Mickleboro Lodge

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

This is the first assessment for this newly registered service. This key question has been rated Good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

Before people moved into the service, a full assessment was carried out to ensure the service was able to meet their individual needs. The assessment included the full range of the person’s diverse needs, including their wellbeing, communication needs, mental and physical health. People were involved in the assessment which ensured their individual needs had been appropriately assessed, fully understood and were confident their needs could be met.

The initial assessments were used to formulate people’s care plans. These contained details on people’s strengths and the nature and level of support they needed to meet their needs, support their independence and to stay safe. The service made sure people’s care and treatment was effective by assessing and reviewing their needs on a regular basis. Support plans were revised accordingly to accurately reflect changes to people’s needs and the level of support required to maximise their health and wellbeing. This meant people received proper, consistent and safe care and support.

Conversations with staff reflected they had a good understanding of people’s current needs, how to meet them and how to support people to have a good quality life. One member of staff told us, “We document everything on daily notes, if a person is identified as being at risk from their actions, we pass the information to the provider who will discuss the issues with the person, their relative and / or other professionals. We try to respect people’s choices but explain the consequences of their actions and explain why it is risky and what could potentially happen. We give information, but we don’t say ‘no’.

The provider planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards.

People’s care and support including what was important and mattered to them was planned and delivered in line with recognised tools for screening and monitoring their health and welfare. These included but were not limited to the malnutrition universal screening tool (MUST) used by healthcare professionals to assess the nutritional risk of adults and the Glasgow antipsychotic side-effect scale (GASS) used to assess for side-effects of antipsychotic drugs. People prescribed antipsychotic medication attended monthly specialised healthcare clinics dedicated to monitoring the effects of the medicine, with regular blood tests and physical health checks to ensure their safety and optimise treatment outcomes.

The provider had a good understanding of national legislation, evidence-based practice and standards, specifically in relation to the needs of the people using the service. Staff were encouraged to learn about new and proactive well-being strategies to better support people when experiencing stress and challenges with their mental health. This ensured care, treatment and support was planned in accordance with the most up to date best practice guidance to achieve the best possible outcomes for the people using the service.

People’s nutrition and hydration needs were met in line with current guidance to maintain their health and well-being. This included access to nutritious food which reflected their preferences. One relative told us, “The menu and quality of food is good, my (Person) is able to choose if they would like to cook for themselves and is supported to buy the ingredients and cook for themselves.” We saw people had full access to the kitchen to prepare their own breakfast and lunch and make drinks throughout the day. Staff told us they cooked a main meal in the evenings and encouraged people to have a healthy diet. People were given a weekly budget to purchase their own food. If they did not like the main evening meal, they could have an alternative or buy themselves a takeaway. One member of staff told us, “We don’t restrict people’s diets, we do discuss what types of food they should eat, specifically those who are diabetic and promote healthier alternatives lower in sugar, for example zero coke. We can encourage and advise, but people are able to make unwise decisions.”

The provider worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

The provider communicated with relatives, external professionals and services to ensure a coordinated approach and continuity of care for people moving into the service. The provider showed a strong awareness of the risks to a vulnerable person across their care journey to their recent admission. They had advocated for this person and pro-actively sought a Care Act review with NHS England to enable access to effective care and support to keep the person safe. A multi-disciplinary meeting was in progress on the day of our visit, as part ongoing discussions with the person, their relative and their social worker to secure additional funding for 1 to 1 staff support. Their relative commented, “My (Person) cannot go out as much as they would like because of the lack of appropriate funding. The provider is fighting to get additional funding, I could not ask for more. The staff do a great job keeping my (Person) safe, even without the appropriate funding. They are always trying their hardest”.

Information was routinely shared between staff and services to ensure people received joined up and continued care. This ensured staff had access to the information they needed to deliver responsive, safe and effective care. People using the service and their relatives told us they were supported to access healthcare services when needed. The district nursing team visited the service twice daily to assist with the administration of insulin where people needed this medicine to manage their diabetes. The provider told us they and staff had built a positive and collaborative relationship with the nurses ensuring effective management of people’s diabetes.

