Archived: Madeira Lodge Care Home

Madeira Lodge Care Home is registered to provide personal care and accommodation for 48 older people, people who live with dementia and people who need support to maintain their mental health. At this inspection there were 48 people living in the service.

People’s experience of using this service and what we found

People were not protected from harm. We found people had been locked in their bedrooms during the night without their consent and without appropriate legal authorisation. . People did not have full, detailed risk assessments and care plans to enable staff to care for people appropriately. Staff did not follow safe practices when supporting people who needed help to move.

There were significant concerns with the records completed at Madeira Lodge Care home. Care plans lacked detail and had not been regularly reviewed. Some were held on paper records, others on the electronic care planning system, some held on both but did not show the same information. Audits and checks had been completed but were not effective in identifying issues.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. Mental capacity assessments were not completed properly and were not individual to the person being assessed to make the decision.

We had significant concerns regarding the culture of the service. Concerns had not been raised by staff to the management team about poor practice in the service. The registered manager told us they noticed a change in the atmosphere amongst the staff since actions were taken following our unannounced visit but did not recognise the wider culture of poor practice in the service.

Staff were not deployed effectively to meet people’s needs. There were many people who were independently mobile and living with advanced dementia who walked around the service without support or interaction from staff. Staffing numbers were determined by the providers dependency tool, which calculated the numbers of staff required to safely meet people's needs. However, this was not reliable or accurate as people’s needs had not been reviewed regularly to determine if the dependency was still relevant.

Accidents and incidents were recorded, but records lacked details of what action was taken, by who or what was needed to reduce the risk of reoccurrence.

Staff did not have the skills or experience to meet the needs of people who were living with advanced dementia.

The dining experience we observed was not positive. Although people were given a choice of food, there was a lack of staff input to make this a pleasurable experience.

People were not always supported to access healthcare in a timely way. Although we found records of people having follow up review appointments with professionals involved in their care, instructions from professionals were not always followed.

Staff did not always treat people in a caring, personal and dignified way. Language used by staff was not kind and interactions we observed did not always treat people well. Staff appeared to lack skills to manage situations where people were becoming distressed or anxious. There was a lack of resources to ensure all people had the chance to engage in activities to help them interact and socialise. There was one wellbeing coordinator responsible for activities for all people in Madeira Lodge Care Home. People did not always have their social needs met.

Staff were recruited safely and demonstrated good infection prevention and control practice.

The layout of the service was large and spacious and there were a number of communal areas for people to choose to spend their time.

The provider and registered manager had a system in place to appropriately record and investigate complaints which had been raised. The registered manager understood their regulatory requirements to inform the Care Quality Commission (CQC) of significant things which had happened at the service and had completed this.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was good (published 04 June 2021)

Why we inspected

We undertook a targeted inspection to follow up on specific concerns which we had received about the service. The inspection was prompted in part due to concerns received about safety of people, staffing levels and risk assessment and care planning. A decision was made for us to inspect and examine those risks.

We inspected and found there was a concern with the safety of people using the service, governance, mental capacity assessments, DoLS and care plans so we widened the scope of the inspection to become a comprehensive inspection which included the key questions of safe, effective, caring, responsive and well-led.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to people’s safety, abuse, person centred care, safeguarding, mental capacity, record keeping, effective checks, audits and staffing at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.

The provider applied to remove this location from their registration in order to register it under a new company. This was completed following this inspection. We will use the findings from this inspection to inform the regulation of the new provider for Madeira Lodge

Madeira Lodge Care Home is registered to provide personal care and accommodation for 28 older people, people who live with dementia and people who need support to maintain their mental health.

At this inspection there were 23 people living in the service. Some bedrooms had been decommissioned due to building works to complete a large extension.

People’s experience of using this service and what we found

People told us they were safe at the service and well supported by staff. A person said, "The staff are good girls. They’re kind to me." A relative said, “I have the highest regard for the home. They’re doing a lot of building at the moment and so things on the outside look a bit messy but the care is spot on. It’s the care that counts.”

