Archived: Middleton's Lane

Middleton’s Lane is a care home without nursing. It supports up to six people with a learning disability or autism. At the time of inspection there were six people using the service. Each person has their own flat within the main building comprising of private lounge, kitchen, bedroom and bathroom. There are also shared gardens and a communal lounge and kitchen. There are two offices within the building.

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

People told us they liked living at the service and they were happy. They told us staff were nice to them and supported them to make choices, access health professionals and activities.

People and relatives told us they were supported to stay in touch throughout the pandemic in person, as well as by use of telephone and video calls. People had any risks for accessing the community assessed and were supported by staff to do so.

Relatives told us staff communicated well with them. People and relatives were both happy and confident to speak with the registered manager or staff team if they had any concerns.

People were supported safely to manage their medicines and health conditions. Staff had a good understanding of people’s needs and preferences.

People were safe as they were supported by staff who understood about the risks of COVID-19 and had abuse awareness. Staff understood how to report concerns to keep people safe and where to go for additional advice.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

Based on our review of safe and well-led; the service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

People told us staff treated them well and they were able to do what they wanted to do. Relatives also told us that staff always treated their family member with respect and kindness.

The model of care supported individualised care that maximised people’s choice and control as they were supported in their own flats and each person had individual staff support. This meant their environment was designed to suit their own needs and tastes and they had full control of who entered and how it was used.

This also meant people were able to follow their own plan of activities with flexibility built in to make changes where they wished. There was always a staff member there for them to engage and interact and offer support.

The registered manager was able to evidence how they promoted valuing people principles and had created a culture or person-centred care and respect. This was observed in practice where staff were seen interacting in ways that promoted people’s independence and dignity and empowered them to make choices and decisions for themselves.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 29 March 2019).

Why we inspected

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 received concerns about the provider’s governance systems and oversight of the service. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection. The overall rating for the service has not changed and remains good. This is based on the findings at this inspection.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe and well-led sections of this full report.

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

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Middleton’s Lane is a residential care home that provides care and support for up to six people with a learning disability. Six people were living in the home at the time of this inspection.

People’s experience of using this service:

The service was safe and people were protected from harm. Staff were knowledgeable about safeguarding adults from abuse and knew what to do if they had any concerns and how to report them. Risks to people who used the service were assessed and their safety was monitored and managed, with minimal restrictions on their freedom. Risk assessments were thorough and personalised.

The service ensured there were sufficient numbers of suitable staff to meet people’s needs and support them to stay safe. The manager confirmed that robust recruitment procedures were followed.

Medicines were stored, managed and administered safely. Staff were trained, and their competency checked, in respect of administering and managing medicines.

People who used the service were supported to have sufficient amounts to eat and drink and maintain a balanced diet. People enjoyed their meals and were supported to choose what they wanted from the menus and options available.

Staff demonstrated a good understanding of the Mental Capacity Act and Deprivation of Liberty Safeguards. Staff understood the importance of helping people to make their own choices regarding their care and support. People who used the service were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible

Staff treated people with kindness, respect and compassion. People also received emotional support when needed. People were involved in planning the care and support they received and were supported to make choices and decisions and maintain their independence as much as possible. Information was provided to people in formats they could understand.

Care plans were personalised and described the holistic care and support each person required, together with details of their strengths and aspirations. Information also explained how people could be supported to maintain and enhance their independence and what could help ensure they consistently had a good quality of life. People’s comments and concerns were listened to and taken seriously. The service also used any comments or complaints to help drive improvement within the service.

People who used the service and staff told us they liked the manager and told us they felt supported. The new manager had applied to become registered with the Care Quality Commission (CQC). CQC’s other registration requirements were met and complied with and effective quality assurance procedures were in place.

Rating at last inspection:

At our last inspection (report published 23 August 2016) all the key questions were rated Good and the service was rated as Good overall. This rating has not changed and the service remains Good.

Why we inspected:

This was a planned inspection based on the date and the rating of the last inspection.

Follow up:

We will continue to monitor the service through the information that we receive.

Middleton’s Lane is registered to provide accommodation for people who require nursing or personal care. At the time of the inspection there were six people living at the home.

On the day of our inspection there was 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.

People were kept safe and their risk of harm was reduced because staff knew how to recognise and report any incidents of harm. Staff were confident that the registered managers would deal with any concerns that they reported.

Staffing levels were adequate to meet people’s needs. Staff were recruited through safe recruitment practices.

Medicines were safely administered and stored.

Staff received an induction, training and supervision and felt supported by the management team. People received sufficient to eat and drink. People had access to external healthcare services.

Staff were trained in the principles of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and could describe how people were supported to make decisions.

Staff were very caring and people felt listened to. Staff were aware of people's support needs and their personal preferences. People and/or their relatives were involved in the development and review of their care plans. People were encouraged to be independent and staff respected people’s privacy and dignity.

Daily records were up to date and gave a good overview of what had occurred for that person. People had the opportunity to take part in a variety of activities both inside and outside the home Complaints were dealt with in a timely manner

The registered manager was supportive, approachable and listened to people, relatives and staff. People and their relatives were involved or had opportunities to be involved in the development of the home. There were systems in place to monitor and improve the quality of the home provided.

We observed that people were involved in making decisions about their care and support. The provider followed appropriate procedures when an assessment was required of people's capacity to consent in relation to a specific decision.

Support plans were detailed, up to date and person-centred. People had individual risk assessments and these were reviewed appropriately. Each person had a Health Action Plan and had given consent for their information to be shared with certain people. We saw evidence that the support workers knew the needs of people and used different communication techniques. These ensured effective communication.

There were appropriate arrangements for the management of medicines and there were checking processes to make sure the administration of medicines was safe.

At the time of our visit there were enough suitably trained and experienced staff to meet the needs of the people using the service. The staff had undertaken relevant training and education, but some people were waiting to refresh their mandatory training.

The service had various methods that were used to ensure the quality of the service was monitored and audited. Meetings, reviews and audits were in place and records available.

We spoke with two of the four people living in the home, one told us "I like living here" and said "'staff [are] good' when describing their support worker. Another person we spoke with told us "'[I] like living here, [I] like [the] staff."

We found that people using the service were treated with dignity and respect, and were encouraged to make decisions about their care and how they would like to spend their free time. One person told us "I like scampi and chips; [I] go to [the] chip shop for scampi".

We saw that people living in the home had the opportunity to participate in a tenants meeting once per week, the minutes of which were recorded in an easy read format. These minutes documented the views and feedback expressed by people using the service. We found that during these tenants meetings, people using the service were able to suggest activities and meals for the following week. People also had the opportunity to give feedback and express their views about the service. We found that the views of people were taken into consideration in order to improve the service and the outcomes for people using the service.