Middleton Care Limited

People were protected from the risk of harm and abuse. There were sufficient staff in place to support people. People were supported by familiar staff who understood their needs. However, we found a breaches of the legal regulations in relation to medicines optimisation. People’s needs and preferences relating to medicines were assessed. People were encouraged to be involved in planning around their medicines, where their capabilities allowed. However, the medicines policy did not meet national best guidance and did not match the medicines practices carried out by staff. Medicines records were also not in line with best practice and contained errors. The provider did not have a robust audit process in place to identify errors nor act upon them. Guidance was not in place to support staff in the safe administration of ‘when required’. medicine. Staff competence in medicines management was checked through regular observations. We also found recruitment processes were not as robust as they should be and were often not done in line with best practice guidelines.

We found the provider did not always follow the Mental Capacity Act (2005) in terms of assessing people’s capacity to make specific decisions and obtaining consent for the care they received. People's needs were assessed. They were able to express their choices and be involved in planning and reviewing care. We did not assess all the quality statements within this key question, as we did not identify concerns in the areas we judged as being met at our last inspection.

People told us they were treated with kindness, compassion and dignity. They told us they were treated as individuals and were supported to make their own decisions and choices. Staff gave examples of how they promoted people’s independence.

The provider had systems in place to promote equity of experience and outcomes. Staff were very familiar with each person’s needs and anticipated these to avoid any preventable discomfort or concern. People said staff took time communicate and engage with them. People and relatives said staff recognised when people might need urgent help or support and gave examples of contacting emergency services.

Staff were able to speak up and felt the service was well managed. The provider worked in partnership with others to assess, monitor and improve the quality of the service. We found a breach of the regulations in relation to good governance. The provider had a range of audits and quality assurance tools in place to monitor the quality of care being delivered, however these were not effectively implemented. The management team recognised where some improvements were needed but were yet to embed these changes sufficiently.