Madeira Lodge

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

People were unable to recall being involved in their assessments and care planning processes. Some relatives told us they had been involved in the assessment and care planning process. Before people moved into the service their needs were assessed. The provider had systems and processes in place to meet people’s nutrition and hydration needs, however these were not always effective. People told us the service worked with GP’s and health professionals to meet their health needs. The provider had a clear process in place to escalate health concerns. Staff had a good understanding of meeting people’s changing needs. Care plans were in place which detailed people’s care and support needs as well as their clinical needs in relation to health conditions. People's choice and consent was not always valued. Staff continually consulted people about their wellbeing and wishes, some people’s wishes were not respected.

This service scored 67 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People were unable to recall being involved in their assessments and care planning processes. A person said, “I have not been asked anything.” Some relatives told us they had been involved in the assessment and care planning process when their family member first moved to the service. Comments included, “I put his likes and dislikes in” and “Right from the beginning, from the minute he went, they let me know of everything.”

People had face to face assessments once they had been referred to the service. These were usually done by the registered manager. Family members were contacted and encouraged to be involved in the initial assessment. The registered manager preferred people and their families to visit Madeira Lodge before making their decision, but this was not always possible. Care plans were started, using the information gained at the assessment together with referral documents from the hospital or local authority. Care plans were further developed once the person moved into the service. Staff told us they had access to the assessments and care plans on their hand-held devices and could read these at any time. Assessments and care plans were reviewed and updated regularly. Changes to people’s care needs were passed on at handover meetings and documented in handover notes on the electronic systems, which all staff had secure access to.

There was inconsistency in assessing people's needs. Some people had risks and needs that had not been fully assessed as detailed in the safe key question and some people’s needs had been assessed and documented, including health needs, personal care and communication. The provider used recognised tools for assessing some risks, such as nutrition and skin integrity. The provider had processes in place for updating care plans using a ‘resident of the day’ approach. This ensured that each person had at least one full review each month. The electronic systems produced reminders and flags when reviews or important events were due, for example, when someone was due to be weighed.

We received negative feedback from people about the food. Comments included, “The food here is mundane. I have not had a cooked breakfast in 2 years since I have been here. I have not had egg or bacon it 2 years it’s ridiculous”; “They forgot my meal initially and I didn’t get pudding. Boiled potatoes were ok, fish was not good”; “It was ok. It was the usual sort of stuff [we observed the person eat 4 forkfuls of carrots and 2 small potatoes].” We observed a staff member tell other staff to save 1 person a meal because they had been forgotten about on the other side of the building (the same person who told us they had been forgotten). We observed people being supported to have their breakfast very late in the morning and then being offered lunch 2 to 2.5 hours later. People were not hungry and did not eat their food which was scraped into a waste bin. No consideration had been made to save food to be offered at a later time to give longer gaps between meals. The nominated individual for the provider told us if a person did not want their lunch, then this meal will be thrown away, but a fresh plate was always made up for them and kept in the kitchen until the person was ready to have this. People had their meals in the dining room, lounge and in their bedrooms. The menu board in the dining area listed choices of food but this did not reflect the food that was available and being served. A relative told us, “He loves his food. They are good and give him extra. He eats like a horse. They have a choice of foods. I have been here when they are asking what he would like. I have eaten here; it was very nice.” A relative told is, “He needs reassurance with food, yesterday we came and we fed him, he ate the lot. If you leave food next to him he often won’t eat and can’t see it all that well. He has lost a lot of weight (at least a stone since February).” We observed staff giving this person food at lunchtime and leaving it next to them, they did not eat the food.

Staff responsible for supporting people with their food did not always have a good understanding of people’s assessed needs in relation to type and texture of food. Staff told us they helped people to make their meal choices if they needed it.

The provider had systems and processes in place to meet people’s nutrition and hydration needs, however, these were not embedded and robust. A person’s care plan and risk assessments provided conflicting information about their choking and swallowing risks. Records of food and fluid taken by people were not always complete. For example, a person’s fluids recorded across 9 days in August showed that they had only drank more than 1 litre of fluids on 1 occasion. Other recordings for daily intake ranged from 0mls to 545ml. Records suggested that when the person has a urine infection it can increase their agitation. Insufficient fluid intake can lead to urinary tract infections. Whilst information was available in other care plans about what modified diets people were prescribed following The International Dysphagia Diet Standardisation Initiative (IDDSI) framework. The IDDSI guidance was also available in the kitchen to staff responsible for preparing, cooking and serving meals.

People told us the service worked with GP’s and health professionals to meet their health needs. Relatives confirmed they were kept informed about changes in their loved one’s health needs. They said, “They usually come and talk to me about things. I can’t think of a specific, just things like a chest infection and they tell me” and “He occasionally he has anti-biotics as he has water infections. They tell me about water infections.”

Staff worked with health professionals such as dementia nurse specialists to ensure people got the care and support they needed. The registered manager told us they worked in partnership with local health and social care teams.

