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Inspection carried out on 10 December 2018

During a routine inspection

Middleton Lodge is a care home. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Middleton Lodge accommodates 10 people in one adapted bungalow. The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.” Registering the Right Support CQC policy.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Staff knew how to keep people safe and reduce the risks of harm from occurring. Staff had completed training in safeguarding and understood their responsibilities to report any concerns.

Robust recruitment and selection procedures ensured suitable staff were employed. Risk assessments relating to people's individual care needs and the environment were reviewed regularly. Medicines were managed safely and administered by staff trained for this role.

Staff received appropriate training and support to meet people’s individual needs.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. People were supported to have enough to eat and drink and had access to healthcare professionals as and when this was needed.

People were supported by kind and respectful staff who valued people’s individuality and independence. We observed positive interactions between people and staff. People could make choices about how they wanted to be supported and staff treated them with dignity and respect. There was a welcoming and homely atmosphere at the service.

People received support which was person-centred and responsive to their needs. Person-centred is when people’s preferences are respected. Personalised care plans were in place which helped staff to know how people wished to be supported with daily living. People were involved in developing and reviewing their care plans and decisions about their care.

People were supported to take part in valued individualised activities including looking after the home’s pet rabbits to engage people and prevent social isolation.

People spoke positively about the registered manager and the wider management team. There was an effective quality assurance system in place to ensure the quality of the service and drive improvement.

There were systems in place for communicating with staff, people who used the service and their relatives to ensure they were fully informed via team meetings and newsletters.

Further information is in the detailed findings below.

Inspection carried out on 7 June 2017

During a routine inspection

The inspection took place on 7 June 2017. The inspection was unannounced.

Middleton Lodge is a residential home based in Middleton St George on the outskirts of Darlington. The home provides personal care for people with learning disabilities who also experience mental ill health. It is situated close to the local amenities and transport links. The service is registered to provide support to 10 people and on the day of our inspection there were 10 people using the service.

The service had a registered manager in place. 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.

We last inspected the service in April 2016 and rated the service as ‘Requires improvement.’ At this inspection we found the service was ‘Good’ overall and met all the fundamental standards we inspected against.

The atmosphere of the home was homely, warm and welcoming. People who used the service were relaxed in their home environment and visitors were welcomed.

People were supported on a daily basis in a person centred and caring way. Person centred is when the person is central to their support and their preferences are respected.

Visiting professionals offered praise of the service and how improvements had been made.

We spent time observing the support that took place in the service. We saw that people were always respected by staff and treated with kindness. We saw staff being considerate and communicating with people well.

People were supported to ensure they maintained their independence with one to one support.

Support plans were developed with people and not for people and these set out exactly how people liked to be supported.

People were encouraged to enhance their wellbeing on a daily basis by taking part in activities of their choice both at home and within the local community.

Staff told us they felt supported to carry out their role and to develop further and that the registered manager led by example, was supportive and always approachable.

Throughout the inspection we saw that people who used the service and staff were very comfortable, relaxed and had an extremely positive rapport with the registered manager and also with each other.

People’s support plans were written in plain English. They included personal history and described individual’s support needs. These were regularly reviewed; and people were at the centre of the process.

Support plans contained risk assessments. These identified risks and described the measures and interventions to be taken to ensure people were protected from the risk of harm.

People’s health was monitored and referrals were made to other health support professionals where necessary, for example: their GP, community nurse or optician.

People were supported by sufficient numbers of staff to meet their individual needs and wishes in a person centred way.

People were supported by trained staff. Who were supported to maintain and develop their skills through training, and development opportunities.

We viewed records that showed us there were robust recruitment processes in place.

Medicines were stored, managed and administered safely. We looked at how records were kept and spoke with the registered manager about how senior staff were trained to administer medicines and how this was monitored.

We saw people were encouraged to eat and drink sufficient amounts to meet their needs. People were involved in planning the menus and choosing what they would like to eat and were involved in shopping and preparing food.

A complaints and compliments procedure was in place. This provided information on the action to take if someone wished to make a complaint and what they should expect to happen next. The compliments t

Inspection carried out on 21 April 2016

During a routine inspection

The inspection took place on 21 April 2016. The inspection was unannounced and took place following concerns raised with us. We previously inspected this service on 9 September 2015 and the service was rated as ‘Good’.

Middleton Lodge is a residential care home based in Middleton St George on the outskirts of Darlington, County Durham. The home provides care for people with learning disabilities, physical disabilities and Autism. The home is situated close to local amenities and transport links. The home is registered to provide accommodation and personal care for ten people and on the day of our inspection there were six people using the service.

The provider had recently appointed a new manager who at the time of our inspection wasn’t yet registered. A registered manager is a person who has registered with the Care Quality Commission 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.

We spoke with a range of different team members; the chief operations manager, the regional director, the manager and care staff who told us they felt positive about the new manager and supported by them. Throughout the day we saw that people who used the service and staff were comfortable, relaxed and had a positive rapport with the manager and with each other. The atmosphere was welcoming. We saw that staff interacted with each other and the people who used the service in a friendly, caring, positive manner.

