Madeleine House

We found the following examples of good practice.

¿ Visitors were screened for symptoms of Covid-19 and were required to complete a lateral flow test on their arrival to ensure their visit could take place safely in line with current guidance.

¿ People had been supported to maintain contact with people who were important to them. Virtual family meetings and a virtual Christmas carol concert had taken place.

¿ A Perspex screen was used during some visits. Use of the screen meant people could meet with their visitors in a safe and comfortable environment.

¿ Staff wore their PPE correctly, but this made some people feel anxious because they were unable to recognise the staff who were caring for them. Staff wore a photograph of themselves on a lanyard around their necks which reminded people who they were. This had a positive impact people on people’s wellbeing.

¿ People had been involved in creating a ‘video tour’ of their home. The video had been shared with potential new admissions to help them decide if the home was the right place for them to live.

¿ Staff including housekeepers worked in specific areas of the home which reduced the risk of cross infection. They spoke positively about using ‘walkie talkies’ to effectively communicate with each other and share information.

¿ Cleaning schedules had been increased to monitor cleanliness of the environment. A 'fogger' cleaning machine had been purchased and was used to complete deep cleans of the environment. Use of the machine meant areas that were difficult to clean by other techniques were sanitised.

Madeleine House is a care home registered to accommodate up to 41 people, some of which were living with dementia. The home also provides short stay interim beds (EAB) for people discharged from hospital, who may require further assessment of their care and support needs before returning to their own home or another care home. Madeleine House is a purpose-built home with bedrooms situated across two levels with lift access to the first floor. At the time of our inspection 40 people were living at the home. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided and both were looked at during this inspection.

There was a registered manager in post at the time of the inspection. 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 our previous inspection in September 2017, we had rated the service under the key questions is the service safe, effective, caring, responsive and well-led as ‘requires improvement’ and found they were not meeting fundamental standards. At this inspection, there had been sufficient improvements to improve the rating to ‘good’.

People were protected from the risk of abuse and avoidable harm because staff knew what action to take and the provider had safeguarding systems and processes in place to keep people safe. People were supported by sufficient numbers of staff who were kind and respectful and had the knowledge they required to care for people safely. The provider’s recruitment processes were robust and ensured the necessary security checks were completed to make sure persons employed by the provider were safe and appropriate to provide care and support to people living at the home. People received support from staff to take their prescribed medicines. Systems and processes were in place to ensure medicines were managed safely and only staff who had undergone training were permitted to administer medicines.

Staff received supervision and appraisals, providing them with the appropriate support to carry out their roles.

People and their relatives were involved as much as practicably possible alongside healthcare professionals, to ensure that any decisions made in respect of their care and support needs, were done so within their best interest’s and in accordance with the Mental Capacity Act 2005.

Where people were assessed to lack the capacity to consent to the support they received, the provider followed key processes to ensure the care being provided was in the least restrictive way possible. Applications had been made to safeguard people against the unlawful deprivation of their liberty, where necessary. People’s privacy, dignity and independence were respected.

People were supported to maintain a healthy diet with choices of different foods available and all their health needs were met with the support from staff and healthcare professionals. Staff knew people well and people felt they received care and support from staff that had the skills to meet their needs. There was a complaints process in place and where there had been complaints, these had been addressed. Appropriate action had been taken to reduce risk of reoccurrences. People and relatives were complimentary about the management and staff.

People were relaxed and were supported by staff and the management team to maintain relationships that were important to them. There were activities that provided opportunities to optimise people’s social and stimulation requirements. The home was in the process of implementing a programme of change to the environment to ensure it was more ‘dementia friendly.’

People and relatives had received satisfaction questionnaires to comment on the quality of the service being delivered. Everyone spoken with told us they would not hesitate in recommending Madeleine House to others.

Systems in place to monitor and improve the quality of the service had improved to ensure people received a good and continually improving quality of service.

