Midtown House is a care home that provides accommodation and personal care for up to 20 older people, some of whom may be living with dementia. At the time of our inspection there were 19 people living at the home.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

The inspection took place on 6 December 2018 and was unannounced.

The service did not have a registered manager in place at the time of inspection but had a registered provider who oversaw the day to day running of the service, and was the manager. 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 who used the service felt safe and at home in a welcoming and relaxed environment. Staff ensured people felt at ease in their surroundings and their individualities were respected.

All staff knew how best to reduce the potential anxieties and risks people faced. Specific risks were clearly assessed with actions in place to reduce them.

All aspects of medicines management were safe, including storage and disposal, administration and ongoing monitoring of staff competence. Staff were suitably trained and knowledgeable.

There were sufficient staff to ensure people were safely supported. The premises were well maintained and clean throughout. Servicing to equipment had happened regularly.

Staff were well supported through formal mandatory training and ad hoc support from the manager and senior staff. This training was well monitored and managed. Effective systems were in place to ensure the accurate documentation and update of people’s care needs. Staff understood these systems well and liaised proactively with external healthcare professionals.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

The premises were well suited to people’s needs, with a range of communal spaces indoors and outdoors. Meals were planned with people’s preferences in mind.

People were extremely complimentary about the care they received from staff, as were relatives. Staff knew people extremely well, were able to anticipate their needs, and reciprocated the affection and warmth they were shown.

People were encouraged to take part in the planning of their care but were respected when they chose not to engage in specific conversations about aspects of care. The manager ensure family members were involved to ensure people’s best interests were known and acted on.

Activities were meaningful and led by people’s preferences.

Staff morale was high, turnover low, and the team worked well together.

The manager and staff had worked hard to ensure the culture remained strongly focussed on the needs of individuals and ensured they felt cared for in a place they considered home.

All staff confirmed the management of the service was open, collaborative and approachable. We found the manager had successfully balanced strong oversight of the service with a hands-on approach to helping people who used the service on a day to day basis.

Further information is in the detailed findings below.

This unannounced inspection took place on the 15 and 22 August 2016. The service was last inspected on 6 September 2013 when the provider met all the standards inspected on that date.

Midtown House is situated within its own grounds at the centre of the village of Caldbeck. The home provides accommodation and personal care for up to 20 older people, some of whom may be living with dementia.

Accommodation is provided in ensuite bedrooms with additional communal space such as lounges, a conservatory, dining room and specially equipped bathrooms and toilets.

The accommodation is spread over two floors, with access to the first floor via stair lift. Outside there are enclosed garden areas with car parking.

There was a registered manager in post on the day of our inspection visit.

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.

When we spoke to people who lived in Midtown house they told us the staff “are lovely and they always keep us safe”.

People were protected by staff who knew how to keep them safe and managed individual risks well. Staffing levels were appropriate which meant there were sufficient staff to meet people’s needs and support their independence. There was evidence that staff recruitment and selection was robust and guaranteed only suitable people were employed to care for and support people using this service.

The registered manager was aware of her responsibilities in relation to the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).

The registered manager provided details of the staff training plan that evidenced staff training was up to date. Staff confirmed they received training appropriate to their roles within the staff team.

People had access to external health care services which ensured their health care needs were met. Staff had completed training in safe handling of medicines and the medicines administration records were up to date. Protocols were in place for the receipt and disposal of all medicines that came into the home.

People were provided with sufficient food and drink in order to maintain good levels of nutrition and hydration. People told us “We have a choice of meals and if there is anything we don’t like we can choose something else” and “The food is excellent and all home cooked”. We saw that drinks and snacks were available throughout the day.

We saw that people were included in decisions about their care and were supported to maintain their independence and control over their lives.

People’s privacy and dignity were respected at all times and they had access to an advocacy service if this was necessary.

Staff knew the people who lived in Midtown House well and we saw very warm caring interactions between the staff and the people they supported.

People had their care and support needs kept under review. Staff responded quickly when people’s needs changed, which helped to ensure their individual needs were met.

The management and staff at the home worked well with external agencies and services to make sure people received care in a consistent way.

There was an appropriate system in place to records complaints. People told us they never had cause to complain.

The registered manager had developed a strong and visible person centred culture at Midtown House. Staff were fully supportive of the aims, values and vision of the service.

Notifications of accidents and incidents required by the regulations had been submitted to the Care Quality Commission (CQC) promptly by the registered manager.

Quality assurance and audit systems were used to monitor and assess the service’s performance and to drive a culture of improvement.

During this visit to the home we looked at the way in which people were supported with their nutritional needs and their medication needs. We looked at the staff recruitment processes in place at the home to make sure that the people who used this service were supported by suitable care staff.

We looked at a sample of records, including care records, medication records and records relating to the running and maintenance of the home. We spoke with people who used this service, some of the visitors to the home as well as members of staff, including the manager.

The sample of records that we looked at showed that people who used this service were appropriately cared for and supported. We found that records had been reviewed and kept up to date as people’s needs and requirements changed.

We found that the home was well maintained and kept in a clean and hygienic condition. Staff had been recruited safely. People who used this service were generally well protected from the risks of harm or injury.

A health care professional who was visiting the home told us that staff “acted appropriately and called for help and support when needed.” They had “no concerns” about Midtown House.

Other visitors to the home commented that their relatives “were very happy here” and that they thought their relatives received “good care.” One person said “The communication between myself and the home is very good. I am kept up to date. I have no concerns or complaints and if I had I would speak to the owner. I am confident that any worries would be sorted out quickly.”

People who lived at Midtown House told us that they were “very comfortable” and that everyone was “very nice and friendly”. People told us that the “food was excellent” or “very good.” One person said “The food is home cooked and there are always choices.” Another person said “The food is very good, there is always plenty to eat and drink. The food is cooked nicely, just as you would cook it yourself at home.”

People told us about their involvement with the home and that their choices were respected no matter how insignificant they might seem. Examples of what people told us included:

‘I have my favourite newspaper delivered everyday’.

‘Staff do everything I ask for’.

‘I like my tea in a cup and saucer, not a mug. Staff bring this for me’.

One of the people we spoke with told us that ‘I am still getting used to my condition but staff manage it very well’.

Another said; ‘nothing is too much trouble for staff and I am not made to feel as if it is either.’

We were also told that ‘it is very nice here; we are very well looked after’ and ‘I am very happy here. My room is comfortable and I have been able to bring some of my own things into the home with me.’