We observed how the service administered medicines and how they did this. We looked at how records were kept and spoke with the management team about how staff were trained to administer medication and we found that numerous medication errors had been made and administering process was being improved and audited to reduce errors occurring.

We looked at how the service looked after people’s monies and how they were kept safe. We found that the financial audits were not highlighting issues and we brought this to the attention of the manager.

From looking at people’s care plans we saw they were written in plain English and in a person centred way. A ‘person-centred’ approach focuses on the individual's personal needs, wants, desires and goals so that they become central to the care and support process. The care plans made good use of personal history and described individuals care, treatment, wellbeing and support needs. These were regularly reviewed by staff and updated by the manager.

Individual care plans contained risk assessments. These identified risks and described the measures and interventions to be taken to ensure people were protected from the risk of harm. The care plans we viewed also showed us that people’s health was monitored and referrals were made to other health care professionals where necessary for example: their GP, mental health team and care manager.

Although on the day of our inspection people who used the service were supported by sufficient numbers of staff to meet their care needs. However we could see from the previous staffing rotas that there had been recent issues where people who used the service were not supported by enough staff.

When we looked at the staff training records they showed us staff were supported and able to maintain and develop their skills through training and development opportunities. We found that some training was due to expire and staff would need to attend refresher training imminently.

When we looked at supervision and appraisal records we saw that these had not been carried out regularly. Care staff we spoke with told us they had recently started to get regular supervisions and appraisals with the manager, where they had the opportunity to discuss their care practice and identify further mandatory and vocational training needs.

We also viewed staff recruitment records th

Inspection carried out on 10/9/2015

During a routine inspection

The inspection took place on 10 September 2015. The inspection was unannounced.

Middleton lodge is a residential care home based in Middleton St George. The home provides care for up to 10 people with learning disabilities or autism. On the day of our inspection there were 8 people using the service.

The home had a registered manager. A registered manager is a person who has registered with the Care Quality Commission 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.

We spoke with care staff who told us they felt supported and that the registered manager was always available and approachable. Throughout the day we saw that people who used the service and staff were comfortable and relaxed with the registered manager and each other. The atmosphere was calm and relaxed and we saw staff interacted with each other and the people who used the service in a very friendly, positive and respectful manner.

From looking at people’s care plans we saw they were written in an easy to read and person centred way and made good use of photographs to describe their care, treatment and support needs. These were regularly audited and updated. The care plan format was easy for service users or their representatives to understand and we could see that some family members and people had signed their care plans in agreement. The manager also showed us three care plan reviews that had been captured on video using images and video content with consent and these clearly reflected a person centred approach.

Individual care plans contained risk assessments. These identified risks and described the measures and interventions to be taken to ensure people were protected from the risk of harm. The care records we viewed also showed us that people’s health was monitored and referrals were made to other health care professionals where necessary for example: Speech and Language Therapy. We saw records were kept where people were assisted to attend appointments with various health and social care professionals to ensure they received care, treatment and support for their specific conditions.

Our observations during the inspection showed us that people were supported by sufficient numbers of staff. We saw staff were responsive to people’s needs and wishes.

When we looked at the staff training records they showed us staff were supported to maintain and develop their skills through training and development activities. The staff we spoke with confirmed they attended both face to face training and eLearning opportunities. They told us they had regular supervisions with the registered manager, where they had the opportunity to discuss their care practice and identify further training needs. We also viewed records that showed us there were robust recruitment processes in place.

There were policies and procedures in place in relation to the Mental Capacity Act and Deprivations of Liberty Safeguards (DoLS). The registered manager had the appropriate knowledge to know how to apply the MCA and when an application should be made and how to submit one. This meant people were safeguarded.

During the inspection we witnessed the staff rapport with the people who used the service and the positive interactions that took place naturally. The staff were caring, positive, encouraging and attentive when communicating and supporting people.

We observed people were encouraged to participate in a range of activities that were personalised and meaningful to them. For example, we saw staff spending time engaging people with people on a one to one basis on an activity and others being supported to go out and be active in their local community.

We saw people were encouraged to eat and drink sufficient amounts to meet their needs. We observed people being offered a selection of choices of drinks and the menu that also offered choice.

We found the building and outside sensory garden area met the needs of the people who used the service. We were told that work on the kitchen refurbishment will be in place in coming months.

We saw a complaints procedure that was in place and this provided information on the action to take if someone wished to make a complaint and what they should expect to happen next.

We found an effective quality assurance survey took place regularly. The service had been regularly reviewed through a range of internal and external audits. We saw that action had been taken to improve the service or put right any issues found. We found people who used the service, their representatives and other healthcare professionals were regularly asked for their views.

At the inspection we were made aware of the recent changes being implemented by the registered manager and from looking at the records and speaking to the people who use the service we could see the positive impact this was having on their quality of life.

Inspection carried out on 9 July 2014

During a routine inspection

The inspection team consisted of one inspector. During the inspection, we spoke with five out of nine people living at Middleton Lodge, the manager, the deputy manager and six staff. We looked at three sets of care records. We also observed care practices within the home.

