Madeira Lodge

On this page

• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

People were not always treated with respect and kindness. This was a continued breach of Regulation 10 (Dignity and respect). People’s cultural and religious needs were respected. The provider had systems and processes in place to promote and support staff wellbeing. Staff told us they received appropriate support.

This service scored 45 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People gave us positive views. A person said, “The staff are nice and they are kind.” Another person told us about a member of staff they really liked, “He is a very nice man and my favourite staff member”. We observed that the person’s face lit up when the staff member entered the room and when the staff member walked over to the person and shook their hand. Relatives said, “The carers are lovely and polite”, “All the staff are very good and very kind. Staff knock on doors and he says they always do that” and “Staff are very nice and kind, they are kind to me as well, they speak to him really nicely and kindly. Staff will always have a chat and have interactions.”

Staff detailed how they treated people with kindness and compassion. A staff member said, “I keep their door closed when I am supporting someone with personal care, and shut their curtains, put towels on their body to keep them warm and I always explain what I am doing and reassure them.” What staff told us they would do to maintain dignity is not what we always observed in practice.

A healthcare professional told us they felt staff did not always treat people with kindness, dignity and respect. They gave an example about a person who was on the end of life pathway and had become poorly over a weekend. Staff at Madeira Lodge had called the Out of Hours team and informed them the person was end of life and they subsequently they attended the care home. On this occasion the person was just very thirsty and once they had given the person a drink they sat up in bed and requested magazines. A follow up visit was carried out to check on the person. Again the person was very thirsty and did not have their buzzer so could not call for any help.

We observed people were not always treated with respect and kindness. A person’s bedroom curtains were missing, which meant that when they were in receipt of personal care in their bedroom, their dignity was not protected. It also meant that they were awakened early due to the sun streaming into their room. We reported this to the management team, they told us they were unaware of missing curtains and carried out an investigation. They advised that the curtains had been removed for deep cleaning. Records showed the room had been deep cleaned a week prior to our visit. Staff had not identified the issue and reported it in this time. The day after we visited the management team sent us photographs to evidence the curtains had been replaced. We observed that staff were friendly towards people and each other. There was a relaxed atmosphere within the service. We observed doors to people’s rooms were closed when people were being supported with their personal care needs. Staff knocked on doors before entering.

People told us they were not always treated well. Comments included, “I am not happy with the service I want to move out. I would like to sit in the garden. The staff go out there to have their cigarettes, I am going to take up smoking to get out there. There is more to care than shoving people in their rooms” and “I can’t even smoke outside. It’s a ball ache especially when I see the staff going out the back here to smoke.” A relative said, “They are very compassionate and caring about every individual, nothing is too much trouble for them.” Another relative told us, “[Loved one] notices how kind they are and told me how nice they are.”

The management team gave us examples of how staff worked with people and their relatives to explore their cultural and religious needs as well as their likes, dislikes, wants and needs. A staff member told us, “Relatives are always contacted if there is a change in their relative’s condition and relatives are always welcome, there is an open door here.”

We observed times of the day where staff were sat utilising the garden on their breaks. People were able to see staff in the garden and could not understand why they were not allowed to go into the garden. We observed people trying the door to the garden a number of times and staff did not support people to go out there. Records showed that a lot of people liked to go into the garden in nice weather, either to just sit and get fresh air or to help with some gardening tasks. On the day of our inspection people were not supported to access the garden even though the weather was pleasantly warm and dry.

People’s care plans included likes, dislikes and preferences, but some of these lacked details, particularly in the food and drink preferences sections. One person’s records stated, ‘Staff are to remove their cigarettes and lighter’. Records did not demonstrate that any conversation had taken place with the person or that their consent was obtained to remove these from their possession. There was no mental capacity assessment relating to this. Care documents stated that having a cigarette could calm this person. People’s religious or cultural needs were not always documented. However, there were weekly visits by a person from the local church and people were supported to have visits from other ministers if they wished. People had communication plans in place so staff could help them to be as involved as possible in their care and support, for example, by ensuing people needing glasses or hearing aids had these in and working.

People had mixed experiences of independence, choice and control. People who required support to have a bath, shower or hair wash were not always offered the choice of having one. A person told us, “There is an assisted bath along the corridor. I have not had a bath or a shower or my hair washed since I have been here. I would like one.” Their care records evidenced that they had not had any in the month of August. Another person told us, “I do my own showering, shaving and teeth, I have dentures.” A person said, “I have visits from friends and family.” Relatives told us that staff support their loved one to maintain contact with them.

Staff told us they were well supported and this encouraged a good work life balance. They were happy at work and enjoyed working with people. A staff member said, “Their door is always open, and they are very supportive and are trying to make lots of improvements like a better layout and nicer décor and more detail in the care plans.”

We observed meaningful interactions between staff and people, which showed that staff knew people well and knew how to communicate with them. Staff used respectful language when communicating with people and when talking about the people they supported. Staff called people by their preferred names. We observed people’s relatives visiting the service, some people were supported to answer the door and let them in.

The environment had been adapted with equipment in place to ensure people could be bathed appropriately and moved safely. Protecting their privacy and dignity. Rooms were personalised and individual.

People gave us mixed reviews as to whether their needs were met. A person told us, “I have not seen a doctor or nurse, It is not likely when I haven’t even had my hair done.” Another person said, “I have had a shower, they offer me in the mornings.” Relatives mostly gave us positive feedback. However, a relative told us, “[Loved one’s] clothes are clean, not wet now." They then shared information to explain there had been a situation where staff weren’t changing their loved one's continence aids. This led to the relatives doing this and writing a date on them. When they came back 24 hours later their loved one was was still using the same continence aid. Another relative said, “They all know her and do their best for her.” A relative told us “It is a lovely place and welcoming and I get lots of cuddles from the staff, they are very nice to me and to him.”

People’s needs were not always met, such as, triggers for distress and anxiety were not always documented. Where people had detailed plans of how best to support them through these anxieties, we did not see evidence that the actions had been tried. For example, care records showed that one person who regularly became anxious benefited from being taken into the garden and offered tea and food. Records did not evidence that staff had tried these strategies to support the person. Staff did not always recognise when people needed urgent help, for example, details in care plans advised staff when to seek assistance from healthcare professionals, but staff did not always act on these instructions in a timely manner. The registered manager told us that staff were receiving additional training in managing people’s anxieties and distressed behaviours.

We observed staff responding to people’s needs in a timely manner. Call bells were answered quickly and staff discreetly supported people who required support with their personal care.

Staff told us they received good support from the management team and the provider. Staff told us they had regular supervision sessions where they could raise any concerns and attended regular meetings. Staff spoke positively about teamwork and training. The registered manager told us they were planning in the future to assign some staff as ‘champions’ for areas such as infection control or dementia care to give staff more responsibility and a structured progression pathway.

The provider had systems and processes in place to promote and support staff wellbeing. The registered manager told us that there were strict standards that they expected staff to adhere to and some staff had left the organisation. Recruitment had been good and there were no vacancies apart from one activity coordinator who was going through the recruitment process and was due to start imminently. Agency staff were no longer deployed routinely. Staff were supported with additional training opportunities, including training in caring for people living with dementia, positive behaviour support and some bespoke training relating to one individual person.