People were safeguarded from the risk of abuse. People received the personal care they needed and medicines were managed safety. There were enough staff and lessons were learned when things went wrong.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Quality checks had not identified and resolved a small number of shortfalls we found relating to environmental risks and the safe recruitment of staff. After we spoke with the registered manager these shortfalls were quickly put right.

People and their relatives had been supported to suggest improvements to the service. Regulatory requirements had been met and good team-working was promoted.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was Requires Improvement (published 25 June 2019). The service was in breach of regulations of the Health and Social Care Act 2008. There were shortfalls in the systems and processes used to monitor and evaluate the service. The registered provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had been made and the registered provider was no longer in breach of regulations. However, further improvements were still needed to the way some quality checks were completed.

Why we inspected

We undertook this focused inspection to gain an updated view of the care people received. This was a planned inspection based on the previous rating. This report only covers our findings in relation to the Key Questions Safe and Well-led.

The inspection was also prompted in part by notification of a specific incident. Following which a person using the service sustained a serious injury. This incident may be subject to a criminal investigation. As a result, this inspection did not examine the circumstances of the incident.

The information CQC received about the incident indicated concerns about the management of falls. This inspection examined those risks.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infectious outbreaks effectively.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from the previous comprehensive inspection for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has improved to Good. This is based on the findings at this inspection. Please see the Safe and Well-led sections of the full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Madeira Lodge Care Home on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Madeira Lodge is a residential care home that provides personal care and support for up to 28 older people, some of whom have dementia. At the time of our inspection there were 23 people living there.

People’s experience of using this service:

People told us they felt safe at Madeira Lodge. Relatives we spoke with felt staff knew people well and understood their support needs.

Potential risks to people’s health and welfare had been assessed, there was guidance for staff to reduce risks and keep people as safe as possible. However, some environmental checks and audits had not been fully effective. This was because some planned safety checks had lapsed and other checks had not resulted in risk being reduced. Additionally, fluid monitoring measures, intended to support people to drink enough were not sufficiently developed to support people effectively. Management oversight of the service had not identified or addressed these concerns and was not therefore effective.

We observed people being treated with kindness and compassion. People were supported to be as independent as possible.

Medicines were stored, managed and administered safely; improvements suggested during the inspection were put in place immediately.

People’s needs were assessed and used to develop a care plan. These were reviewed regularly and, where possible, people agreed their care plan and they and their relatives were involved in reviews.

Accidents and incidents were recorded, investigated and action taken to reduce risk. Risk assessments were reviewed and updated to ensure they were effective.

People told us there were enough staff to support them as they preferred. Staff had been recruited safely and they received appropriate training and supervision.

Staff and the registered manager understood their responsibility to protect people from abuse. Staff spoken with could explain how any suspected abuse would be reported.

People were encouraged to make decisions about their care and how they spent their time. They received access to healthcare professionals and were supported to be as active as possible.

People knew how to complain and were comfortable to raise any issues with the registered manager.

Rating at last inspection:

The service was rated Requires Improvement at the last inspection on 07 February 2018 (Report published 20 April 2018). This service has been rated Requires Improvement at the last two inspections. This is the third consecutive time the service has been rated as Requires Improvement.

Why we inspected:

This was a planned inspection based on the rating at the last inspection.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Madeira Lodge is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. Madeira Lodge is registered to accommodate care and support for up to 28 older people. At the time of the inspection there were 25 people living at the service.

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.

We last inspected the service on 8 and 9 January 2017, the service was rated as requires improvement. There were three breaches of regulations at this inspection. These were the lack of information written in the care plans which did not always reflect people’s assessed needs and preferences. Risks had been assessed but not always mitigated to keep people as safe as possible and the systems in place to monitor the care being provided were not effective.

At this inspection new personalised care plans had been implemented with additional information; however these had not always been updated to reflect the care being provided. Detailed risk assessments were in place but lacked information about how to manage the risk and what further action should be taken to keep people safe.