The service had a new manager in post. At the time of the inspection they were going through the registration process. The management of the home was good and we saw strong leadership in place and a positive environment for people and staff. Staff spoke highly of their manager and the support which they received.

We set out to answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

Peoples care plans were person centred and provided information on what people liked/disliked, how people liked to be woken up of a morning and how staff should behave around them. Middleton Lodge uses a system called Caresys, where they update people's care plans on a monthly basis, log daily notes and any accidents and incidents.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care home. While no applications had needed to be submitted the home had proper policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards and there was evidence to show that this had been followed appropriately. Staff had received training in relation to these topics along with the safeguarding of vulnerable adults and had an understanding of the actions to take. This meant that people were safeguarded as required.

Middleton Lodge was clean and tidy; although the provider may wish to note that the communal bathroom boxed in area was bare wood, majority of carpets needed replacing or required a deep clean and the settee in the main lounge had a tear.

Is it caring?

The majority of people who lived at Middleton Lodge could not communicate verbally; there was information in the care plan about ‘how I communicate.’ Middleton Lodge had also devised a small communication booklet for one person who used the service. This was so that the person and the staff could communicate effectively. The manager stated that they are planning to do this for all people who could not communicate verbally.

Peoples care plans provided information on their medical and personal life history. The care plans detailed 'what I can do for myself,' 'what support I need' and 'how the home will meet my needs in this area.' Care plans were individualised and included people's preferences, interests, aspirations and diverse needs.

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people.

People, who could communicate verbally, told us that they were happy with the care and support provided to them.

People who used the service were supplied with an easy read ‘service user guide’, Depravation of Liberties information and how to make a complaint.

Is the service effective?

Everyone had their needs assessed and had individual care records which set out their care needs. It was clear from our observations and from speaking with staff that they had a good understanding of the care and support needs of people living at the home and that they knew them well. Assessments included money management and behaviour that challenges.

People spoke highly of the staff and said that they were happy with the care that had been delivered and their needs had been met.

Is the service responsive?

There was clear evidence contained within people's care plans to show how they worked with other health and social care professionals. People told us that they knew how to make a complaint if they needed to. The home was responsive to people's needs, wishes and preferences.

One person who used the service had a ‘coming home plan’ for when they returned from a day centre. Every member of staff we spoke with, were aware of this plan and the reasons behind it.

People using the service and the staff, completed an annual satisfaction survey. Where shortfalls or concerns were raised these were addressed with an action plan. The staff survey mentioned the need for a sensory room and money they received from a ‘staff excellence’ award had been used to purchase items for this.

Is the service well led?

We did see a cleaning schedule, but more robust audits needed to be in place to make sure this schedule was adhered to and was working. The manager told us that they have just employed a cleaner and were waiting the return of The Disclosure and Barring Service (DBS).

The service had records of quality assurance systems in place. Therefore the manager was protecting the people who used the service and others against the risks of inappropriate or unsafe care and treatment.

What people said:

People who used the service were very happy with the care they received. One person we spoke with said, "Everything is good about living here.” And “I am going into town for lunch.” Also “They (the staff) took me to see my mum.”

Staff we spoke with said “I love working here, we are like one family,” and “I get good job satisfaction,” “I get loads of support,” and “I get on with them all, I am very calming when people show behaviours that challenge.”

Inspection carried out on 14 November 2013

During a routine inspection

Staff had a positive attitude and we saw good interaction with people who were supported to undertake various activities. One person told us; “I’m going horse-riding today”.

There were systems in place for checking the safety and quality of the service. We saw that people living at the home were involved as far as possible in the planning and cooking of meals and people’s nutritional needs were monitored.

Care plans were written from the point of view of the person and peoples care and support were reviewed with them monthly by their keyworker.

There were enough staff on duty to meet the needs of the service and staff members on duty displayed a caring and supportive approach to people at the service.

Inspection carried out on 17 December 2012

During a routine inspection

Some of the people who used the service had complex needs which meant they were not able to tell us their views. Because of this we used a number of different methods to help us understand their experiences.

We spoke to one person who told us that they liked living at the home and they were “really happy”. They told us all about a visit that was planned to the local pantomime. They also told us how they go out in the home’s minibus to the shops and also to the beach. They told us that the staff looked after them and kept them safe.

We contacted two relatives by telephone. One relative said that the care was “brilliant” at Middleton Lodge. There had been problems in the past which had been addressed and they were “quite happy”. They said their relative called it home and if anything was needed they just had to ask. They also said that their relative had been on holiday abroad several times with their carers.

Another relative we spoke to said they were “happy” with the care at the home and that everything was “fine”. Staff listened to them and their relative went horse riding which they loved.

Inspection carried out on 17 January 2012

During an inspection to make sure that the improvements required had been made

We were able to speak with one person who used this service. They told us they did not want to move from the home. We spoke with all of the staff who were on duty. We did not hear any negative comments about the home.

Inspection carried out on 11 August 2011

During an inspection to make sure that the improvements required had been made

Two people said that the food was always good.

Inspection carried out on 14 January and 14 June 2011

During an inspection in response to concerns

Many of the people who lived here could not give us their view because of their communication difficulties.

Reports under our old system of regulation (including those from before CQC was created)