Middleton Lodge

Agency use had reduced significantly in the two months before the inspection. This helped staff know people better, although relatives still reported a lack of continuity.

“The use of agency staff had significantly decreased in the last 2 months.” from the report

People generally appeared happy and relaxed with staff. Relatives gave mixed feedback overall but were positive about staff being caring.

“People told us they were happy with the support they received and had a good relationship with the staff who supported them.” from the report

The outdoor area had been made more accessible, including for people who used wheelchairs, to support independence.

“The garden area had been made accessible to those in wheelchairs to promote people's independence.” from the report

The acting manager was open about the problems and was taking action, including arranging additional training and making safeguarding referrals when concerns came to light.

“The acting manager was honest and open with us during the inspection.” from the report

Hoist slings were not routinely checked and some could not be used because their instructions had been washed off. One person stayed in bed for two days as a result.

“One person had to remain in bed for 2 days as staff had not routinely checked slings used to hoist them.” from the report

Instructions and records for creams and medicines taken when needed were incomplete. This created a risk that medicines would not be given consistently or their effects properly reviewed.

“Guidance and records were not always in place to support the safe administration of topical medicines.” from the report

Care plans and risk assessments did not always change when people's needs changed. The new electronic care plan was better, but still needed to be introduced and embedded for everyone.

“Care plans and risk assessments were not always updated after someone's needs changed.” from the report

The home did not have effective systems to monitor medicines, risks, incidents, records and overall quality. Some notifiable events had also not been reported to CQC.

“An effective quality monitoring system was still not fully in place.” from the report

Inspectors heard staff discussing people's toilet use in front of others. Some records were also left on a kitchen worktop, and one person's preferred name was not used.

“We did observe some staff openly talking about taking people to the toilet and that they were still on the toilet in front of other staff and people using the service” from the report