Checks and audits were being carried out regularly by the registered manager and staff but these audits had not identified the shortfalls found at this inspection. Therefore, the breaches identified at the last inspection had only been partially met.

The registered manager worked in partnership with other professionals, such as people’s care managers and the mental health team. However they had not informed the local authority safeguarding team of an incident which occurred at the service. We have made a recommendation about consulting the local authority safeguarding protocols.

Medicines were not always managed safely. Accidents and incidents were recorded and analysed by the registered manager. However further analysis was required to show that previous falls and incidents were taken into account to reduce the risk of them happening again.

People’s needs had not always been assessed when they came into the service for a short period of time (known as respite care) and detailed care plans were not in place for these individuals. People were supported to eat and drink, however. records of people’s fluid charts were not clear to confirm that people were receiving enough fluids to keep them hydrated.

People’s preferences of how they wished to be cared for at the end of their life were not consistently recorded. We have made a recommendation about seeking advice and guidance from a reputable source about end of life care planning in line with current guidance.

All staff had completed ‘on line’ training courses, however there was no practical face to face training for topics such as moving and handling, challenging behaviour and first aid, to show the practical element and assess staff competency. There was a lack of detail in the complaint records to confirm what action the provider had taken and whether complaints were resolved in a satisfactory manner.

Checks on the premises had been made to ensure it was safe and the provider had ensured that the environment was suitable for people living with dementia.

The registered manager had not always notified the Care Quality Commission, as required by law of events that happened in the service such as safeguarding and when serious incidents occurred.

Staffing levels were sufficient at the time of the inspection and rotas showed that the staffing levels were consistent. New staff had been recruited safely and the necessary checks carried out to make sure they were safe to work at the service. The service was clean and tidy and systems were in place to reduce the risk of infection. Staff were observed wearing protective clothing such as gloves and aprons.

Health care professionals were contacted when people needed additional support, such as the mental health team and district nurses. People were supported to see the optician and the chiropodists regularly visited the service.

People were not always supported to have choice and control of their lives. Staff did not have the full guidance to support them in the least restrictive way possible; the policies and systems in the service were not always clear to support this practice.

People were treated with kindness and respect. Their privacy and dignity was maintained. Staff promoted people’s independence and encouraged them to do things for themselves.

There was a varied programme of activities for people to enjoy and the service was being supported by an outside agency to promote engagement and social activities. There was a dementia cinema, a family support group and wellbeing exercise programme.

The provider had a clear vision of how to provide the service however the culture of the service was not always inclusive. There was no evidence to show how people had been involved in menu planning or easy read information provided to support people living with dementia to complain.

People and relatives told us they were satisfied with the service and the quality of care being provided. They told us that communication with the registered manager was ‘good’ and ‘excellent’. The registered manager knew the people well and they worked alongside staff to assess the quality of care being provided.

Staff told us they felt supported by the registered manager who was always available for support and guidance. The latest rating of the service was on display in the entrance hall and on the provider’s website.

We found two continued breaches and two further breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have asked the provider to take at the end of this report. This is the second time the service has been rated Requires Improvement.

Madeira Lodge Care Home provides accommodation and personal care for up to 28 older people who may have dementia. At the time of the inspection 27 people were living at the service, although two were temporarily in hospital. Where vacancies occurred the service will take people for respite care. The premises are detached and accommodation is provided over two floors. To the rear of the building is a well maintained enclosed garden. Bedrooms are set over two floors with access via a passenger lift. Each person has a single room, with three rooms having ensuite facilities (toilet and wash hand basin). There are three shower/wet rooms and an assisted bathroom. People tend to access the main lounge/diner/conservatory although there are further quiet seating areas and another lounge. There is limited parking, with additional on street parking at the end of the driveway. Madeira Lodge is close to the sea front, local bus routes and shops.

The service is run by a registered manager. 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.

People and relatives all spoke positively about the service received and were happy with the quality of care and support provided.

Risks associated with people’s care and support had been assessed, but there was not always sufficient information recorded in assessments to show how staff kept people safe.

