Madeira Lodge

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

People had care plans in place, they had not always been involved in developing these. Some care plans were not as detailed as they could be to help staff understand people’s care and support needs. This was a continued breach of Regulation 9 (Person-centred care). The provider had systems and processes in place to understand the diverse health and care needs of people living at the service. The service was supported by the Home Visiting Team from the GP surgery and the GP, all of whom conducted regular visits as well as support by telephone. We observed communicating effectively with people. There were way marking signs and information around the service to help people orientate. Menus boards were available but had not been used to tell people what their food options were. People and relatives attended meetings with the management team to feedback about the service.

This service scored 57 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Some people told us they had not been involved in developing their care plans. A person told us, “They talked to me about my wants and things I like. They put a care plan in place. I have not seen it.” Another person said, “There is no care plan at all. They are trying their best but it’s not good enough.” Most relatives told us they had not been involved in developing care plans or reviewing care. However, 1 relative said, “I have been involved in reviewing care plan.” We discussed activities with people. They told us, “There are things to do. They do games and quizzes”; “I’d like to get out more. I don’t do activities, I spend time watching tv in my room” and “I don’t go to the lounge as there’s nothing going on and its miserable.”

The management team said people were supported to make their own decisions whenever possible. Staff told us people’s care plans were updated frequently. A staff member said, “Care plans are updated and risk assessments as changes happen.” The management team explained they were in the process of recruiting another activities staff member, which would enhance the activities available in the service. A staff member told us, “We have a hairdresser here every Thursday, although she is off for the summer.”

We observed staff supporting people in a person centred way, offering reassurance and kindness. However, we observed that personal care (including nail care and oral care) was not always adequate. We observed people with dirty nails and some people’s teeth were not clean. We observed that no planned activities were taking place. In the activities lounge, one person had a crossword puzzle book, others had colouring books/pens. A few people were reading the paper or a magazine. Care plans were person centred and included individual preferences, likes, dislikes and favoured routines. For example, they included what time a person liked to get ready for bed, what time they liked to get up, how they wanted their personal hygiene needs met and how they liked to spend their day. However, some care plans lacked information and guidance for staff on how to meet people’s needs. For example, staff had not been directed in 1 person’s care plan to offer a shower each day and or hair wash. As it was not in the care plan, staff had not been offering this. The person’s care records did not show that they had been offered a shower. Oral care such as teeth cleaning was missing from people’s care plans. We raised this with the management team, they created oral health care plan and began to implement these during the assessment. People’s care plans reflected their physical, mental, emotional and social needs, including those related to protected characteristics under the Equality Act. People were supported to make their own decisions whenever possible. Visits from health professionals were documented in the care plans or were accessible direct from the GP surgery through the electronic systems.

We observed some good practice with staff responding with kindness and compassion, tailoring their responses to people’s different needs. Staff were courteous and kind with people, listening and respecting their personal choices and were at eye level and speaking quietly and respectfully with people. A person told us, “I have a lot of time for the staff here, they are very kind.” Relatives told us, “There has been new staff and they are all very nice and very good” and “I think they are trying not to take on so many agency staff, they know him and his needs and limitations.”

Staff told us that there was continuity of support for people living at the service. Some staff had worked at the service for a long period of time. The management team told us agency staff were occasionally used to provide care and support when there had been absences, but new staff had been employed which reduced the need for agency workers.

Healthcare professionals told us that Madeira Lodge made regular contact with them but this was not always timely when people’s health changed.

The provider had systems and processes in place to understand the diverse health and care needs of people living at the service. The provider ensured care was joined-up, flexible and supported choice and continuity. For example, when agency staff were used it was staff members that had been used before.

We observed there was some way marking in place to help people navigate around the service. However, not all areas had way marking, the door leading from the main lounge area near the main entrance door did not have way marking to the bedrooms and lift beyond the door. The door to the garden was labelled, however it was partially obscured by other signs. Doors to people’s rooms were the same colour and had little personalisation on the outside. We observed people walking around the service with purpose, they frequently opened doors that were closed and closed people’s bedroom doors when they wanted to have them opened, this caused some anxiety and distress for people at times. Communal areas such as toilets, bathrooms, dining room and lounge were signposted with pictures as well as words and there was some waymarking. There were menu boards on display in both dining rooms. However, one was blank at lunchtime and the other one listed that tuna pasta bake was on offer when that was not what had been cooked.

Staff told us, “People tell us how they feel about things and there are picture cards that we use to help some people, families tell us, and a few people here have advocacy support too.”

Since 2016 all organisations that provide publicly funded adult social care are legally required to follow the Accessible Information Standard. The Accessible Information Standard tells organisations what they have to do to help ensure people with a disability or sensory loss, and in some circumstances, their carers, get information in a way they can understand it. It also says that people should get the support they need in relation to communication. The accessible information standards were followed. Care plans detailed people's communication needs. Complaints processes were on display. People had consented to share their information with professionals and others who needed to access it. Personal information about people was kept confidential on electronic password protected systems. The systems included an audit facility so that any data breaches could be identified quickly and action taken. Meetings were held with people and their relatives regularly and notes from the meetings were shared with all relatives, even those who did not attend. A local update was sent to relatives monthly by the registered manager and newsletters were sent from the provider’s head office every 3 months. Most relatives told us communication in the service had improved since the new registered manager started.

