Archived: Maddalane Care Home

Updated 21 October 2017

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

We visited the care home unannounced on 06 December 2016. The inspection team consisted of two inspectors and a pharmacy inspector.

Before our inspection we reviewed the information we held about the home. We reviewed notifications of incidents that the provider had sent us since our last inspection. A notification is information about important events, which the service is required to send us by law. We spoke with the local authority safeguarding team and Commissioners.

During our inspection, we spoke with six people living at the service, one visitor, three members of care staff, a house assistant (domestic/helper), the chef, the deputy manager, the business manager and the provider. We observed care and support in communal areas and people's lunch time experience. We spoke with people in private and looked at eight care plans and associated care documentation, 11 medicine administration records (MARs). We assessed the environment for safety, and looked at staff recruitment and training records.

After our inspection because of identified concerns we raised safeguarding alerts as needed with the local authority. We also contacted local authority Commissioners, a GP practice and an occupational therapist.

Updated 21 October 2017

The overall rating for this service is 'Inadequate' and the service remains in 'special measures'.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

We carried out a comprehensive inspection on 05 August 2016 and the service was placed into ‘special measures’. We asked improvements to be made to ensure people’s care records were accurate, changes to people’s health was referred to relevant external services promptly and people were protected from risks associated with their care. We also asked that people’s medicines were managed safely, infection control practices were adhered to and people’s human rights were protected. In addition, we requested effective governance systems were put into place to assess, monitor and improve the ongoing quality of the service, and that the provider informed the Commission of all significant events in line with their legal obligations.

Action was also required to improve the leadership and culture of the service, social activities and vary food choices, protect people’s privacy and dignity, review staffing levels, respond promptly to people’s changing care needs, work in collaboration with external professionals, and learn from mistakes and safeguarding investigations.

We carried out a focused inspection on 06 December 2017 this was because we had received concerns in relation to the management of the service, medicine administration, and the recruitment of staff. We were also told the temperature of the service was not always warm, and people were not being supported safely with their moving and handling needs. The provider was requested to take action to improve the management of people’s medicines, ensure people were protected from risks associated with their care and address the recruitment practices of staff; As well as taking action to improve the leadership and culture of the service, to inform the Commission of significant events and implement effective governance systems.

Following both inspections, the provider sent us action plans telling us how they intended to meet the associated regulations. During this inspection we looked to see if improvements had been made. We found some action had been taken, but further improvements were required.

We carried out an unannounced comprehensive inspection on 30 May 2017. Prior to our inspection the Commission had received concerns that people were being unsafely supported with their mobility, food was not always handled hygienically and people were not always spoken to in an adult manner.

Maddalane Care Home provides care and accommodation for up to 14 people. The service is on two floors, with access to the upper floor by stairs or a stair lift. Shared facilities include bathrooms, a lounge, a dining room, and a conservatory and patio area. All bedrooms have en-suite facilities.

On the day of the inspection there were only two people living in the home because the local authority were not commissioning with the service. The local authority safeguarding team had an adult protection plan in place to make sure people were receiving safe care. This meant people were being visited three times a week by local authority care staff.

The provider managed the service and was registered with the Care Quality Commission. However, had employed a new manager and deputy manager to assist them with the day to day running of the service. 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.

People were not always protected from risks associated with their care. For example, risk assessments were not always in place to provide guidance and direction to staff about what action to take and staff had not always received essential training in order to keep people safe. This meant people were at risk of not being supported safely. People’s medicines were not always managed safely despite the provider introducing a new medicines system, a new policy and a quality checking process.

People’s care plans had been re-written since our last inspection to help ensure they provided guidance and direction to staff about how to meet their individual needs. Staff, told us they felt people’s care plans were now much improved and were reflective of the care people required. However, although action had been taken to make improvements, some care plans still did not provide staff with accurate information about how to meet people’s needs. This meant people’s needs may not be met consistently.

People lived in an environment which had been assessed to ensure it was safe. However, training courses relating to the health and safety of people had not been completed by all staff. The provider told us related subjects were covered in staff inductions, but future training courses would be booked in order to make sure staff were fully trained to meet people’s needs.

People and their families told us they felt safe living at the service. People were supported by sufficient numbers of staff to meet their needs. Recruitment checks were carried out to ensure staff working with vulnerable people, were suitable. However, gaps in employee’s previous employment were not always scrutinised.

People were protected from abuse because staff knew what action to take if they were concerned about a person’s wellbeing. The provider had implemented a safeguarding audit to help identify themes to ensure improvements were made within the service. However, the provider and new manager continued not to learn from safeguarding investigations in order to keep people safe.

People were protected by infection control practices. The service was free from odour. The kitchen had been awarded five stars. The highest rating available. However, the provider’s quality checks had not identified leftover food was not always dated when placed into the fridge.

People and relatives told us staff looked after them well. People and relatives told us staff looked after them well. However, all staff were not always trained in subjects specific to people's individual needs. For example, dementia, nutrition, skin care and to respond to certain types of seizures. Following our inspection the provider told us immediate action had been taken and training had been booked.

People’s human rights were protected. People's care plans recorded their mental capacity. People’s consent to care was obtained. People and or their families had been involved in reviewing their care plans and had consented to the care and support they were receiving.

People were supported to eat and drink and were offered a variety of different meals. People’s changing health care needs were not always recognised and responsive action was not always taken to involve external professionals as necessary. Clinical decisions were not always made in consultation with external professionals.

People and their relatives were complimentary of the caring ethos telling us, “Very good here, it’s a nice home”. Staff spoke respectfully to people and in an adult manner. People’s privacy and dignity was respected. People’s family and friends could visit at any time and were warmly welcomed by staff. People and / or their families told us they felt involved in decisions relating to care and support, and their views were respected.

People’s social activities were tailored to their individual preferences. Volunteers had been engaged to improve the quality of the social care provided.

The provider had a policy to help investigate complaints effectively. The new manager told us they would ensure the policy was in a suitable format for everyone to understand.

The provider’s new monthly audits had failed to effectively assess and monitor the service, in order to help identify areas requiring improvement. Policies and procedures were being re-written and staff were being asked to read and sign to confirm their understanding, however these were not always being followed.

The new manager was engaging with people and their families, and there was a suggestions box in place. Families told us they were happy with the leadership of the service and told us they were seeing some positive changes to the service.

The provider and management team were honest and engaged with the inspection process and they told us they were committed to improve the service. The provider had improved their knowledge of when to notify the Commission in line with their legal obligati