This unannounced inspection took place on 12 and 17 April 2018.

At our last comprehensive inspection in March 2017 we gave the service an overall rating of 'Requires Improvement'. This was because we found concern around the deployment of staff, knowledge and understanding of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). We also received mixed views on how the service was run. At this inspection we found improvements had been made.

Middleton Park Lodge is a purpose built home providing care for up to 50 people requiring personal and nursing care. All bedrooms are single occupancy with ensuite toilet facilities. The home is arranged over two floors accessed by stairs and lift. Both floors provide communal lounge and dining areas.

The service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission 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 received their care and support safely. People's risks were assessed and reduced by staff who understood how to protect people from improper treatment. People's medicines were stored securely and administered in line with the prescriber's instructions. Staff followed appropriate personal care and food safety practices to prevent infection. We found some aspects of the environment could affect people’s health such as unlocked fire doors and broken seals round toilets. We raised these with the registered manager who amended these shortfalls during the inspection.

Staff were supported in their role by the registered manager who delivered supervision and appraisal and coordinated staff training. People's needs were assessed and they received support to maintain their nutritional and hydration needs. People were supported to have maximum choice and control of their lives.

Caring staff maintained people's privacy and dignity. People were supported to maintain relationships with relatives and friends. Visitors were made to feel welcome and people were supported to practice their faith.

People had personalised care plans which detailed how they wanted staff to meet their individual needs. However, care records were not always clear, up to date, concise or easy to understand. Staff were allocated to support the implementation of people's personalised care. A range of activities were provided by staff for people to participate in. Information was available for people to access the provider's complaints procedure. The registered manager understood the provider's procedure for handling complaints which we saw was clearly documented.

The registered manager had improved quality assurance processes and actioned the concerns raised at the last inspection. There was an open culture at the service and the views of people, relatives and staff were gathered. The service worked in partnership with other agencies to secure positive outcomes for people.

This was an un announced inspection carried out on 21 March 2017. This was the first inspection the home had received since the change in provider.

Middleton Park Lodge provides accommodation and care for up to 50 older people. At the time of our inspection there were 43 people living in the home. The home is purpose built and there is car parking available. The home is divided over two floors and people living there have en-suite rooms. Both floors have communal lounges, dining rooms and bathing facilities. The home has a garden to the rear of the building which is secure.

At the time of our inspection there was a registered manager in the home. A registered manager is a person who has registered with the Care Quality Commission 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 told us they felt safe at the home. There were effective systems in place to ensure people’s safety at the home, whilst also encouraging and promoting their independence. Staff could describe the procedures in place to safeguard people from abuse and unnecessary harm.

There were systems in place in the home to ensure that people received their medication as prescribed.

There were at most times enough staff to meet people’s needs, however we spoke to the registered manager and area manager around the arrangements and deployment of staff around the home when staff call in sick and the use of agency staff in the home. Robust recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work. Staff were given effective supervision and appraisals.

Staff were up to date with all mandatory training in the home. However care staff did not have a good understanding in relation to DoLS. We made a recommendation to the home for all care staff to receive further training in this area to enhance their knowledge.

Staff were aware of the processes in place to report incidents of abuse and had been provided with training on how to keep people safe from abuse and harm. Processes were in place to manage identifiable risks and to promote people’s independence.

People were supported to eat and drink well and to maintain a varied and balanced diet of their choice. People had access to healthcare facilities and support that met their needs. We received mixed responses from people about the food at the home.

People had developed good relationships with the staff team who treated them with kindness and respect. Systems were in place at the service to ensure that people’s views were listened to and their privacy and dignity was upheld and respected.

People's needs had been assessed and care plans outlined their preferences and how they should be supported. Staff showed a good knowledge of these preferences when asked about the people they supported.

People were supported in the main to enjoy activities of their choice. The service had an activity coordinator who worked part time and another activity coordinator had been recruited to support the home; the registered manager told us they were waiting for recruitment checks, which had been requested. The registered manager told us activities would improve greatly once they had two activity coordinators in post.

The provider had quality assurance systems in place which were used to drive improvements within the home.

The provider ensured the premises and equipment were safe to use. We saw evidence of certificates in response to these. At the time of the inspection the lift at the home was out of use and had been for a few weeks, maintenance was underway with this at the time of our inspection. The home had arranged for a stair lift to be put in place at the home. Appropriate risk assessments were in place for this.

People had mixed views as to if the home