The inspection was carried out on 10, 11 and 13 January 2017 and was unannounced. At the last inspection carried out on 17 and 24 November 2014 the provider was meeting all the regulations that were assessed. Middleton Hall Retirement Village comprises a range of accommodation and care options for older people. Within the grounds are bungalows and apartments for fully independent people who use the facilities on site. There is Middleton Court providing nursing care and the Family Living service providing care and support for people with dementia. Middleton Gardens provides residential care and Middleton Grove has self contained apartments for those people who wish to continue living independently but may have some care and support needs provided by staff.
At the time of our inspection the service was providing support to 74 older people.
There was a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission 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 were actively encouraged to maintain as much independence as possible with a positive approach to risk taking in day to day life gaining positive results in people’s mental and physical health. Staff had also been responsible for encouraging and supporting people to explore new interests which they enjoyed.
The service had made positive changes to enhance their training, ensuring staff supported people to stay safe. They had developed interactive learning sessions which included role play where the management team “acted out” a wide variety of scenarios which helped staff reflect on their own practice to identify potentially abusive situations. The feedback from staff about this training was excellent. Staff told us it was thought provoking and really promoted discussions about their own practice and what could be seen as restrictive.
The service used state of the art GPS (global positioning system) technology to support people to independently explore the extensive grounds at Middleton Hall Retirement Village in a safe way.
The registered manager ensured that staff had a full understanding of people’s support needs and had the skills and knowledge to meet them. Staff training was innovative and staff were given the opportunity to explore and implement best practice approaches with excellent outcomes for people. The nursing team had researched oral health and had delivered training, implemented a new policy, screened all people and had a public information giving event with feedback from the NHS oral health lead that this work had been ‘outstanding’.
People’s independence was actively encouraged through a range of imaginative, person-centred approaches to activity-planning which the service called “Living Well”. The service provided innovative support to people to enable them to live fulfilled and meaningful lives.
All staff across the service including the estates and administration departments brought added value to the service by bringing their individual personal skills to the service. These included bird watching, technology, exercise and fitness. The service utilised these skills so their job satisfaction and motivation were visible to see.
The registered manager and staff team demonstrated commitment to providing the best possible care and opportunities for people. The close links with the local community meant the service provided support to local schools, churches and community groups via sharing their facilities and we saw people either independently or with support could access the community freely.
People were fully involved in staff recruitment and the service utilised an advanced tele-screening package which assessed candidates during practical and written exercises with people using the service, to assess key qualities such as attitude and skills matching. We saw this screening helped second interviewers target questions more specifically to areas they wished to pursue with candidates. This showed the service excelled at ensuring they had a robust recruitment process that focussed on selecting people with the best skills and attitudes.
We saw people, their families and friends were an integral part of the service, actively engaged in many areas; from meeting with the chefs to the planning and development of the new extension to the current ‘Family Living’ service. This was the service’s specific way of supporting people living with a dementia.
People were supported to maintain optimum physical and mental health by a team of staff across the Living Well and care service. People had access to bespoke sessions with qualified physical trainers, use of the gym, pool and spa facilities as well as the service promoting sessions to promote well-being such as new Mindfulness sessions and a raft of treatments such as a Nail Bar to help people feel positive in mind and body. People told us of the outcomes they experienced using this approach which for some people had been huge improvements in their physical health, for one person meaning despite their chronic condition, they had not had a hospital admission for over two years, something which has been a regular occurrence prior to moving to the service.
The registered provider demonstrated how they had sustained outstanding practice, development and improvement at the service. The leadership sought out creative ways to provide a personalised service and had achieved excellent results through exploring best practice both in the UK and abroad and implementing them at Middleton Hall Retirement Village. The staff team were highly motivated and were actively involved in and contributed to continuous improvements in care and running of the service.
Staffing ratios were excellent and responsive to people’s changing needs and preferences. This allowed for people to make full use of all of the facilities the service had to offer, to go out on trips, both as a group and individually, be supported to healthcare appointments and to experience unhurried and attentive care.
Without exception people and visitors we spoke with told us that staff were extremely caring. We were given lots of examples by people of when staff had gone the “extra mile” to show excellence in caring. We saw the service encouraged staff to share their interests and hobbies, for example one staff regularly brought in their trained Pets as Therapy (PAT) dog to visit the service which people enjoyed. All interactions between staff and people were caring and respectful, with staff being patient, kind and compassionate. Feedback from relatives showed end of life care was undertaken with extreme care and compassion by staff. We saw staff had created beautiful hand crafted ‘Memories’ books for the relatives of people who had passed away. This showed the service cared for people and their families even after death with love and support.
The service excelled at promoting choice and in catering to hotel quality standard whilst ensuring people’s nutritional needs were met. The chef and catering team showed they listened to people’s views and provided a service that enabled people to enjoy a wide variety of food in settings such as the Orangery café, the restaurant and quieter dining rooms which meant people could enjoy meals, drinks and snacks with family and visitors.
For those people at risk in relation to nutrition, the service had attained accreditation with the national Focus on Undernutrition (FoU) programme and the records the service developed in relation to supporting nutrition had been highlighted by the FoU programme as an example of best practice to share with other care services.
Staff at the service had excellent links with healthcare services and people told us they were involved in decisions about their healthcare. People gave us examples about how their health had improved since being at the service.
People were placed at the heart of the service by strong, caring leadership which promoted an open culture. The service was recognised by schemes which reward quality practice, for example, achieving Investors in People Gold Award. The management team respected, supported and listened to staff at all levels to improve the quality of service. There were a number of champions within the staff team who each took enthusiastic responsibility to improve the quality of service in their chosen area.
The service acted on staff and people’s views and regularly consulted with them about how to improve. Communication at all levels was clear and encouraged mutual respect. The senior management team understood the service’s strengths, where improvements were needed and had plans in place to achieve these with timescales in place.
There were robust systems and processes in place to protect people from the risk of harm. Thorough checks of the buildings, grounds and maintenance systems were undertaken to ensure health and safety for people and staff was maintained. We saw accidents and incidents were closely monitored by the registered manager.
Records and conversations with the registered manager, people and relatives showed us that people were listened to and complaints or concerns were taken seriously and responded to appropriately
Staff had received training in the Mental Capacity Act 2005 (MCA) to make sure they understood how to protect people’s rights. There was clear guidance in relation to the MCA and people were asked for their consent before staff carried out any care or treatment and care records also showed how the service sought written consent. CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We saw the registered manager; registered provider and staff ensured that people were supported in w