Madeleine House is a residential care home providing accommodation and personal care for up to 41 people, some of which were living with dementia. The home also provides short stay interim beds (EAB) for people discharged from hospital, who may require further assessment of their care and support needs before returning to their own home or another care home. At the time of our inspection 40 people were living at the home.

It is a legal requirement that the home has a registered manager in post. There was a registered manager in post. 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 our previous inspection in June 2015, we found that for the questions is the service safe, effective, caring, responsive and well-led, we rated the provider as ‘good.’ At this recent inspection, we identified areas of the service that required some improvement.

Systems in place to monitor and improve the quality of the service were not consistently effective in ensuring people received a good and continually improving quality of service. The audits had not identified the issues we found. They had not always been consistently applied to ensure where shortfalls had been identified, they were investigated thoroughly and appropriate action plans put into place to reduce risk of reoccurrences.

Staff were trained to identify signs of abuse and supported by the provider’s processes to keep people safe. However, staff did not always follow the provider’s own safeguarding procedures when unexplained bruising or marks were noted on people’s bodies. Potential risks to people had been identified and appropriate measures had been put in place to reduce the risk of harm, although the information contained within some risk assessments was not always effectively communicated to staff. People were supported by sufficient numbers of staff but they were not always effectively deployed around the home. People were supported to receive their medicines as prescribed. Although protocols to support staff on when to administer medicine that was required on an ‘as and when’ basis were not consistently in place.

Where people lacked the mental capacity to make informed decisions about their care, relatives, friends and relevant professionals were involved in best interest's decision making. However, mental capacity assessments and best interest decisions were not always applied consistently to clearly show what decisions people were being supported or asked to make in relation to their care. Applications had been submitted to deprive people of their liberty, in their best interests; therefore, the provider had acted in accordance with the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).

We saw staff treated people as individuals, offering them choices whenever they engaged with people. Where people had the capacity to make their own decisions, staff sought people's consent for care and treatment and ensured people were supported to make as many decisions as possible.

People spoke positively about the choice of food available. People were supported to eat and drink enough to maintain their health and wellbeing, although the overall meal experience required some improvement. People were supported to access health care professionals to maintain their overall health and wellbeing. People’s health care needs were assessed and regularly reviewed. Relatives told us the management team were good at keeping them informed about their family member’s care.

People and relatives told us that ‘some’ staff were kind, caring and friendly and treated people with respect, although there were occasions when people’s dignity was not maintained. People were relaxed and were supported by staff and the management team to maintain relationships that were important to them. There were activities that provided opportunities to optimise people’s social and stimulation requirements although they were not always suitable for those living with dementia. People and their relatives told us they were confident that if they had any concerns or complaints they would be listened to and matters addressed quickly.

The provider’s recruitment processes were robust and ensured the necessary security checks were completed to make sure persons employed by the provider were safe and appropriate to provide care and support to people living at the home.

People and relatives had received satisfaction questionnaires to comment on the quality of the service being delivered. The management team had started to put in place systems to gain feedback from people living at the home, relatives and visitors through group meetings. People, their relatives and staff told us the management of the home had improved with the arrival of the new registered manager.

People felt they received care and support from care staff that had the skills to meet people’s needs. Staff received supervision and appraisals, providing them with the appropriate support to carry out their roles.

We found one breach in the legal requirements and regulations associated with the Health and Social Care Act 2008. (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

All of the staff spoken with was able to tell us about people's needs so that they received care in a way that they preferred. Both relatives told us they were consulted about their relative's care and kept informed about their relative's health so they felt involved in their care. One person told us, 'The food is nice, my flat is clean and staff are nice so I am ok '.

We saw that people had a choice of meal each day and people religious and cultural needs were being met. One person told us you can have what you want really If you ask they will sort it out for you'.

Staff told us they had a range of training so that they have up to date knowledge and skills in order to support the people who live there.

The provider was in the process of seeking people views about the service provided. The manager told us when all the information had been collated a analysis would be completed and action would be taken where need.to improve the service for people living there.