18 July 2016
During a routine inspection
Madison Court provides accommodation for up to 66 people requiring nursing and personal care and for people living with dementia who require care and support. The service is located close to shops and a bus route into the town of St Helens. Set in its own grounds the service has car parking facilities. At the time of this inspection 64 people were living at the service.
A registered manager was in place. 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.
At the last inspection of the service in July 2015 we found that a number of areas around the service required improvement. We found that people’s medication was on occasions being stored in rooms that were too warm in temperature. During this inspection we found that improvements had been made to controlling the temperatures in the services medication storage rooms.
At the previous inspection in July 2015 we found that assessments of people’s capacity and best interest decisions made under the Mental Capacity Act 2005 had not been recorded. During this inspection we found that improvements had been made in this area. However, we have made a recommendation that the registered provider reviews their processes in place to ensure that assessments in relation to the Mental Capacity Act 2005 contains all of the information required. This is because not all of the documents we saw in relation to people’s decision making contained all of the information required.
We have made a recommendation about monitoring the use of bedrails. This is because we found that although risk assessments had been carried out for the use of bedrails, there was no formal recording system for the monitoring of bedrails in use.
A further recommendation has been made in this report that the registered provider reviews the monitoring systems in place to ensure that they are robust and consider all aspects of equipment and people’s care. This is because we found that the current monitoring systems in place had failed to identify a lack of monitoring of bedrails in use and had failed to identify a lack of information being recorded in relation to people and decisions made under the Mental Capacity Act 2005.
People were protected from the risk of abuse. Procedures were in place to assist staff to identify and report any concerns that they had about a person’s safety. Staff had received training in safeguarding people and they demonstrated a good knowledge of what actions they needed to take if they thought a person was a risk from harm.
Systems were in place for the safe management of people’s medication. Designated storage rooms were available to ensure that people’s medicines were kept safe and records of all medication people received were maintained.
Safe recruitment procedures were in place. Newly recruited staff had attended an interview and produced documents that confirmed their identity. The registered provider had applied for references to demonstrate people’s character and had obtained a Disclosure and Barring Service check prior to a member of staff commencing their employment. These checks helped the registered provider ensure that only suitable people were employed.
People were supported by a staff team who received regular training and support to carry out their role. Staff had undertaken training which included health and safety and safeguarding people. Having access to up to date training helped to ensure that staff had the knowledge to carry out their role safely.
People’s nutritional and hydration needs were assessed and provided for. When a specific need in relation to a person’s nutrition and hydration had been identified their meals were appropriately planned. For example, a number of people received low sugar diets to help manage diabetes. Other people received their foods of a specific consistency so that they could swallow their meals safely. Choices of meals and drinks were available to people throughout the day.
The registered provider had recently sought people’s opinions in relation to the care and support they received. All people had stated that they could choose what time they went to bed, had a choice of a shower or bath and that they felt their clothes were well cleaned and looked after. The majority of people had stated that they were happy with the care provided, were treated with respect and liked the food. A summary of people’s views based on their responses had been created to feedback to people and to also identify areas of improvements that could be made around the service.
The atmosphere at the service was calm and relaxed and it was evident that people had formed strong respectful relationships with others. Staff offered comfort and reassurance by sitting and talking to people and by using positive touch.
Policies and procedures were in place to offer staff guidance and support in decision making in their role. The documents were reviewed and updated on a regular basis to ensure that staff had access to information about current best practice.
Staff demonstrated a good awareness of people’s rights under the Mental Capacity Act 2005. When required, appropriate applications had been made to the local authority in relation to depriving a person of their liberty.
A service user guide was available to inform people and relevant others. This information included details of the services and facilities which people had access to.
The registered provider had a complaints procedure that was readily available to people who used the service. People and their relatives were aware of who they could speak to if they had a concern or complaint. The registered provider had a clear system for recording, responding and monitoring all complaints made about the service.
People had access to meaningful stimulating activities. These activities included group and individual sessions with activities co-ordinators. People had access to a safe garden area in which vegetables, fruit and flowers were grown. In addition, a further gardening project was underway to create an area of sensory stimulation for people. When possible, people were encouraged to access the local community independently, for example, to visit the local barbers and the local shop.
Quality assurance systems were in place to ensure that the service was safe and that people received the care and support they needed. Regular checks were made of equipment, people’s living environment, the fire detection system and care planning documents. When improvements had been identified, changes were made.