This inspection took place on 05 and 07 September 2017 and was unannounced on both days. At the last inspection on 08 and 09 June 2015, we found that the provider had met all the legal requirements of the Regulations we inspected. Madeleine House is a residential care home providing accommodation and personal care for up to 41 people, some of which were living with dementia. The home also provides short stay interim beds (EAB) for people discharged from hospital, who may require further assessment of their care and support needs before returning to their own home or another care home. At the time of our inspection 40 people were living at the home.
It is a legal requirement that the home has a registered manager in post. There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.
At our previous inspection in June 2015, we found that for the questions is the service safe, effective, caring, responsive and well-led, we rated the provider as ‘good.’ At this recent inspection, we identified areas of the service that required some improvement.
Systems in place to monitor and improve the quality of the service were not consistently effective in ensuring people received a good and continually improving quality of service. The audits had not identified the issues we found. They had not always been consistently applied to ensure where shortfalls had been identified, they were investigated thoroughly and appropriate action plans put into place to reduce risk of reoccurrences.
Staff were trained to identify signs of abuse and supported by the provider’s processes to keep people safe. However, staff did not always follow the provider’s own safeguarding procedures when unexplained bruising or marks were noted on people’s bodies. Potential risks to people had been identified and appropriate measures had been put in place to reduce the risk of harm, although the information contained within some risk assessments was not always effectively communicated to staff. People were supported by sufficient numbers of staff but they were not always effectively deployed around the home. People were supported to receive their medicines as prescribed. Although protocols to support staff on when to administer medicine that was required on an ‘as and when’ basis were not consistently in place.
Where people lacked the mental capacity to make informed decisions about their care, relatives, friends and relevant professionals were involved in best interest's decision making. However, mental capacity assessments and best interest decisions were not always applied consistently to clearly show what decisions people were being supported or asked to make in relation to their care. Applications had been submitted to deprive people of their liberty, in their best interests; therefore, the provider had acted in accordance with the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).
We saw staff treated people as individuals, offering them choices whenever they engaged with people. Where people had the capacity to make their own decisions, staff sought people's consent for care and treatment and ensured people were supported to make as many decisions as possible.
People spoke positively about the choice of food available. People were supported to eat and drink enough to maintain their health and wellbeing, although the overall meal experience required some improvement. People were supported to access health care professionals to maintain their overall health and wellbeing. People’s health care needs were assessed and regularly reviewed. Relatives told us the management team were good at keeping them informed about their family member’s care.
People and relatives told us that ‘some’ staff were kind, caring and friendly and treated people with respect, although there were occasions when people’s dignity was not maintained. People were relaxed and were supported by staff and the management team to maintain relationships that were important to them. There were activities that provided opportunities to optimise people’s social and stimulation requirements although they were not always suitable for those living with dementia. People and their relatives told us they were confident that if they had any concerns or complaints they would be listened to and matters addressed quickly.
The provider’s recruitment processes were robust and ensured the necessary security checks were completed to make sure persons employed by the provider were safe and appropriate to provide care and support to people living at the home.
People and relatives had received satisfaction questionnaires to comment on the quality of the service being delivered. The management team had started to put in place systems to gain feedback from people living at the home, relatives and visitors through group meetings. People, their relatives and staff told us the management of the home had improved with the arrival of the new registered manager.
People felt they received care and support from care staff that had the skills to meet people’s needs. Staff received supervision and appraisals, providing them with the appropriate support to carry out their roles.
We found one breach in the legal requirements and regulations associated with the Health and Social Care Act 2008. (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.