Middleton Lodge

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

At our last inspection this key question was rated inadequate. At this assessment the key question has been rated good. This meant people were safe and protected from avoidable harm. People were supported to remain safe and staff showed a good understanding of the safeguarding process. One relative we spoke with told us, "[Name] is in a safe place and the staffing has improved. Staffing was provided by a consistent and well trained team who told us they were well supported. Recruitment was carried out safely and involved people who used the service. Medicines were stored and administered safely. The service was clean and equipment was well maintained. One relative told us, "I wander around the service, and it is clean and hazard free." The registered manager had good oversight of accidents and incidents and we saw learning was shared via meetings and handovers. Staffing was provided at safe levels. One staff member told us, "Staffing levels are really good we are never short staffed."

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.

We saw people were now involved more in their care and support needs and were able to share their care plan with us. Relatives we spoke with also spoke of improved communication and records which involved their loved one. One relative said, "There have been lots of improvements and its continuing."

The registered manager told us about improved audits that were now in place to identify daily risk and staff we spoke with also said, "We now do daily walk arounds to check the environment is safe." The registered manager was the identified lead for safeguarding at the service and all staff now had key roles in areas such as health and safety and fire safety.

The registered manager had put in place a robust action plan from our last inspection in July 2023. This continued to be worked through and updated and it had clear actions and timescales for completion. Learning from incidents and accidents was shared with the staff team and partners where appropriate and we saw effective systems for communication were in place. They used all feedback to assist them improve the quality of care and support. The registered manager had an effective system in place to monitor the quality and safety of the service and ensure people achieved positive outcomes.

People told us they felt safe. The service ensured care and support plans contained pertinent information about people’s needs and preferences to enable staff to provide appropriate and safe care. We saw people now had safe equipment with clear guidance on how it was to be used such as photographs of the safe use of equipment which staff signed on a daily basis before use.

The registered manager discussed with us the plans they had in place to ensure effective transitions to people moving into the service. This included staff supporting people at their current placements with their staff team to get to know people as individuals. The service was also working with current service users to let them get to know new people at a pace of their choice. The staff we spoke with told us about ensuring people's voice was heard. One staff said, "I'm a key worker for [Name] and they have no family involvement so I make sure they have regular access to their advocate and social worker."

The service had been working with a variety of health and social care professionals since our last visit and feedback from them was that the service actively followed their advice and was engaged and working well with professionals such as physiotherapists and speech and language therapists. One therapist told us, "The service has been proactive to request training about dysphagia (swallowing difficulties)."

Systems were in place to ensure people transitioned to the service in a safe manner and there was continuity of care and support. The registered manager told us they would only accept new service users when they were confident they could meet all aspects of the care and support required. The registered manager ensured care and support plans contained pertinent information about people’s needs and preferences to enable staff to provide appropriate care. Mechanisms were also in place for staff to raise concerns and share their views over the development of the service.

We observed people were happy, comfortable and confident with the staff team who were supporting them. People told us about their keyworkers and how staff supported them to stay safe. Relatives we spoke with all felt their relations were safe. One relative said, "[Name] is in a safe place and the staffing has improved."

Staff members we spoke with all understood safeguarding and how to report any concerns. Staff said they were confident the management team would take the appropriate action in relation to any concerns. The registered manager kept a clear record of any safeguarding incidents and reviewed these for learning. We also spoke with staff about managing difficult situations if people became distressed. One staff member said, "We usually try take the person out of the situation - for a walk - to the sensory room or get them involved in an activity to distract them positively."

Staff were caring and spoke with people in a respectful and dignified manner. They had a good understanding of people’s needs and how to promote and maintain their safety, for example by using appropriate equipment to ensure people safely transferred and mobilised.

The provider had safeguarding systems in place. Staff said they had training and a good understanding of what to do to make sure people were protected from harm or abuse. Records were well maintained and up to date.

People told us they were going out a lot more and accessing the community. People were being supported to manage risk positively.

Staff we spoke with told us that they followed people's plans and risk assessments to enable them to undertake more activities of their choice. We received feedback from a visiting speech and language therapist that they observed guidance on reducing the risk of choking was followed in a "relaxed, friendly and respectful way."

