We inspected the service on 7 November 2018. The inspection was unannounced. Middlegate Lodge is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The service accommodates up to six people living with mental health needs, a learning disability or have misused drugs and or alcohol.

On the day of our inspection five people were living at the service.

The service had been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen. However, people were given choices and their independence and participation within the local community encouraged.

At our last inspection on 8 March 2016 we rated the service ‘good.’ At this inspection we found the evidence continued to support the rating of ‘good’ 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.

People continued to receive a safe service. They were protected from avoidable harm, discrimination and abuse. Risks associated with people’s needs including the environment, had been assessed and planned for and these were monitored for any changes. People did not have any undue restrictions placed upon them.

People continued to receive an effective service. Staff received the training and support they required to meet people’s individual needs, including meeting their nutritional needs. Staff worked well with external health care professionals and people were supported to access health services when required. 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 home supported this practice. The principles of the Mental Capacity Act (MCA) were followed.

People continued to receive care from staff who were kind, compassionate and treated them with dignity and respected their privacy. Staff had developed positive relationships with the people they supported, they understood people’s needs, preferences, and what was important to them. Staff knew how to comfort people when they were distressed and made sure that emotional support was provided. People’s independence was promoted.

People continued to receive a responsive service. People were involved with assessing and planning for their care needs and regularly reviewing their progress. They were supported to pursue their interests and hobbies, and social activities were offered. There was a complaints procedure in place and people knew how to use the procedures when required.

The service continued to be well led. There was an open and transparent and person-centred culture within the service. People were encouraged to give their views on how the service was run and there were systems in place to monitor and improve the quality of the service provided.

The inspection took place on 8 March 2016 and was unannounced.

Middlegate Lodge is registered to provide accommodation for personal care for up to six people living with mental health problems, a learning disability or have misused drugs and alcohol. There were six people living at the service on the day of our inspection.

There was a registered manager in post at the time of our inspection. 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 the legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated

The Care Quality Commission is required by law to monitor how a provider applies the Mental Capacity Act, 2005 and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way. This is to protect them. The management and staff understood their responsibility and made appropriate referrals for assessment. No one at the time of our inspection had their freedom restricted under a DoLS authorisation.

People were safe because staff undertook appropriate risk assessments for all aspects of their care and care plans were developed to support people’s individual needs. The registered manager ensured that there were sufficient numbers of staff to support people safely and this varied depending on the activities and events that people were involved in.

People were cared for by staff that were supported to undertake training to improve their knowledge and skills to perform their roles and responsibilities and meet the unique needs of the people in their care.

People had their healthcare needs identified and were able to access healthcare professionals such as their GP, dentist and drug and alcohol rehabilitation team. People were supported by staff to plan, shop and cook healthy and nutritious meals.

The service had a homely family atmosphere and people were at the centre of all decision making about the smooth running of the service. Staff enabled people to be independent and achieve their personal goals for independent living.

People lived busy and active lives and were encouraged to take part in hobbies and interests of their choice. Some people were supported in education, others in work placements, sporting activities and all enjoyed being part of a strong social network.

People had a say in most aspects of the running of the service, including staff recruitment. People and staff attended regular meetings about the continued development of the service.

The registered provider had robust systems in place to monitor the quality of the service, including regular audits and feedback from people. Staff received feedback on their performance through supervision and appraisal.