Madeira House

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

Well-led – this means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture. At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement. This meant the management and leadership was inconsistent. Leaders and the culture they created did not always support the delivery of high-quality, person-centred care. The service was in breach of legal regulation in relation to governance at the service.

This service scored 61 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Shared direction and culture during this assessment. The score for this quality statement is based on the previous rating for Well-led.

The previous registered manager had not understood the context in which the provider delivered care, treatment and support. They did not always embody the culture and values of their workforce and organisation nor had the skills, knowledge, experience and credibility to lead effectively. Staff felt communication needed to improve between senior managers and themselves and were concerned about the continuity of support while there was no permanent manager in post. One staff member told us, “We don’t see head office all that often, there is not much communication, so I don’t think they do much for us to be honest. The staff are amazing, we are a good team.” Another staff member said, “There needs to be a permanent manager to provide leadership for the staff to feel part of a positive team. At the moment there is only a temporary manager which cannot provide secure leadership.” However, despite these concerns, the new manager and senior leaders worked with integrity, openness and honesty and had identified areas that needed to be improved. Staff appreciated the new manager and agreed with all the changes, saying they felt more valued and less micro-managed.

Staff did not always feel they could speak up and that their voice would be heard. Staff told us when they had spoken up, they did not believe they had been listened to or that action had been taken. One staff member told us, “I don’t think [senior managers] are aware. I think a lot has been brushed under the carpet or ignored and when we go to them with a problem we get ignored as well.” People and relatives felt that concerns raised had often also gone unanswered and they were not listened to. Relatives told us they had not been asked for their views or feedback about the service. However, they told us this had changed since the new manager was in post. One relative said, “When we do have questions it is really assuring that the new manager is always available and deals with things at once.” Another person said, “I know the temporary manager is approachable and have spoken to them.” The provider had processes in place for people and staff to speak up and these were monitored. They were in the process of reviewing recent survey outcomes, which they told us would be shared with staff and people to inform them of what action they had taken following feedback.

We did not look at Workforce equality, diversity and inclusion during this assessment. The score for this quality statement is based on the previous rating for Well-led.

Systems to monitor quality and identify concerns were in place. There were clear roles and responsibilities at provider and manager level and the provider was quick to act on risk and performance and share this information where relevant. The provider had been very open about areas for development and how they would achieve their plans. Good quality care and effective staff support had not been delivered during the time of the previous registered manager. Changes in management and plans that were not yet fully implemented meant quality was not yet evidenced as applied to practice and sustained. We understood this would take time to do meaningfully. Staff were hopeful about the future but told us they would like better communication and to build relationships with all senior managers to enable confidence to raise concerns and make suggestions to improve the quality of care. One staff member told us, “The new manager is approachable and listens. The home most definitely was not well managed with the previous manager.” Another staff member said, “The new manager is really nice but we hardly see or hear from head office staff. They are coming down now, but we are not at all confident to approach them if we had a concern. They don’t really talk to us unless there's a problem. We need more staff meetings with them in it. We haven't had a staff meeting in ages.”

The provider understood their duty to collaborate and work in partnership, so services worked seamlessly for people. They shared information and learning with partners and collaborated for improvement. One professional who worked closely with the service told us, “The care I have witnessed in the home has been very good. Compassionate care is provided by the carers in Madeira House. All the senior staff are very good at escalation. The new manager is very approachable and willing to work with us. New equipment has been ordered and in the care home in a timely manner. I have no safeguarding issues within the home from my perspective. All the staff are very approachable and willing to listen to any information which we advise at the time of our visits. I think all staff would benefit in some basic wound care training on how to apply simple dressing and correct dressings.” The provider had already acted on this advice and had arranged for staff to attend training on wound management. Staff were keen to participate and learn from this.

The provider understood their duty to collaborate and work in partnership, so services worked seamlessly for people. They shared information and learning with partners and collaborated for improvement. One professional who worked closely with the service told us, “The care I have witnessed in the home has been very good. Compassionate care is provided by the carers in Madeira House. All the senior staff are very good at escalation. The new manager is very approachable and willing to work with us. New equipment has been ordered and in the care home in a timely manner. I have no safeguarding issues within the home from my perspective. All the staff are very approachable and willing to listen to any information which we advise at the time of our visits. I think all staff would benefit in some basic wound care training on how to apply simple dressing and correct dressings.” The provider had already acted on this advice and had arranged for staff to attend training on wound management. Staff were keen to participate and learn from this.