 February 2021 to enable us to complete the inspection.

Updated 10 March 2021

About the service

Middleton Hall Retirement Village is a residential care service providing personal and nursing care to older people and people living with a dementia type illness. The service can support up to 90 people. At the time of our inspection the service was supporting 66 people.

Middleton Hall Retirement Village is set in substantial grounds and provides a range of accommodation and care packages. Not everyone who lives in Middleton Hall Retirement Village requires personal or nursing care. Within the grounds are bungalows and apartments for fully independent people, who have access to the on-site facilities. CQC only inspects where people receive personal care. Support is provided across four distinct areas, with each area having its own facilities. Middleton Court provides nursing care. Middleton Oaks provides care and support for people living with a dementia related condition and is divided into two inter-linked bungalows. Middleton Gardens provides residential care with a choice of care packages to meet people’s needs and preferences. Middleton Grove provides apartments for people who are largely independent but who may require some personal care support. At the time of our inspection, 14 people were living in Middleton Grove, 3 of whom required personal care.

People’s experience of using this service and what we found

Since the last inspection, improvements had been made regarding the administration and management of medicines. However, records for topical preparations were not always completed. We have made a recommendation about the management of some medicines.

Improvements had been made to people’s care plans and risk assessments. The provider had implemented a new electronic care plan system. The care plans and risk assessments were up to date, comprehensive and personalised.

People said they felt safe and well cared for. There were enough staff on duty to meet people’s needs and keep people safe. Staff were recruited safely. The home had robust safeguarding policies in place and staff understood their safeguarding responsibilities.

Since the last inspection improvements had been made with regard to assessments under the Mental Capacity Act. Some carers did not fully understand best interests decisions and we have made a recommendation about additional training in this area.

People were supported to eat and drink enough to maintain a balanced diet. Since the previous inspection, people had more choice about their food and drink and people had opportunities to give feedback. Staff were aware of individual residents’ nutritional needs.

People’s individual choices and preferences were recorded in their care plans. Staff had completed training in all core areas identified as mandatory by the provider and additional training was available on their online training system.

Since the last inspection, the provider had made improvements and had implemented and maintained effective procedures to review the quality of the service. The provider had a regular system of supervision, spot checks, and appraisals.

The provider encouraged and welcomed feedback from people and staff. Staff felt well supported by the management team and spoke positively about their roles. The provider’s visions and values were person-centred and focused on continuous improvement and providing good quality 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.

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 12 November 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 improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We received an anonymous concern in relation to care, treatment and nutritional needs. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe, effective and well-led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Middleton Hall Retirement Village on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.