People and/or relatives were involved in the assessment and the initial planning of their care and support. However the level of detail in people’s care plans needed to be improved to ensure people received care and support consistently and according to their wishes. People told us their independence was encouraged wherever possible, but this was not always supported by the care plan.

There were audits and checks undertaken to ensure the service was effective. However shortfalls identified during the inspection had not been identified as requiring improvement and action was not always taken in a timely way to address shortfalls that had been identified.

People received their medicines when they should. People’s health was monitored and they had access to appropriate health professionals to ensure good health. People had a varied and healthy diet.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Where people were restricted DoLS authorisations were in place or had been applied for. People were supported to make their own decisions and choices and these were respected by staff. Staff had received training in the Mental Capacity Act (MCA) 2005. The MCA provides the legal framework to assess people’s capacity to make certain decisions, at a certain time. When people are assessed as not having the capacity to make a decision, a best interest decision is made involving people who know the person well and other professionals, where relevant. The registered manager demonstrated they understood this process.

People were protected by safe recruitment procedures and had their needs met by sufficient numbers of staff. People were relaxed in staff’s company and staff listened and acted on what they said. People were treated with dignity and respect and their privacy was respected. Staff were kind and caring in their approach.

New staff underwent an induction programme, which included shadowing experienced staff, until staff were competent. Staff received training relevant to their role. The registered manager worked ‘hands on’ and regularly observed staff working. In addition staff had some opportunities for one to one meetings, team meetings and appraisals, to enable them to carry out their duties effectively. Most staff had gained qualifications in health and social care.

People had opportunities for a range of activities, which they enjoyed and on occasions went out and about into the community. People did not have any concerns, but felt comfortable in raising issues. Complaints had been taken serious and were used to improve the service. There were opportunities for people to give feedback about the service provided.

The registered manager worked ‘hands on’ and they took action to address any concerns or issues straightaway to help ensure the service ran smoothly. Management and staff worked as a team to help ensure people received good care and support.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have asked the provider to take at the end of this report.

People told us that the staff were kind and that there were enough staff to meet their needs. Staff spoke with people in a calm, positive reassuring manner. The provider had a robust recruitment procedure and suitable checks were carried out on prospective staff prior to them working at the service.

People maintained good health as the service worked closely with health and social care professionals. Activities were provided which were advertised and people had support to take part in meaningful activities in the home and at a day centre run by the provider.

People were treated with respect and their dignity and privacy maintained. A visiting relative told us that they felt their relative was safe and had the care and support they needed.

The provider had systems in place to monitor the quality of care people received.

At our previous inspection we found that there were incidents of potential abuse that the provider had failed to report to the local authority safeguarding team. We also found that the provider had not appropriately recorded some of these incidents in people's care records.

At this inspection we found that the home had reviewed their local procedures to include and reflect the recording and reporting requirements to protect vulnerable people from the risk of abuse or the possibility of abuse.

We found that care plans contained mental capacity assessments for those people who lacked capacity to make some decisions for themselves.

We spent some time in the lounge and dining area of the home, where most people who used the service spent their time during the day. We made observations of people and the staff who supported them. We spoke to four members of staff, as well as the manager overseeing the service, who was the registered manager of another home owned by the provider. The overseeing manager had been covering the service for some months in the absence of a permanent manager.

People we spoke to all stated that they were happy with the service and relatives told us they were involved in discussions about the care and support provided. People told us they could choose how they spent their time during the day and that the staff knew and understood their needs.

In this report, the name of the registered manager appears who was not in post and not managing the regulatory activities at the home at the time of our inspection. Their name appears because they were still registered with us at the time of our inspection.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time.

People told us they were very happy with the care they received at Madeira Lodge. Some people said staff had discussed their care and support needs with them. People told us they could make their own decisions regarding their day to day lives. People said there were enough staff on duty and that staff came when they needed help. They said all the staff were friendly and helpful. Some people told us that staff asked them occasionally if they were happy living at the service.