Madeira Lodge

Updated 14 March 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was carried out by 2 inspectors on 1 December 2022. One inspector carried out a remote review of evidence on 6 and 7 December 2022 and visited on site again on 8 December 2022.

Service and service type

Madeira Lodge is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Madeira Lodge is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was a registered manager in post.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service. We sought feedback from the local authority, including their safeguarding team, commissioners, and professionals who work with the service. As the service had registered as a new legal entity, we had not asked the provider to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make.

We used all this information to plan our inspection.

During the inspection

We spoke with 4 people who used the service and 4 relatives about their experience of the care provided. We observed the care provided within the communal areas. We spoke with 7 members of staff including the registered manager, operations director, deputy manager, senior care workers and care workers.

We reviewed a range of records. This included 7 people's care records and multiple medication records. We looked at 2 staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.

Updated 14 March 2023

About the service

Madeira Lodge is a residential care home providing accommodation and personal care to up to 48 people. The service provides support to older people with varying care needs including, dementia, diabetes and mental health needs. At the time of our inspection there were 45 people using the service.

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

People were not always protected from harm. Processes to keep people safe from abuse were not followed robustly by staff. Individual risks were not always assessed appropriately, and safe measures were not in place to manage and mitigate risk.

People’s needs were not always assessed accurately or kept up to date to make sure people received safe and appropriate care. Staff supporting people received mandatory training but required a further development of skills to be able to meet people’s specific needs. Healthcare advice was not always sought in a timely way, putting people at risk of deterioration in their health. People had a choice of food, but their dining experience was not always positive and dignified.

People’s care was not always person-centred, and people were not always supported to maintain interests and hobbies to prevent boredom and to provide stimulation. Plans to support people with their wishes at the end of their life were not always in place.

Staff told us they could raise concerns and be assured action would be taken. However, there was evidence staff had not always raised concerns of potential abuse. The provider and registered manager believed there to be an open culture, but evidence, including investigations held by health and social care professionals did not always show this.

Monitoring and auditing processes were in place to check the quality and safety of the service. These were not always successful in picking up issues that needed action taken.

Some staff had worked long hours which meant people may not always receive good quality care. We have made a recommendation about this.

We were only somewhat assured that people were kept safe by infection prevention and control processes in place. Systems to learn lessons through incidents were not always robust

People were somewhat supported to have maximum choice and control of their lives and staff at times supported them in the least restrictive way possible and in their best interests; the policies and systems in the service somewhat supported this practice. We have made a recommendation about this.

People’s prescribed medicines were administered and managed safely.

Some people were supported to maintain and improve their independence.

A suitable complaints process was in place. The provider had not received any complaints. The provider had engaged with people, relatives and staff to keep them updated about important information and gain their views.

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 provider registered with CQC under a new legal entity, on 14 November 2022. The service continued to run with the same nominated individual, management team and staff team under the new legal entity. The last rating for the service under the previous legal entity was inadequate, published on 24 January 2023.

This is the first inspection under the provider’s new legal entity.

You can read the report from our last comprehensive inspection under the providers previous legal entity, by selecting the ‘all reports’ link for Madeira Lodge on our website at www.cqc.org.uk and choosing ‘old profile’.

Why we inspected

The inspection was prompted due to continuing concerns received from health and social care professionals about people’s care and their access to prompt healthcare. A decision was made for us to inspect and examine 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 infection outbreaks effectively.

Enforcement and Recommendations

We have identified breaches in relation to the management of risk, keeping people safe from abuse, accurate record keeping, person centred care, dignity and respect, and monitoring and oversight at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will also request an action plan to understand what they will do to improve the standards of quality and safety. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

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 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.