The inspection took place on 4 December 2018 and was unannounced. The previous inspection was undertaken in December 2017 when we found a breach of regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 with regard to good governance. This was because of some inaccurate documentation with regard to food and fluid charts.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key question to at least good. At this inspection we found the provider had addressed this because documentation was an accurate record of care provided and regular audits ensured continued accuracy with regard to this documentation. The regulation was met.

Middleton Hall 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.

Middleton Hall provides residential care for up to 24 people. At the time of the inspection there were 21 people using the service. The home is a detached building providing accommodation over two floors and is situated in the Middleton area of Rochdale. It is surrounded by a large garden. There is a small car park to the front of the property.

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. There was a registered manager in place at the service.

There were up to date safeguarding policies and staff had safeguarding training. Health and safety measures were in place with regard to environment, fire safety and equipment. People were kept safe within the home via locked doors with key pads, so that people could not just gain access to the building unseen. Accidents and incidents were recorded clearly and were analysed monthly to look at any patterns or trends.

Staffing levels were sufficient to meet people’s needs and the recruitment system was robust. General and specific risk assessments were in place and up to date.

Medicine systems were safe and there had been no medicines errors in the last 12 months. Infection control measures were in place to help prevent the spread of infection within the home. The premises were clean and clutter free and there was signage around the home to assist people with orientation.

Care files included relevant health and personal information. A thorough induction was in place for all new employees and the training matrix evidenced regular mandatory and refresher training. Staff files confirmed regular staff supervision and appraisals took place.

Nutritional and hydration information was recorded and charts, which had not been accurate at the previous inspection, were completed accurately, evidencing no continuing breach of the regulation. Food was plentiful and nutritious and sufficient drinks were offered throughout the day.

The service was working within the legal requirements of The Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS).

Throughout the inspection day we observed staff to be kind, patient and friendly. People’s dignity and privacy was respected by staff. Information was supplied to people in the form of a service user guide. Confidentiality was taken seriously at the home and staff had received training in data protection.

Care files were person-centred and included people’s choices, likes and dislikes. Care plan evaluations were undertaken monthly and people who used the service, and their relatives where relevant, were involved in these reviews.

There was a programme of activities and outings on offer to people who used the service. However, people we spo

Middleton Hall is a care home that provides 24-hour residential care for up to 24 people. At the time of our inspection there were 22 people living at the home. It is a detached building providing accommodation over two floors and is situated in the Middleton area of Rochdale. It is surrounded by a large garden. There is a small car park to the front of the property.

This was an unannounced inspection which took place on 7 and 8 December 2017. We last inspected the service in June 2014. At that inspection we found the service was meeting all the regulations we reviewed. Since then the provider of the service has changed. This was the first inspection for this service under its new provider.

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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At this inspection we found one breach of the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was in relation to inaccurate documentation. You can see what action we have told the provider to take at the back of the full version of the report.

Medicines were stored safely. However, we found there was not always sufficient detail to guide staff contained in the ‘when required’ medicines protocols. We have made a recommendation about this.

There were systems in place to help safeguard people from abuse. Staff understood what action they should take to protect vulnerable people in their care. Recruitment checks had been carried out on all staff to ensure they were suitable to work in a care setting with vulnerable people. At the time of our inspection there were sufficient staff to respond to the needs of people promptly.

The home was clean, well-decorated and well-maintained. Maintenance checks on services and equipment were up-to-date. There were systems in place to protect staff and people who used the service from the risk of fire. Procedures were in place to prevent and control the spread of infection.

All new staff received an induction to the service. Staff had undertaken a variety of training which enabled them to carry out their roles effectively. They received regular supervision which provided them with opportunity to voice any concerns and plan their professional development.

Staff encouraged people to make choices where they were able. The service was working within the principles of the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS).

People were happy with the quality of food provided. People who had poor dietary or fluid intakes had these monitored. However, we found documentation to record this was not always accurate.

People who used the service were complimentary about the staff. We observed kind and caring interactions between staff and people who used the service. Care plans, which were reviewed regularly, were detailed and reflected the needs of each person.

People who used the service and staff spoke positively about the registered manager. There were a range of policies available for staff to refer to for guidance on best practice. Systems were in place to monitor the quality of the service and drive improvement. There was a complaints process in place, although there had not been any complaints during 2017.