Archived: Maddalane Care Home

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 an unannounced comprehensive inspection of this service on 05 August 2016. After that inspection we received concerns in relation to the management of the service, medicines 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. As a result we undertook a focused inspection to look into the concerns. This report only covers our findings in relation to those topics. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for (location's name) on our website at www.cqc.org.uk.

Maddalane Care Home provides care and accommodation for up to 14 people. On the day of the inspection 11 people were living at the home. Maddalane Care Home provides care for older people. The provider managed the service and was registered with the Care Quality Commission. 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’s medicines were not always managed safely. The systems and process which were in place did not ensure people received their medicines in line with prescribing guidance. People were given time to take their medicines and staff showed respect and patience.

People were not protected from risks associated with their care. People who required support with their mobility were not always supported by staff who had been trained to use equipment, such as hoists and stand aids. People’s care plans were not always being followed.

People’s healthcare needs were not always referred to relevant healthcare services in a timely manner. Risks associated with people’s nutrition were not always managed to ensure they received responsive care and support.

People were supported by staff who had not been recruited safely to ensure they were of good character and safe to work with vulnerable people. The temperature of the environment was suitable, and daily checks had been put in place to ensure it was to people’s satisfaction.

The provider was not always open and transparent during our inspection. This did not reflect the requirements of the duty of candour. The duty of candour is a legal obligation to act in an open and transparent way in relation to people's care and treatment.

The provider did not have effective quality monitoring systems to help identify when changes to people's care occurred and when action was required. Quality monitoring systems were not in place to help develop and improve the service.

The provider had not always informed us of significant events in line with their legal obligations, for example we had not been informed that someone had sustained a fracture.

After our inspection because of identified concerns we contacted the local authority safeguarding team. The local authority took immediate action to ensure people’s health, safety and wellbeing.

We found breaches of the regulations. You can see what action we told the provider to take at the back of the full version of the report.

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 an unannounced comprehensive inspection of this service on 5 August 2016.

Prior to our inspection we had received information of concern that people were not being treated kindly by the provider and the meals were of a poor standard with little choices. We were also told people were not always able to have a shower when they chose to, the heating was not always turned on, there were poor infection control and medicine practices, and a shortage of staff. The local authority had also informed us that five safeguarding alerts had been raised in relation to people’s care.

Maddalane Care Home provides care and accommodation for up to 14 people. On the day of the inspection 12 people were living in the home. Maddalane provides care for older people.

The provider managed the service and was registered with the Care Quality Commission. 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 told us there were not always enough staff to meet their needs. People were not always protected from avoidable harm and abuse because the provider did not implement recommendations from safeguarding investigations and did not learn from mistakes. People’s privacy was not always respected as some people told us they were unable to have appointments or visits in private. People were not always treated with respect and dignity. People and relatives told us the care staff were kind, but also mentioned some staff showed more compassion than others.

People were at risk of the spread of infection because people’s soiled laundry was not always handled in line with infection control guidelines, and moving and handling equipment which was shared, was not always cleaned between use. Staff were not always trained in correct infection control practices and the provider’s knowledge about infection control was limited.

People’s medicines were not always managed, administered and stored safely. Staff who were left in charge of the service in the absence of the manager or provider, were not always trained to administer people’s medicines. This meant people’s medicines were being pre-potted; an unsafe practice which was not in line with National Institute for Clinical Excellence guidelines (NICE).

People were not always protected from risks associated with their care because risk assessments were not always in place to provide guidance and direction to staff about how to keep people safe. People who were moved in wheelchairs were not always supported to use the footplates; this meant people were at risk of tipping forward and falling out.

People were not protected by the Mental Capacity Act 2005 (MCA) which meant their human rights were not always supported or respected. Where decisions were being made for people, there was no evidence to show that best interests meetings had taken place to ensure the least restrictive options were being considered. People told us there was not always enough to do to occupy their minds and to keep them entertained.

People were not always given a choice about what they would like to eat. People told us they liked the meals, but the quality sometimes varied. People’s specialist diets were not always known or recorded to ensure they were supported correctly. People’s weight was monitored; however action was not always taken to seek advice when someone had lost weight.

People’s changing healthcare needs were not always referred to relevant healthcare services promptly to ensure they received responsive care. External healthcare professionals also raised concerns that there had been delays in obtaining people’s medicines and responding to advice given.

People’s healthcare needs were not always known by staff. People did not always have care plans in place to provide guidance and direction to staff, ensuing their needs were met in line with their wishes, preferences and advice from external health and social care professionals.

People, relatives, staff and some external health and social care professionals told us they did not feel the service was always well-led. The Commission shared people’s, staff’s and relatives’ feedback with the local authority safeguarding team.

The provider did not always work constructively with external health and social care professionals. Safeguarding matters were not always dealt with in an open and transparent way. The provider was not always open and transparent during our inspection. For example, the Commission did not always get the correct information about people’s care. This did not reflect the requirements of the duty of candour. The duty of candour is a legal obligation to act in an open and transparent way in relation to people’s care and treatment.

