Middleton 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

At our last inspection this key question was rated requires improvement. At this assessment it is now rated good. This meant our evidence showed people's care, treatment and support achieved good outcomes and promoted a good quality of life. The registered manager maximised the effectiveness of people’s care and treatment by assessing and reviewing their health, care, wellbeing and communication needs with them. Social workers supplied the registered manager with their assessments and these were used as the basis for the care records. The care records clearly detailed people’s needs. Staff planned and delivered people’s care and treatment with them, including what is important and matters to them. This was in line with legislation and current evidence-based good practice and standards. Staff supported people to manage their health and wellbeing in ways which maximised their independence, choice and control. The staff routinely checked people were satisfied with the service and whether any needs had changed. The registered manager ensured people experienced positive outcomes from the support the service offered. Staff worked with local healthcare professionals and sought advice when required. Staff worked as a team to ensure people’s support needs were met. The service had worked with Speech and Language therapy to improve the safety and quality of people's mealtime experience. One therapist told us, "The chef has gone to a lot of trouble to make meals look and taste appetising, I am hugely impressed." Staff made people aware of their rights around consent and respected these when they delivered person-centred care and support. Staff had received training around the Mental Capacity Act 2005 and associated code of practice. People had their rights upheld and advocacy services were actively involved with people. Staff had received mandatory and person specific training.

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.

Everyone living at Middleton Lodge had been there for several years. People told us about their support plans and that they chose to be involved in planning their support and activities. Relatives fed back they were involved in planning and reviewing people' needs with the staff team. One relative said, "They stick to his care plan and keep me well informed."

The provider had worked well with partners to undertake supportive and effective transitions for people moving into and out of the service. Staff found there were effective systems in place to assess and monitor people's needs. The registered manager discussed how they were planning a phased transition for 3 people who would be moving to Middleton Lodge. The management team recognised that 3 people moving in at once would have a huge impact on the service so they were working with the peoples current provider, social workers and families to ensure this transition was as smooth as possible. The service was also preparing the people living at Middleton Lodge and the staff team via training and developing information so people would understand what would be happening. One staff member told us, "The registered manager has been doing transition work with 3 people and we have done an assessment and used PBS (Positive Behaviour Support) support. The local authority have been supportive too and family. We will share all information with staff and staff will work in their current placements."

Assessment plans were available that fully captured people's needs. The staff would use these assessments as the basis for developing the detailed risk assessments and care and support plans.

Peoples support plans now reflected their current needs and we saw they had been improved to ensure people were involved in them. People were happy to show us their plans and pointed to photos and achievements within them. Relatives said they were also consulted and kept up to date with plans. One relative said, "I was impressed with their care plan and the documentation. The diet sheets were impressive and showed what [Name] could eat as a result of his swallowing difficulties."

One of the senior team shared with us about a forthcoming transition, "We will share all information with staff and staff will work with people in their current placements." Staff felt confident about transitional arrangements and said they were looking forward to getting to know people and enabling people at Middleton Lodge to make new friends.

Assessment policies, procedures and draft plans were in place that would fully capture people's needs. The staff would use these assessment templates as the basis for developing the detailed risk assessments and support plans. The registered manager discussed with us that transitions would be undertaken in a multi-disciplinary format to all parties would feel competent and prepared to ensure a smooth and effective transition.

People we spoke with told us they attended other services and clubs and staff we spoke with told us that relevant information was shared so people's needs were met. Relatives we spoke with also said they felt involved. One relative said, "They understand his needs, likes and dislikes. They offer him choices."

Staff shared that they worked well with other agencies and actively sought support and advice if they were unsure of anyone's care and support needs. One staff told us, "Yes we constantly check care plans and visually assess people each day."

Feedback we received from visiting professionals with the service was positive. A speech and language therapist we spoke with said, "The support given to clients at mealtimes was excellent. The food provided for people needing modified diets was excellent."

Professionals we spoke with told us communication was positive between the service and themselves and that the staff and management team were receptive to feedback. One visiting professional told us an example of the service being proactive with others; "I commend staff for knowing people well and acting instinctively which was demonstrated during a small outbreak of respiratory illness where a person was rapidly admitted to hospital. Without knowing this person well, they may have missed the early stages. Happily, all ended well and the person returned home when recovered. They contacted us and other relevant bodies in a timely manner and followed advice given."

We saw people looked well cared for, happy and healthy. People we spoke with said they enjoyed the food and that staff supported them to visit their GP when needed. Relatives were confident the service would seek appropriate health and wellbeing support. One relative said, "I have no concerns regarding medical appointments and they inform me of incidents and accidents."

Staff and managers told us there were improved systems to ensure people received support to promote their well-being. One staff member said, "Yes if someone goes in hospital one staff would go with them and another would come in and cover. Extra cover came in last week when [Name] had to go to hospital in the night." This showed the service ensured continuity and person centred care. Staff had undergone training across a wide variety of areas including person specific healthcare support as well as autism and positive behaviour support.

We saw there were good working relationships with partners. The service showed it had learnt from previous transitions. Management told us, "Seeing the challenge we had, it's about making sure future transitions and the period and level of support for people is correct. If it's slow its slow but we have learnt that people here are older and so we need to reflect."

We saw people had improved outcomes since our last inspection in July 2023. People had greater community access, improved support from staff who were well trained and supported and were involved more in the service in making choices and increased accessability. People told us the support they received was good and they were happy with the service provided.

The registered manager told us they closely monitored the service to ensure people experienced good outcomes. They said, "We have had service forums - so we have talked about motivation for one person and how we have worked on activities and going out which for them can be a barrier."

The registered manager regularly reviewed the systems and processes in the service to determine if improvements could be made. Action plans were used to identify and monitor where changes were required and how these could improve the service. They used all feedback to assist them improve the quality of care and support.

People were supported to have the maximum choice and control over their lives and staff supported them in the least restrictive way possible and in their best interests. People told us they were involved in decisions about their care.

Staff were able to tell us about how they supported people to seek consent. One staff said, "We get verbal consent from people who can and I would ask and look for actions and signs for [Name] for example they wont get up unless they wants to do something so we are guided by them. " We also saw the service supported the use of advocacy services and staff were aware of the importance of independent advocacy.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. Staff had received training around the Mental Capacity Act 2005 and associated code of practice and felt confident applying this in their practice.