The whole environment at the service was now more accessible with the kitchen and garden now being adapted to enable people who used wheelchairs to fully participate in activities in those areas with support. We saw people helping prepare food and spending time with staff who were cooking the evening meal in the kitchen area.

The registered manager had an effective system in place to monitor the quality and safety of the service and ensure people achieved positive outcomes. Systems were in place to ensure staff understood when people required support to reduce the risk of avoidable harm, and risk assessments were in place. The risk assessments were detailed and enabled staff to support people to take positive risks.

We saw that people's personal bedrooms were improved with new decor and equipment and one person was delighted to show us her new bedding which they had chosen. They showed us they now had pillows which they had not been able to cope with before and they were so pleased with their room. We saw people had chosen decor but most importantly areas of the home such as the kitchen and garden were now accessible to everyone. Relatives we spoke with said, "Overall, have never seen the place looking so good in 15 years," and "When you go in its more like home. Things on the walls, memorabilia, pictures. New furniture and they discussed it with me. Its loads better."

Staff we spoke with were able to tell us and show us how they used equipment and technology to keep people safe. We saw that staff had been trained and were confident in supporting people in their environment. Staff told us, "Its so nice to work here now, look at it, its like a new house!" The management team ensured that the environment was safe by regular checks on the service and equipment.

The service had been transformed from our last inspection in July 2023. Decor, equipment and accessibility had improved. The service was clean and well maintained. We saw people and staff were now proud of where they lived and worked. With the purchase of a minibus people were able to access the community more and visit friends and family.

The registered manager and provider had worked to make significant improvements to the safety and quality of the environment and systems and processes were in place to keep the service clean and free from any hazards.

People engaged positively with all the staff team. Everyone appeared comfortable with staff and were able to tell us about their keyworkers and activities they enjoyed with them.

The staff team had remained consistent since our last inspection but they now told us how well supported and trained they were. One of the senior support workers told us, "It's 200% better." Staff training had been delivered to ensure staff understood safe working practices and also they had been trained in the specific needs of people living at the service. Staff we spoke with said there were always enough staff. The registered manager told us, "We have made improvements incrementally, once we have made a change and know its in place consistently then we move on."

Our observations were of a staff team who worked together to achieve positive outcomes for people and who were knowledgeable about people's needs and how they wished to be supported. We heard a senior staff member saying, " Hi [Name] do you want to have your lunch in the kitchen or the dining room, its up to you." We saw people appeared happier, calmer and people had made improvements physically with positive weight gain and also appeared less distressed.

The provider ensured staff had the skills and knowledge to carry out their role effectively. Records showed staff had regular supervision and completed a wide range of training which included safeguarding, infection control, medication, moving and handling, and pressure care. There were enough staff to ensure people were supported safely and were able to access activities of their choice in the community. Safe recruitment practices were followed, including in relation to the recruitment of overseas staff.

People showed us their newly decorated bedrooms and communal areas with pride. They showed us pictures and new furnishings they had been supported to choose. The biggest change since our last visit was the new kitchen which was accessible to everyone with lowered worktops and greater space for wheelchairs and we saw people using it to help with cooking and just spend time with staff. We received feedback from an infection prevention control specialist who had worked with the service since our last inspection. They said, "Overall, I have seen evidence of a process of continuous improvement which includes feedback to staff and open and honest discussions. They appear receptive to constructive criticism and general feedback. Environmentally there have been structural improvements and remedial works timetabled. Cleanliness has improved."

Staff confirmed they received training on infection control procedures. They had all the equipment they needed to reduce the risk of spreading infections.

We saw massive improvements in the environment from cleanliness to clean and safe equipment as well as new decor and furnishings. The service was brighter and more accessible. We observed staff using appropriate PPE to support people with personal care.

The provider had systems in place to mitigate the risks of people and staff from catching and spreading infections.

Medicines were stored securely and safely. We observed part of a medicine round and people received their medicines respectfully.

Staff told us they had completed medicines training and had been assessed as competent. The registered manager told us about the variety of medicines audits completed.

Comprehensive policies and procedures were in pace to support the safe administration of medicines. Records of regular medicines were generally well maintained and followed national guidance including recording peoples allergies. Processes for applying and recording creams as part of personal care were in place. However, we found these weren't being consistently followed by staff.