CQC report explained · a residential care home
What the CQC found at Middleton Lodge
Rated Good: inspectors found the home performing well and meeting their expectations.
What inspectors found, October 2023
Middleton Lodge rated Inadequate and placed in special measures; inspectors found serious problems with safety, records and management despite some recent improvements.
Inspectors visited on three days in July, including two unannounced visits. They spoke with people, relatives, staff and visiting professionals. They reviewed care files, medicines records, incident reports, training records and quality checks.
The home was not safe. Equipment was not always checked, care plans and risk assessments were out of date, and medicines guidance and records were incomplete. Infection control checks also missed dirty and rusty bath chairs.
The home had caring staff and staffing had become more consistent. People were accessing the community more, and the garden had improved. However, care was not always based on people's current needs, preferences or goals, and staff training and supervision were not consistently up to date.
The overall rating fell from Requires Improvement to Inadequate. The home is in special measures, so CQC will keep it under review and normally re-inspect within six months unless it takes other action.
More consistent staffing
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
Kind relationships
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
Improved garden
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
Acting manager's approach
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
Unsafe equipment and risk checks
seriousHoist 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
Medicines records
seriousInstructions 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
Out-of-date care information
seriousCare 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
Weak management checks
seriousThe 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
Privacy and dignity
needs fixingInspectors 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
- 01Have all people's care plans and risk assessments been updated, and how do you check staff are following them?
- 02What changes have been made to medicines guidance, records and checks since the inspection?
- 03Have all hoist slings and other equipment been checked, labelled and provided with clear instructions?
- 04Which staff training and supervision requirements were outstanding, and have they now been completed?
- 05What quality checks are now in place for incidents, safeguarding, infection control and management oversight?
This inspection assessed all five CQC key questions and included infection prevention and control; inspectors also continued gathering information from staff, relatives and professionals until 13 July 2023. This explanation was written from the published report of 11 October 2023 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, January 2023
Rated Requires Improvement, with well-led rated Inadequate; inspectors found risks in medicines, care planning, staffing and dignity.
The inspection was unannounced and took place on 23 and 28 November 2022. One inspector spoke with people living at the home, relatives, staff and managers. They toured the home and checked care records, medicine records, staff files and quality checks.
Inspectors found that people were not always supported safely or in a personalised way. Care plans were out of date, medicine records had gaps, some staff training had expired, and agency staff did not always know people's needs. Some people's dignity, access to activities and independence were not consistently supported.
There were some positive findings. Safeguarding systems were in place, infection control arrangements were considered suitable, and people could keep in touch with relatives. The provider accepted the shortfalls and began making some environmental changes during the inspection.
The overall rating fell from Good at the previous inspection to Requires Improvement. All five areas were rated Requires Improvement except Well-led, which was rated Inadequate because the home's checks and management had not identified or dealt with problems effectively.
Safeguarding
Safeguarding systems were in place. Concerns were referred to the local authority and staff knew how to recognise and report abuse.
“Concerns were raised as safeguarding alerts with the local authority for investigation.” from the report
Infection control
Inspectors were assured about infection prevention, outbreak management, PPE, testing and visiting arrangements.
“We were assured that the provider was preventing visitors from catching and spreading infections.” from the report
Recruitment checks
The provider had completed appropriate recruitment checks and safety induction before staff and agency workers started.
“Safe recruitment processes had been followed for staff employed by the provider.” from the report
Healthcare links
People had contact with healthcare professionals and referrals were made when needed.
“Other healthcare professionals worked with the people who used the service and referrals were made where needed” from the report
Medicine records and checks
seriousMedicine administration records were incomplete and some medicines were not dated when opened. Audits were not done regularly, so problems were not reliably found.
“Medicines Administration Records (MAR's) were not always completed and we found gaps in administration records and there were no incident reports for these gaps.” from the report
Out-of-date care plans
needs fixingCare plans did not always contain current information, dietary guidance, communication details or achievable goals. Some records did not show that planned activities were taking place.
“People's care plans did not always contain person centred details and enable people to progress, plan or achieve outcomes.” from the report
Staff training and agency use
needs fixingSome training had expired and staff had not been trained in all the needs of people living at the home. A high level of agency use and limited induction affected person-centred support.
“Effective person centred inductions were not always carried out with new agency workers which meant they did not have time to get to know people and their communication and person-centred needs.” from the report
Dignity and personal care
seriousInspectors found examples of personal care not being completed properly and equipment not being used discreetly or in line with best practice.
“People's personal care needs were not always met; one person's fingernails were extremely long, and their clothes had been put on them back to front.” from the report
Access and activities
needs fixingSome people were not supported to access the community as planned. Parts of the home were not fully accessible, and communal areas lacked a homely feel.
“Some people were not supported to go out often at all.” from the report
Weak management oversight
seriousThe home's monitoring systems did not identify or address important problems. There was also no recent recorded engagement with people or relatives about their views.
“The quality assurance processes in place were not always carried out therefore did not give oversite of the service.” from the report
- 01What has changed in medicine administration records, medicine audits and checks on opened liquid medicines and creams?
- 02Which staff have now completed or refreshed training in medicines, epilepsy, diabetes, learning disability, autism, mental capacity and deprivation of liberty safeguards?
- 03How do you make sure agency staff receive a proper induction and understand each person's communication and care needs?
- 04How are care plans now kept up to date, including dietary needs, hospital information, personal goals and planned activities?
- 05How are you supporting each person to access the community, use the home independently and maintain their dignity during personal care?
This was an unannounced inspection covering all five key questions and infection prevention and control; all five ratings were assessed during this visit. This explanation was written from the published report of 19 January 2023 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of Middleton Lodge
6 rated inspections over 8 years: the service has slipped, from Good to Inadequate.
- October 2023Inadequatecurrent ratingdown from Requires improvementSafe: InadequateEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Inadequate
- January 2023Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Inadequate
- November 2021Inspected but not ratedSafe: Inspected but not rated
- January 2019Goodstayed GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- July 2017Goodup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- June 2016Requires improvementdown from GoodSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- October 2015GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- August 2014
Report published without a new overall rating.
- December 2013
Report published without a new overall rating.
- January 2013
Report published without a new overall rating.
- April 2012
Report published without a new overall rating.
- September 2011
Report published without a new overall rating.
- August 2011
Report published without a new overall rating.
- January 2011
Registered with the Care Quality Commission on 28 January 2011.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
Weigh the report against the rest
Fees, photos and reviews from families
How to read CQC ratings and reports
What to check when you visit
36 live-in carers within about an hour of Darlington
These are self-employed carers on PrimeCarers, the introductory agency that runs this directory. Each has a profile with their own rates and reviews from families, and you choose who to talk to.
Most charge £970 to £1,230 a week. 35 can care for a couple. 11 years' experience on average.
“Petty introduced herself to Mum every time she was caring for her and responded very quickly to Mum if she was distressed in the night.”
Every carer has had an enhanced DBS check in the last 18 months, ID and right-to-work checks and an online interview. Their skills and training are for you to check with them. Carers set their own rates, and who is free changes week to week.