Middleton Lodge

Updated 11 October 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection team consisted of one inspector and a medicines inspector.

Service and service type

Middleton Lodge is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Middleton Lodge provides personal care only. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

At the time of our inspection there was a registered manager in post who had been on leave from the service since 18 October 2022.

Notice of inspection

The first two days of this inspection were unannounced.

Inspection activity started on 1 July and ended on 13 July 2023. 1 inspector visited the service on Saturday 1 July and returned with a medicine inspector on Tuesday 4 July. 1 inspector also visited the service on 5 July 2023. We continued to speak with relatives, professionals and staff and receive information from the service until 13 July 2023.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

During our visits we spoke with 6 people who used the service about their experience of the care provided and with 2 relatives. We looked at records relating to the management of the service. These included medicines, accident and incidents, safeguarding, recruitment and quality assurance records. We looked at five people's care and support files. We spoke with 9 members of staff, including the area manager, locality manager, acting manager, senior support workers and support workers. We spoke with 2 visiting professionals.

After the visit we continued to seek clarification from the provider to validate evidence found. We looked at quality assurance systems and training records. We spoke with 2 staff by telephone and 2 visiting professionals. We spoke with 2 relatives by telephone.

Updated 11 October 2023

Middleton Lodge is a care home providing care and accommodation to people with autism and a learning disability. People live in a bungalow in its own grounds. The service is registered to support a maximum of 10 people. At the time of the inspection there were 8 people using the service.

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

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right Support: Equipment to ensure people received safe and correct care was not always in place. People did now access the local community much more, but activities to develop life skills and to meet objectives were not always in place. Care records did not always reflect people's preferences. Following our inspection, we saw a new care plan the provider had developed that was much improved, this needs to be put in place for everyone and for support staff to be given access and training on the new electronic system. People were not always assisted with their medication in a safe and appropriate manner. We did see that staffing was much more consistent and there was not a reliance on agency usage that we saw on our last inspection.

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; however, systems in the service did not always support this practice and some best interest decisions were overdue for review.

Right Care: Care records including risk assessments were incomplete meaning staff did not always have the correct information on how to deliver safe care. Care was not always person centred, care records did not reflect people's goals and outcomes. Staff training and supervision was not up to date, but we saw a plan going forward was in place to address this and staff said they felt supported. We observed people positively engaged with the staff team.

Right Culture: Since our last inspection, the service had 2 different managers. Staff told us they had felt very unsupported during this time and morale had been "terrible." Management of the service was not robust, with incomplete records or documents such as care plans and audits that were not effectively reviewed and updated. An acting manager had been in post for 2 months and was committed and fully aware of the issues that needed to be addressed. Staff told us they felt supported by the new acting manager and were positive that they would continue the improvements made from when they started employment. The home’s garden area had improved since our last inspection and was now more accessible and homely, ongoing redecoration and furniture replacement was in place.

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 18 January 2023.) There were 6 breaches of regulations. At this inspection we found the provider was in continued breach of 3 regulations. The service is now inadequate.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

The inspection was also prompted in part due to concerns received about safeguarding issues, staffing and management of the service. A decision was made for us to inspect and examine those risks.

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.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, caring, responsive and well led sections of this full report. The provider has taken action to address immediate concerns.

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

The overall rating for the service has changed from requires improvement to inadequate based on the findings of this inspection.

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

Enforcement and Recommendations

We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to medicines management, equipment, care records, staff supervision and training, person centred care, service quality and overall management of the service at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Special Measures:

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe, and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.