Madeira House

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question Requires Improvement. At this assessment the rating has changed to Good. This meant people were safe and protected from avoidable harm. At our last assessment, we found the service was in breach of legal regulations in relation to staffing. At this assessment we found enough improvement had been made and the provider was no longer in breach.

This service scored 66 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

The provider responded to concerns raised at our last assessment and made improvements at the service. This demonstrated a positive learning culture. Staff understood the process for reporting and recording incidents. One staff member told us, “If someone has a fall, we press the emergency call bell for assistance. We record the incident on [care planning software] and tell the senior. Incidents are then investigated by leaders.” Safety events were reviewed and learning was shared with team members during meetings and other communication mechanisms. The registered manager was open and honest throughout this assessment and implemented immediate improvements when shortfalls were highlighted. Feedback from people and their relatives supported our judgement of a positive learning culture at the service. One person told us, “A lot has changed since [registered manager] has come and for the better too. I feel a lot more listened to now and it is just better all-round.”

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services. Prior to admission, an assessment of people’s needs was completed. This involved the person, their relatives and other professionals involved in their care to ensure their needs could be met by the service. One relative told us, “The referral situation was brilliant and smooth. The registered manager was fantastic, they came to do the assessment at the hospital and spoke with [relative] and the nurse, they both loved [registered manager]. They [registered manager] gathered all the info they needed. It was so smooth.” Staff and leaders had a good understanding of people’s needs, which helped to establish and maintain safe systems of care.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect.

The provider shared concerns quickly and appropriately. People were protected by effective safeguarding processes. These were supported by the provider’s policy and procedures. Staff were trained in safeguarding and had good knowledge on how to identify and report signs of abuse or harm. People and relatives told as they felt safe at the service and spoke positively about the leaders and care staff. One relative told us, “[Relative] feels very safe with staff. The only thing anyone is in danger of is from being hugged to death. Staff are very good with [relative]." 

People can only be deprived of their liberty to receive care and treatment with appropriate legal authority. In care homes, this can be done through a procedure called the Deprivation of Liberty Safeguards (DoLS), which is part of the Mental Capacity Act 2005 (MCA). We checked whether the service was working within the principles of the MCA and how they managed DoLS within the service. We found that people who did not have the capacity to agree to their care and treatment had the appropriate legal safeguards in place, including Deprivation of Liberty Safeguards (DoLS).

The provider mostly worked with people to understand and manage risks, however there were some shortfalls that needed to be addressed. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Risks related to people’s care and treatment were mostly well-managed. For example, where people required support with moving and handling, measures were put in place to ensure this was delivered safely and the necessary equipment was available. Where people were at risk of developing pressure injuries, regular repositioning was completed and pressure relieving equipment was used. However, risks related to some specific care tasks had not been fully assessed, therefore the registered manager and provider could not be fully assured that all associating risks and required mitigating actions had been considered. For example, there were no risk assessments in place for one person in relation to their diabetes care requirements. For another person receiving care with a stoma, there were no associated risk assessments or care plans in place. Despite this, staff understood people’s care needs and evidence suggested people were receiving safe care and treatment. We raised these short falls with the registered manager during this assessment, and they promptly responded by putting in place all the necessary documentation. People and their relatives were very satisfied with the care they received and felt risk was managed well. One relative told us, “They take time to get the hoist right.”

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.Moving and handling equipment was clean and wellmaintained.Environmental risks wereidentifiedandmitigated. Whenspillageshappened,and these were promptly cleanedupanda wet floor sign was used.The provider wasin the process of makingsignificant improvements topeople’s living environment.Renovations anddementia friendly redecorationswerebeing completedtoa high standard,and incomplete areasof the service had signs up to inform people there were works scheduled.People’s private bedrooms were comfortable and personalised.Feedback frompeople and theirrelativesabout the environment was positive.One relative told us, “A lot of the rooms have been re-furbished. There was a funny smell in myrelative’s room, which has gone since a new carpet was fitted.[Register manager]isstrictabout hygiene.”

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs. The registered manager had worked hard since our last assessment to develop a permanent staff team and reduce the services dependency on agency staff. This improved safety and continuity of care. One person told us, “Staff are better than previously. Things have changed. There used to be agency staff, so the service is a lot more settled now staff are permanent.” Another person told us, “Now that the staff are permanent, it is more settled and calmer.”

Staff were competent and received training related to the needs of people using the service. For example, staff were trained to understand Parkinson’s disease and Dementia, and how to support people with specific health conditions impacting safe eating and drinking. However, evidence suggested that not all staff had received training on how to support with a person’s stoma. The registered manager had arranged for the district nurses to provide specific health care training for a select group of staff, but unfortunately this did not include all staff delivering this care. We raised this with the registered manager, they responded promptly by assigning all staff an online training course. Despite this evidence suggested the person received safe care with their stoma. Feedback from people and their relatives indicated they felt there were enough well-trained staff. Safe recruitment processes were in place and these were supported by provider policy.

The provider mostly assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly. Care staff wore personal protective equipment when required and this was readily available. Hand wash facilities were available and well stocked, and antibacterial hand sanitizer dispensers were well placed and stocked to promote effective had hygiene.

Service cleanliness in people’s private rooms and living spaces was good. Bathrooms and toilets were cleaned regularly, and malodours were well managed to ensure people were provided with a pleasant environment to live in. However, some areas of the kitchen were visibly dirty and not all staff working with food were wearing appropriate hygiene equipment. For example, the microwave was very dirty and was damaged, making it unsafe for use. The kitchen bin, deep fat fryer and some areas of the floor under countertops were visibly dirty. We raised this with the registered manager and they took prompt action to make and plan improvements in the kitchen area.

The provider mostly made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened. We observed safe medicines administrations of people’s daily prescribed medicines, including the safe management of controlled drugs. People’s medicines were well stocked, stored safely, and medicines records were completed effectively.

People had personalised care plans in place to provide staff with suitable guidance on how to meet people’s medicine needs effectively. However, there was no available guidance in 1 person’s care plan regarding covert medicine administrations. This means they were given their medicines in their food without their knowledge. The service had been instructed to do this by the person’s medical professionals and had completed the necessary assessments. We raised this with the registered manager, and they responded promptly by updating the person’s care plan to include this essential guidance. Evidence suggested the person was receiving safe care and treatment.