Middleton Manor Care Centre

Auguste Communities Care Centre is a residential care home providing personal and nursing care to up to 83 people. The service provides support to adults and older people, including people living with a dementia. At the time of our inspection there were 17 people using the service.

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

People and relatives told us they felt the service was safe. The home was clean and safety checks were carried out. Since the last inspection the home had improved its fire procedures. There were enough staff to meet people’s needs quickly. Staff were clear about the tasks they had to complete and had time to do these. Any incident or accidents in the home were responded to and learning shared.

Staff were trained and skilled to meet people’s needs and were supported through regular supervisions. People were supported with their nutritional needs. 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.

Everyone we spoke with described staff as caring. Staff supported people in a way that protected their privacy, dignity and promoted their independence. People received personalised care, and planning reflected this. People and relatives we spoke with told us they felt able to raise concerns and these would be responded to. People were supported with social activities and to have contact with loved ones. The service was developing the ways families could be involved and enjoy time in the home, such as creating a café area and improvements to the garden. The environment was design to help people with dementia find their way around the home.

The home had an experienced registered manager who had good knowledge of people’s needs and clear oversight of the processes in the home. There were systems to assess the quality of the service, which were closely monitored by the management team. People, relatives and staff gave us positive feedback and told us they had opportunity to comment on the service. Professionals we contacted also told us they felt there had been recent improvements and that the manager was approachable and responsive.

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 10 June 2021).

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.

At our last inspection we recommended that the provider review its approach to activities, deployment of staff and continue to develop training and planning around end of life care. At this inspection we found the provider had acted on any recommendations and had made improvements.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Auguste Communities Care Centre on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

Staff and people were tested regularly for COVID-19. Evidence of completion of the required vaccinations was maintained for staff.

The environment was clean and additional cleaning was taking place for surfaces that were touched frequently, such as handrails.

There was enough PPE. There was clear signage on the correct use of PPE and handwashing techniques, and staff had received training in infection prevention and control.

The management team used an auditing tool which was based on CQC and best practice guidance. The home had an infection prevention and control lead who was responsible for sharing best practice with other staff.

Staff gave positive feedback about the registered manager and the support they were offered during the pandemic.

Staff told us people were supported to have contact with, and visits from, relatives in-line with government guidance.

Auguste Communities Care Centre is a care home providing personal and nursing care to 25 people aged 65 and over at the time of the inspection. Some of the people using the service had a dementia. The service can support up to 83 people.

The home can accommodate people across two floors; however, people were only residing on the ground floor at the time of the inspection. The ground floor is divided into two separate wings, one of these is for people requiring nursing care.

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

The management of the home had been inconsistent and there had been recent changes to the management team who supported the home. The manager was temporary in post and had not applied to be registered with CQC. The management had recently made improvements, were continuing to drive improvement and staff had confidence in the manager.

Audits and action plans were in place and the management were working proactively to meet these. There had not been enough time since action plans were started to demonstrate that improvements were embedded or to show continuous improvement over time. Audits had identified that fire safety needed improvement, but this had not been actioned by the time of our inspection.

People were supported safely in their daily care, and checks were made of the equipment and premises. Fire safety risks assessment, however, were not robust or tested leaving people at risk of possible harm.

There had been recent improvements to the way staff were supported but this had been inconsistent in the past. Staff were not always given a robust induction into the home, so they knew the provider’s expectations of them, and were not always given opportunities to discuss their work or development in their roles.

The service had been reliant on agency staff to fill roles in the home. There was mixed feedback from staff about how this, and how tasks were allocated, effected the running of the service. We have made a recommendation about the deployment of staff and allocation of tasks.

Activities were not consistently organised to ensure people had access to regular social stimulation. Improvements were planned but were not yet in place. We have made a recommendation about activities.

Improvements had been planned to end of life care arrangements. The information currently available was not comprehensive. We have made a recommendation about end of life training and planning.

There had been significant improvements to monitoring around people’s nutrition, which had been inconsistent. The provider had engaged with professionals to support people to live healthier lives and ensure people had appropriate diets.

Medicines were administered safely. There were safe practices to support skin care and medicines for this purpose were used appropriately. Infection control practice in the home followed guidance and the home had high standards of cleanliness. Recruitment practices were safe. Staff knew how to raise and action concerns about suspected abuse.

Staff were kind, caring and people told us person-centred care was delivered. Care was planned and delivered in a way that supported people’s dignity and independence.

The service was responding to concerns and complaints. People told us the manager was approachable and they felt they would resolve issues raised.

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

This service was registered with us on 22 February 2019 and this is the first inspection.

Why we inspected

The inspection was prompted in part due to concerns received about medicines, management of people’s needs including weight-loss and skin care, and the overall management of the service. A decision was made for us to inspect and examine those risks.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, responsive and well-led sections of this full report.

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.

This was a first rating for this service. The overall rating is requires improvement.

You can see what action we have asked the provider to take at the end of this full report.

We found the management were acting to address all the concerns, new systems and processes were in place which had begun to rectify any issues and mitigate any current risks.

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 have identified two breaches in relation to fire safety and management oversight at this inspection.

Please see the action we have told the provider to take at the end of this report.

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.