Middleton Fells

We assessed the quality statements from all the key questions; safe, effective, caring, responsive and well-led. We also assessed the service against our ‘Right Support, Right Care, Right Culture’ guidance to make judgements about whether the provider guaranteed people with a learning disability and autistic people respect, equality, dignity, choices, independence and good access to local communities that most people take for granted.

We found breaches of the regulations in relation to dignity and respect and good governance. The overall rating for this service is requires improvement.

People’s liberty had been restricted in a variety of ways including the regular use of seclusion. In some situations, we found people’s dignity was being compromised. A variety of records associated with care and treatment were not always accurate, current or recorded sufficiently. These included records for assessing and managing known behaviours and risks.

Some parts of the home were not clean or well maintained and could pose a risk in managing infection prevention and control. Staff assigned to working with individuals were also responsible for cleaning and cooking. Staff had completed training in safeguarding. However, we found some safeguarding concerns had not always been reported to the local authority or to us. Staff received training and supervision to support them in their roles. Medicines were managed safely.

People where appropriate and their families were fully involved in assessments of their needs. Staff regularly reviewed these assessments taking account of people’s communication, personal and health needs. People’s nutritional needs were assessed and being met. The staff team worked well with other organisations and services to support people to manage their health and wellbeing.

Staff knew people well and treated them as individuals and with kindness and compassion. People had choices in their care and where appropriate independence was encouraged. People were supported to engage in regular activities, social interests and maintain relationships with family and friends. Some activities were used to support people in regulating their emotional state.

The service worked with commissioners to ensure that continuity of care for people was managed. People’s individual communication needs were identified, and information was provided in a variety of accessible ways. Staff understood about equality and diversity. The service contacted emergency services when required and knew when to involve specialist services in people’s care. There was a system in place for responding to concerns or complaints. People’s end-of-life wishes were noted where appropriate and was reflected in their care records.

The management team led the service with integrity, openness and honesty and valued diversity in their workforce. Staff felt supported by the registered manager and were able to report concerns and said they were listened to. There was a range of quality monitoring and auditing processes in place. However, findings by the inspection team during the assessment had not always been identified through the provider’s oversight and audit processes. The management team recognised where improvements were needed and took immediate action to address some of the concerns found during the assessment.

We have asked the provider for an action plan in response to the concerns found at this assessment.