The provider did not have effective systems and processes in place to help monitor the quality of care people received. The provider had not always informed us of significant events in line with their legal obligations, for example the provider had not informed us that someone had sustained a fracture. People’s feedback about the provider was shared with the local authority safeguarding team.

We found breaches of the regulations. You can see what action we told the provider to take at the back of the full version of the report.

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

We considered our inspection findings to answer questions we always ask;

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well-led?

This is a summary of what we found-

Is the service safe?

People told us "The finest staff you could find anywhere, I couldn't want for anything'; 'It's fantastic here, one of the best things is the hygiene"; " We are very well cared for and well looked after"; and " I can't fault anything, very clean, I enjoy living here, I'm very happy."

We spent time talking to people at the home and observed people being supported and cared for in the lounge and in their bedrooms. We saw staff moving people using the correct equipment as described in their care plan and noted all interactions between staff and people who used the service were respectful and people's dignity was maintained.

We saw in people's care files that prompt referrals for advice and support were made for people when their health deteriorated and the home acted on the advice given. People told us without exception that they felt safe at the home and that there was sufficient staff on duty to meet their needs.

The staff we spoke to could not communicate a good understanding of the Mental Capacity Act 2005 or the Deprivation of Liberty Safeguards. However, they demonstrated their ability to carry out their responsibilities to protect the people they supported, through good understanding of people's care records.

CQC monitors the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The Manager demonstrated they understood this process and told us that they had not had to submit any formal applications.

Is the service effective?

People told us that they were happy with the care that had been delivered and their needs had been met. We spoke with nine people who used the service, comments included: "I like to go out and the staff respect my wishes', 'You only have to look at everyone's faces to know how nice the staff are, they are always happy and smiling.'; 'When I came here, I was asked what I liked and what I disliked, I said that I don't like cheese and I've never been given cheese, if cheese is on the menu I'm always offered an alternative.' and 'I am never rushed, everything is at a pace I'm comfortable with.'

The staff we spoke to demonstrated sound knowledge of the needs of the people they cared for, they were well trained and supported in their roles. We saw that personalised care plans covered all aspects of individual's health and social care needs. The people we spoke with told us they felt involved with all aspects of their care and that their care plans reflected their needs. Care plans and risk assessments were reviewed on a monthly basis.

Is the service caring?

People were supported by kind and attentive staff. All of the people we spoke with told us they felt happy and well cared for. One person said "The staff here are so caring, I feel so well looked after." Another stated 'You couldn't want for a nicer place. The staff are so friendly and caring.' We observed staff laughing and joking with people who used the service; staff showed genuine compassion, concern and patience.

Care plans were person centred and highlighted people's interests, skills and diverse needs. Staff communicated people's needs and interests to us. This meant care was provided in accordance with people's needs and wishes.

Is the service responsive?

People completed a range of activities in and outside the service regularly. The home supported people to attend the activities they enjoyed to maintain their social interests.

People knew how to raise concerns, how to make a complaint and who to speak to if they were unhappy. No one we spoke with had any complaints. People told us that they were confident staff would listen and act upon any concerns they might have.

Detailed care plans and daily notes demonstrated that where staff did not have the knowledge themselves, they sought professional advice in order to respond to people's change in need immediately and ensured people's wellbeing was maintained. Risk assessments were then produced in response to problems that occurred and detailed notes made on how to manage that person's care in the future.

Is the service well-led?

Maddalane Care Home worked well with external health care professionals and social care agencies to ensure people's needs were met. Staff told us that they understood their roles and responsibilities, felt confident to seek advice from senior colleagues and felt supported by the management team.

There was no quality assurance system in place, therefore people's views were not being obtained. People told us no residents' meetings had taken place and as a result they had not been able to discuss important issues to them such as food and activities.

Audits were not conducted. Therefore the provider could not demonstrate how they identified areas where improvement might be required to improve the service.

We found there were no procedures in place to gain people's views. This meant the provider did not have systems in place to improve their service through listening to people's feedback.

There was no evidence that learning from incidents took place. The Manager acknowledged this and was in the process of putting in place an action plan to resolve this as quickly as possible.

We reviewed the care records for two people currently living at the home and saw that they were offered care that ensured their individual needs were met.

Staff told us that they liked working at Maddalane House and that they felt supported by their manager. They told us and we saw that they had sufficient training to be competent in their role as a carer.

People who use the service were asked for their views about their care and people were able to raise any concerns with the staff or the manager and were confident that action would be taken to address the issue.

We talked with two people who lived at the home. One person told us,' Its excellent here' and 'I am enjoying it very much'.

Another person told us 'Everyday is a happy day here, we have a laugh and if not we have a smile'.

We spoke with one staff member and the registered provider. Staff told us they enjoyed working at the home.

We looked at the care records for four people using the service and found them to be accurate and suitable for purpose.

We looked at the systems in place to monitor the quality of the service. We found that auditing systems were in place and efforts had been made by the registered provider to monitor the service and address any problem found.