There was mixed feedback from people about how well they were listened to and involved. A person told us they did not know who they would talk with if they had a complaint. Another person said, “I would know to talk to the staff If I had a complaint.” Relatives told us the management team were approachable and listened to them. Comments included, “Managers are approachable, they listened when we asked for [item]. I’ve not had to complain”; “We feel like we are heard. [Registered manager] listens, I can send her an email or pop into the office” and “Very nice and approachable manager and staff, anything I want to say to them I can and they will go and do what I have said.” The service had received a lot of compliments from people which were either displayed on notice boards or filed. People had access to independent advocates where this was requested or needed. Despite the positive feedback from some people, it was clear from people's experiences that they were not always listened to. For example, going out in the garden, smoking and personal care needs.

We observed good practice from staff in relation to listening and involving people with the care and making decisions.

The service had a complaints policy in place with timescales for responses and resolutions. The service had not received any formal complaints this year. The registered manager told us this was because they dealt with them and resolved them immediately, thereby minimising the need for people to escalate their complaints in writing. A people / relatives survey was conducted earlier in the year and several areas for improvement were identified by those who responded. These concerns included people wearing other people’s clothes. This was concern was also reported to CQC by relatives as part of this inspection. The survey also identified improved activities were needed, information not being shared with relatives when something happens; some staff not wearing name badges and not enough use made of the garden with people sitting inside when the weather is fine. The latter two areas were also noted by inspectors during our inspection where we saw several members of staff without name badges and people not using the garden. We could not see evidence or an action plan to address the shortfalls detailed in this survey, neither were these issues included in the continuous improvement plan. We received information from the provider's nominated individual after the inspection/assessment process, that work had begun on improving these areas.

People were supported with medical appointments and follow up appointments. We observed people receiving visits from healthcare professionals during the assessment visit. People’s care records showed that they had received medical help. A relative told us their loved one has visits from healthcare professionals. They said, “A chiropodist also comes, district nurses come in. [Loved one also] sees the eye hospital consultant.”

Staff gave us examples of when they had recognised people were not acting in their usual manner and the action they took. For example, if a person was experiencing high or low blood sugar levels. Staff were knowledgeable about how to recognise signs of deterioration and care said they would report health changes. A staff member said, “If someone is experiencing pain, I will check they can have pain relief like paracetamol, record when it was given and the dose on the MARs (medicines administration chart), and I monitor them closely and encourage lots of fluids. If there is any concern at all, I record this, contact the GP and let the family know.”

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 if important if it is antibiotics as they need to be commenced as soon as possible.”

There were processes in place to ensure that people could receive care, support and treatment when they needed it. The home visiting team assigned to the GP practice carried out regular visits. People were also supported to attend healthcare appointments at the hospital when required.

Some people did not get support with their bathing/showering or hair washing as often as they would like. Care records evidenced this. A relative said, “Her hair needs a wash, it looks greasy and she always had her hair done nicely. She looks clean and does not smell, but her hair is lank.” Other relatives told us, “He is always clean and smells fresh. He likes to be clean and smart. He lets the men shave him using wet shave” and “Mum is always very clean, they ask her when she would like a shower, she has an ensuite in her room.”

We observed that staff used effective communication when supporting people. The registered manager encouraged good team work and staff told us they worked well with all their colleagues.

The registered manager was alert to discrimination and inequality that could disadvantage different groups of people using their services, whether from wider society, or cultural. The registered manager told us that any bullying or inappropriate behaviour is addressed appropriately. Part of the activities programme is to talk about different cultures and provide cultural experiences and food, for example, there was a ‘Jamaica Day’ planned.

Records showed that some people had been supported to plan for important life changes. Conversations with people had taken place about advanced care wishes and people’s wishes had been recorded. A person told us, “They have not talked about death or my wishes.”

Information for staff about people’s wishes were recorded in their care plans. Staff told us, “Everyone’s DNAR (do not attempt resuscitation) status is recorded on their care plan, and we all have access to this via the phone; their DNAR status is also on the board in the treatment room”; “When someone is at the end of their life, I update myself by checking the treatment room board or their care plan” and “District nurses are involved and support the person with us as needed.”

The provider had systems and processes in place to understand the diverse health and care needs of people living at the service. Some people had a DNACPR (Do not attempt cardiopulmonary resuscitation) form in place. This is an advanced decision not to attempt CPR. It is not about other treatments or care. Healthcare professionals gave us 2 examples of the provider’s systems and processes around end of life not being robust. There had been 2 deaths which should have been recorded as unexpected as the people were not known to be at the end of life and had not been seen by a GP. As these were not logged as unexpected there had been a delay in reporting these to the coroner. The healthcare professionals raised these concerns as incidents.