A representative of the local authority quality improvement team told us the new provider had worked well with them through regular contact and seeking support when needed to improve the service. They commented, “It’s been great to see the positive impact on residents and the improvements they have made. It is so much more structured, people are being supported out in the community, and the staff have clearly built a strong rapport with people living there.” The provider’s monthly analysis of the service for June 2025 reflected there had been a positive shift in the way team leaders were working together, which had had a real impact across the service. This joint effort had significantly strengthened the overall consistency of care delivery and improved communication within the wider team. This was confirmed in discussion with staff and observations during our visit to the service.

The provider supported people to manage their health and wellbeing to maximise their independence, choice and control. Staff supported people to live healthier lives and where possible, reduce their future needs for care and support.

People were empowered and supported to manage their own health, care and wellbeing by staff who understood their needs and preferences. For example, the provider told us, “People are supported to be in control of their own care. Where they make unwise decisions, staff would only intervene if their actions were detrimental to their health, such as if they refused their medicines over a 24-hour period. If this happened staff would intervene by contacting the GP.”

Staff supported people to access routine health screening and check-ups, as well as reviews of prescribed medicines and any long-term conditions such as epilepsy. People were encouraged and supported to make healthier choices to help promote and support their health and wellbeing, including managing diabetes, alcohol consumption and decrease smoking.

The service focussed on identifying risks to people’s health and wellbeing early and on how to support people to prevent deterioration. A member of staff told us, “We work with people daily and see any changes in their health, get to know them and can see vital signs, facial expressions etc are an indicator to how people are feeling. We monitor people all the time, for example [Person] has epilepsy, if they are showing confusion, it could identify they are leading up to a seizure.”

The provider routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

The provider had a robust approach to monitoring the effectiveness of people’s care, treatment and support and action was taken to continuously improve it. For example, a person told us they were moving from Mickleboro Lodge to live in their own flat. The person was being supported to make the transition to live in community after spending nine years in residential care. The provider commented, “[Person] has made significant progress. They have made consistent improvement in managing their mental health and behaviour and with support from staff they have maintained progress as they move toward greater independence, which has marked a major positive milestone in their journey.”

The provider’s monthly audit for June 2025 reflected that since April 2025 there had been a reduction in the number of notifications raised to CQC, and a decrease in the number of physical or verbally aggressive behaviours. This reflected an improved stability within the service, and proactive management of incidents leading to positive outcomes for people. Ongoing monitoring of people’s health and wellbeing ensured any patterns were recognised and addressed promptly. For example, people’s nutritional intake and weights were being monitored. Charts from January 2025 to July 2025 reflected overall people’s weights were stable. Where changes had been identified, such as a person who was at risk of gaining too much weight or a change in a person’s eating and swallowing patterns which placed them at risk of choking, action had been taken to refer to these people to the relevant health professionals, such as the dietician and speech and language therapist (SALT).

The provider told people about their rights around consent and respected these when delivering person-centred care and treatment.

People were empowered to make their own decisions about how their care and support was provided. People received information about their care and support in a way they could understand and were given the right support and time to make decisions, understand their rights around consent and ensure their views and wishes were considered. Staff understood the importance of ensuring people fully understood what they were consenting to and the importance of obtaining consent before they delivered any care, treatment and support. We saw staff supported people to make informed decisions, discussing the benefits and risks around the choices they made including where these led to unwise decisions, for example, choosing less healthy food options, smoking and drinking excessive amounts of alcohol.

The provider and staff had a good working knowledge of the principles of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty safeguards (DoLs). Systems were in place to take account of people’s capacity and their ability to consent. Where people could not make decisions and consent to their care, the correct processes were followed to make sure any decisions were made in their best interests. The principles of MCA had been met and applications for DoLs had been completed and authorised where needed.