A healthcare professional told us, ‘A member of staff from Madeira Lodge is present at appointments and The Home Visiting Team always talk to the patient and the member of staff who is with them to ensure that there is an understanding of the outcome. The Home Visiting Team will advise the care staff if treatment will be issued to ensure they are alert to its arrival. This is particularly important if it is antibiotics as they need to be commenced as soon as possible.’ Feedback was shared that although processes were in place in relation to unexpected deaths, the service had not always followed these which led to delays in coroners referrals being made.

The provider had a clear process in place to escalate health concerns within a timely manner. However, feedback gained from healthcare professionals indicate these processes were not always robust. For example, there had been delays in reporting changes in people’s health. A healthcare professional told us about an incident where The Home Visiting Team had to raise a safeguarding concern in relation to a person who had a grade three pressure ulcer. The person had been under the District Nursing Team for the pressure ulcer until it healed. The staff at the service had not reported to the District Nursing Team that the pressure area had broken down again. This meant there was a delay in gaining treatment. This could have been avoided through effective communication as the District Nurses were still visiting the service and dressing another pressure wound on a different part of the person's body. After the assessment the safeguarding was closed with no further action. The nominated individual told us 'The home reported the ulcer twice, and followed up their referrals when the district nurses did not attend. Prior to the district nurses attending, the Home implemented pressure boots and repositioning this resident every three hours.' However, another example of delays in reporting changes in people's health was the Home Visiting Team raised concerns about a person who they found with a significant traumatic wound to their upper arm. They believed the wound to be a skin tear. The person had told the health care professional that staff had caused it. Madeira Lodge staff were unaware the wound had occurred. The healthcare professional raised a safeguarding alert about this to the local authority.

People were supported with their healthcare. A person said, “I have seen the doctor about the cough.” Relatives told us, “They are responsive in picking up health changes, recently she’s had a lot of UTIs (urinary tract infections), they keep pushing to have fluids.” A relative told us about their family member becoming unwell, “They got the doctor same day. He suffers from UTIs and they get the doctor.”

Staff had a good understanding of meeting people’s changing needs. Staff members told us, “I stay with them if they are poorly and closely monitor them if they are in their room” and “To minimise the person becoming unwell, I keep an eye on their nutrition and keep people hydrated and involve them in.”

People living in the service had access to other health care professionals, such as GPs, dietician’s and specialist nurses.

People received support from staff when health clinicians assessed their health needs. One person told us they had experienced some pain with their teeth but this had now been resolved. We observed a staff member checking with a person to see if they had tooth pain as they were holding their jaw/face. The person told staff they were not in pain and they were holding their face out of habit.

Staff told us they had training and support to meet people’s care and health needs. A staff member said, “Manual handing is face to face as well as online, and I have recently done first aid and CPR (Cardiopulmonary resuscitation) training.”

Care plans were in place which detailed people’s care and support needs as well as their clinical needs in relation to health conditions. For example, where a person had high blood pressure or diabetes. The care plan provided clear information about their care and support needs were and what staff needed to do.

People's comments about their choice and consent were mixed. Some people felt it was not always valued. Staff continually consulted people about their wellbeing and wishes. Some people told us they felt restricted as they were not enabled to use the garden. A person said, “I can’t even open the back door there because it is locked. I would like to smoke but they don’t allow it. You don’t get any freedom and everything is locked against you.” Another person said, “I make my day-to-day choices. They listen to me.” A relative said, “He can say no and they respect this. They will come back later.” Another relative told us, “They support him and ask him what he wants to do.”

Staff completed Mental Capacity Act (MCA) training and had a good understanding of the importance of consent and upholding people's rights to have choice and control over their lives. Staff said, “It’s about supporting people to make decisions and choices for themselves” and “If they can’t make a decision, like to live here, they have a record of why and I know this is reviewed by the social worker.”

We checked whether the service was working within the principles of the MCA, whether appropriate legal authorisations were in place when needed to deprive a person of their liberty. The service worked within the principles of the MCA and if needed, appropriate legal authorisations were in place to deprive a person of their liberty. When people were assessed as lacking capacity to make decisions appropriate procedures were followed to ensure principles within the MCA were followed. DoLS applications and authorisations were in place for people around any restrictions within their lives that they did not have capacity to consent to. Systems to review these were also in place. People’s consent was documented in their care plans. Information was provided to them in a way they could understand. Staff highlighted risks to people who chose to make unwise decisions about their care. People had decision specific capacity assessments in place and best interest decision were made where necessary. There were clear records about offering people choice and respecting their wishes, for example, to make unwise choices where they had the capacity to do so. Where people did not have relatives, independent advocates were available to support them. Staff asked consent before each care or support interaction. Some people had ‘do not attempt resuscitation’ documents in their records, these decisions had been made in partnership with the person. Where a person had not made this choice, instructions for staff were clear about actions to take in emergency situations to support people’s health.