Madelayne Court

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• 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

We reviewed 4 quality statements under this key question: Person-centred care, listening to and involving people, Equity in experience and outcomes and Planning for the future. Care was task focused rather than person-centred. Although we observed people to look well presented, feedback we received indicated some people’s social needs and preferences were not always met. People did not always have access to activities and opportunities to engage in their hobbies or interests, and where people told us they would like to have access to the garden areas of the home, they told us this was not possible unless their relative was visiting and able to take them. However, there was regular communication with health care professionals to ensure people’s health needs were met. People were supported to plan and document their end of life wishes.

This service scored 68 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The atmosphere in the home was calm and relaxing, however we found for people living with dementia there was limited wayfinding (which allows those with dementia and memory problems to maintain a sense of independence to move from one place to another with greater ease) and items such as pictures, or objects of interest. Corridors and bedroom doors looked the same and whilst bedroom doors had signs these did not particularly stand out to help prompt people to find their rooms. People’s bedrooms had their own personal belongings with photographs, pictures and objects of person’s choice. However, the communal lounges we found socially uninviting. Chairs were either placed in semi circles around the room, or some in rows which often impaired people’s view who were seated at the back of the room. We observed staff presence in the communal lounges which provided them with an opportunity to engage in conversation, however we found on most occasions there was limited interaction other than to provide task-based activities such as providing drinks and snacks. There were a few group activities observed on day one of our assessment visit, although this improved on our second visit, with singing, musical card games and ball games taking place. However, we did not observe any 1:1 activity for those people who remained in their rooms.

People and their relatives provided mixed feedback around the opportunities for social interaction and stimulation. Comments included, “I do seated exercises, as well as bingo and handicraft. I have had some trips out; one was to Southend. I never get in the garden, there are not spare staff to take us,” “I am not allowed in the garden because there is no one free to take me out. I have rarely been in there. I have always loved gardening, so it would be a pleasure to be in there. It means I spend my day watching my TV or my DVDs,” “[Family member] likes anything involving music and singing. They do not get out in the garden, which they would like,” “When [family member] arrived, they were asked what activities they were interested in, but they cannot do anything stuck in their room. It would be so nice if one of the care staff would give them some time, just talking, singing or reading with them. As far as I know, no one spends with them. They are isolated really.” And “There is a good activities programme. The activities are on a social media page which we access. We were asked for permission for [family member] to be photographed. We really enjoy looking at what our [family member] is doing as they can no longer use the phone, so it is a good way to keep in touch as we live outside the area.”

Staff we spoke to understood the importance of providing person-centred care and support to people and were able to describe people’s likes and dislikes, however some felt there were not always enough staff available to deliver this. A member of staff told us, “We use communication, people do get preferences, we show them the physical items, like drinks etc. I do think people get good care, but an extra member of staff would make it even better,” “I support a person who likes me to sing hymns to them. Activities do happen here but not often. After breakfast we do try to do activities, but we do get forgotten or we have to take people downstairs, so it is hard.” And “We have several activity staff, we have a calendar, we have stuff up here, but people take things to their rooms, and it can be difficult to get people engaged. We take people out in the garden and on trips.” The registered manager told us they will be working with the organisation’s dementia lead, to look at where improvements can be made to the environment and additional training and coaching for staff.

We did not look at Care provision, Integration and continuity during this assessment. The score for this quality statement is based on the previous rating for Responsive.

We did not look at Providing Information during this assessment. The score for this quality statement is based on the previous rating for Responsive.

The registered manager told us, “I have an open door policy, I am very visible out on the floor. I walk around the home every day, speak to visiting professionals, people using the service, staff and relatives. Any concerns I will address at the time and aim to resolve any issues or concerns brought to my attention. The relative, resident and staff meetings also provide people with the opportunity to provide any feedback which I would then analyse for any themes or trends and work to resolve them.”

The registered manager had a complaints overview in place and had systems in place to share lessons learned with the staffing team to ensure information was shared. We saw resident, relative and staff meetings had been carried out, along with feedback surveys, the registered manager had reviewed these and followed up on issues raised. Visitors’ surveys for 2024 had just been sent out. The registered manager provided us with the 9 surveys received back so far, no concerns identified, comments included, “Staff always friendly and helpful, from admin, kitchen, domestics and carers.” And “Top notch.”

People and their relatives told us they knew how to voice their concerns or raise a complaint if they needed to and were confident any issues would be dealt with. Comments included, “I get on fine with [registered manager]. They have a nice manner, and I am sure they would listen if something were not right, I am happy enough here,” “Registered manager is ok. They are easy to talk to. I suppose if there was something that I really did not like, I could tell them.” And “I know [registered manager] well. They are helpful, an item of [family member] clothing went missing, and they tracked it down for me.”

We did not look at Equity in access during this assessment. The score for this quality statement is based on the previous rating for Responsive.

People and relatives were positive about the care staff and overall people were satisfied with how care was delivered. People were asked about their needs at the initial assessment. Details of people’s cultural and religious needs were also recorded and respected by staff and people had access to healthcare services as and when they required them. One person told us, “I have the GP coming today as I have a cough, they might give me something for it.”

Staff members told us, “Everybody gets whatever they need here, referrals to a variety of health or social care professionals. The district nurse comes out quickly. We go through the GP for occupational therapists, dietician, SALT referrals.” “We are supportive of people’s cultural, religious needs, we have a person who with the support of his family attends his place of worship every week.” And “People are treated equally; we do not discriminate as we are one family.”

Staff had received equality and diversity training. Care records we reviewed for people demonstrated they were able to access services, particularly a range of healthcare services and professionals. There was no evidence to suggest people experienced delays in healthcare provision. On day 1 of our assessment visit we observed a video call with a care team leader and a member of the Speech and Language Therapist team (SALT). They wanted to observe a person eating their lunch as they had been referred to them regarding concerns around their eating and swallowing. From their observations they made a recommendation for a soft diet and further review.

We saw where people’s end of life care had been discussed their wishes had been clearly documented in their death and dying care plan. An excerpt taken from 1 person’s end of life care plan stated, "When I come near to the end of my life, I would like to have a member of my family with me as much as possible. Ideally, I would not like to be alone when I pass. I would like to be made as comfortable and as peaceful as possible."

The registered manager told us, “Although we do not follow a particular end of life pathway, we work closely with the GP, the district nursing team who are authorised to administer anticipatory medicines and have the support of our local hospice. We have discussions with people and/or their relatives regarding any end of life wishes they would like followed.” A member of staff told us, “I make time to sit with people and hold their hands. We use forget me not books, I have attended end of life training.”

Staff had received end of life training in relation to palliative care, death, dying and bereavement. Peoples care plans recorded if they had a ‘do not attempt resuscitation’ (DNAR) order in place and who was involved in the decision making. Some people had treatment escalation plans (TEP) in place; this is a communication tool used to record personalised goals of treatment reflecting a person’s values and preferences in the event their condition deteriorates. The registered manager told us, “Not all people are willing to discuss or have thought about their end-of-life care due to the sensitive nature of the subject, but we will continue to have those conversations when appropriate.”