Archived: Middlefield Manor

Updated 15 December 2017

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked 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 was a comprehensive inspection that took place on 4 October 2017 and was unannounced. The inspection was undertaken by one 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.

Before our inspection the provider completed a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service: what the service does well and improvements they plan to make. We looked at information we held about the service including notifications they had made to us about important events. We also reviewed all other information sent to us from other stakeholders for example the local authority and members of the public.

On the day of the inspection visit we spoke with two people who used the service. Not all people who used the service were able to tell us verbally about their experience of care. We used observation to help us understand people's experience of the care and support they received. We spoke with three people’s relatives. We also had contact with four healthcare professionals.

In the absence of the manager we spoke with the team leader during our visit and liaised with a manager from another part of the provider’s organisation who arrived to support the service for a short time and another manager via email and telephone following our visit.

Whilst on site at the service we spoke with a team leader and six care staff We looked at records relating to three people living at the service. We looked at other information related to the running of and the quality of the service. This included the management of medicines, quality assurance audits, training information, staff meeting minutes and arrangements for managing complaints.

Updated 15 December 2017

This inspection took place on 4 October 2017 and was unannounced. Middlefield Manor is a service that provides personal care and accommodation for up to 15 people who have a learning disability and who may be living with autism. On the day of the inspection, there were 13 people living at the service. Middlefield Manor is split into two houses, Cambridge House and Norfolk House. The two houses are separated by a number of internal doors.

There was no registered manager in post at the time of our visit. A registered manager is a person who has registered with the Care Quality Commission (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. The previous registered manager had left the service in July 2017 and cancelled their registration with CQC in August 2017. They were followed by another manager who commenced work at the service in August 2017 however they left their employment at the beginning of October 2017 without notice.

At our last inspection in July 2016 we rated Middlefield Manor as Requires Improvement in safe and responsive and as a result Requires Improvement overall. This was because we were concerned about the management of people’s medicine and improvements to people’s support plans were needed. The service has a history of non-compliance and concerns. Our past four inspections have highlighted concerns and the past three inspections have been rated Requires Improvement overall. Following this inspection we are planning to meet with the providers to review the management of the service and discuss the plans they have for making and embedding the necessary improvements.

Risks were identified through a range of comprehensive individual risk assessments to help keep people safe however these were not updated following incidents to ensure that they were reflective of the most up to date support needs and risks.

High numbers of agency staff were used at the service due to challenges with their recruitment of permanent staff. This resulted in high ratios of agency staff on shift who did not always have the required level of training and experience.

Medicines were administered by staff who were trained to do so but some aspects of medicines

management needed improvement.

Improvements were needed to the environment; there was damaged paintwork and walls.

The service was poorly managed. The provider did not have an effective governance system to monitor the quality of the service and identify the risks to people. Care records were not dated. Effective audits were not being carried out. The provider had not picked up issues that were identified in this inspection and had not taken appropriate action to make improvements when we had identified them at a previous inspection.

Staff had an understanding of abuse and safeguarding procedures. They were aware of how to report abuse as well as an awareness of how to report safeguarding concerns outside of the service. Staff undertook safeguarding training providing them with knowledge to protect people from the risk of harm.

The provider had a recruitment procedure in place. People were supported by staff who had only been employed after the provider had carried out checks. Once employed, however, staff were not supported in their role through regular training refreshers.

People were supported to maintain good health as they had access to relevant healthcare professionals when they needed them.

We found the home was in breach of three regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.