Madelayne Court

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• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We reviewed 5 quality statements under this key question; Safeguarding, involving people to manage risk, Safe and effective staffing, Infection prevention and control and Medicines optimisation. At this assessment we found a positive culture of safety based on openness and transparency. Concerns about safety were listened to and investigated and reported to the relevant authorities where required. The service used a lesson learned approach to share information to improve the quality of the service to people and staff. Staff had been recruited safely and suitably trained to meet people’s needs. Staffing levels were found to be adequate, with the registered manager utilising domestic staff trained to support at mealtimes and 2 deputy managers who were supernumerary to the daily rotas. People received their medicines by staff who were trained to do so. Care plans contained risk information relating to individual people’s needs. Effective infection prevention and control measures were in place.

This service scored 72 (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 Learning culture during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

Safeguarding policies were in place. The provider had systems in place to ensure all safety concerns were investigated and action taken to ensure people’s safety. The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The MCA requires that, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. In care homes, and some hospitals, this is usually through MCA application procedures called the Deprivation of Liberty Safeguards (DoLS). We found the service had completed applications for people where required and appropriate legal authorisations were in place to deprive a person of their liberty. Any conditions related to DoLS authorisations were being met. Records showed the service had made appropriate safeguarding alerts to the local authority when necessary.

Staff had received training in how to safeguard people and knew how to raise any concerns with the management and how to report concerns externally if required. A member of staff told us, “I look out for unexplained bruising, changes in a person’s behaviour, if I had any concerns I would report to my manager or the local authority or CQC.” Another member of staff told us, “Any concerns, I would report to the team leader and then to the local authority. Whistle blowing allows us to raise an issue straight away and notify higher authorities.”

People and their relatives told us they or their loved ones felt safe. One person told us, “I am safe here because the care I get is very good and they [care staff] know the support I need.” A relative told us, “The place is secure, and [family member] is safe. [Family member] does get confused, but they [care staff] support them well.”

Care plans and risks assessments included information on how to support people safely. However, people’s feedback was mixed regarding being involved in planning their care and managing risks. One person told us, “Carers are around if I need help, I use my walker to the dining room. If I ever fall, they come quickly and notify my relative,” “I have confidence the care staff know the kind of help I need.” And “They (staff) take the easy way out. I like to go to the dining room with my ‘walker,’ but I am slow, so they take me in my wheelchair. I suppose it is easier for them.”

Staff appeared to know people's needs and told us, information regarding risks to people was recorded within their care plans. A member of staff told us, “We know the residents, the care team leaders share information, we also update the care team leaders about any identified risks to people.” Another member of staff told us about a person who was cared for in bed and has bedrails in place to prevent them from falling out they said, “If someone is new, we have a pre-assessment and their initial support plan to follow. We have daily meetings and continually assess people once they arrive.”

During the assessment, we reviewed people’s care plans and risk assessments which provided information about potential risks to people. Systems and processes were in place to cascade information regarding changes to people’s care, and these were reviewed regularly by the care team leaders.

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

On the days of our onsite visits (as part of our overall assessment) we found there was enough staff present to support people safely. The communal lounges had a member of staff present to attend to people’s care and support needs, people’s call bells were attended to in a timely manner and the home’s atmosphere felt calm and relaxed. However, although the care staff undertook their duties responsibly and professionally, showing care and respect for the people using the service, it was observed to be more task focused with little or no time to spend on interaction and engagement with people.

The staff we spoke with were positive about working at the service, however feedback was mixed regarding staffing levels. Staff members told us, “There are not enough staff, the care team leader has to administer medicines, so it is difficult. It means I sometimes have to tell people to wait, I try to make sure people go to the toilet, but they might have to wait for other things,” and “There are 3 staff including me, I do find this enough as I am quite hands on. The management team would flex the staff if we needed it.” Also, “We do not use agency staff. We have a low turnover of staff. We do have enough staff but if there is an emergency we can have support from a sister home or bank staff. Care team leaders and deputy managers do work on the floor to support staff.” The registered manager told us, “I review the homes dependency tool monthly and if we get a new admission. I walk around the home, speak to people and staff. Due to the layout of the home and the needs of people being up and about during the night, we increased the night staff numbers not so long ago as we identified more support was required.”

People and relatives provided mixed feedback in relation to the current staffing levels within the home. Comments included, “When I use my call bell staff response can be quick or long, depending on how busy they are,” “I like it here and [family member] is happy. The issue here is the number of staff. Residents need time to converse with carers. It would give them a sense of well-being and cheer them up.” And “The staff have no time to chat to residents, except when undertaking care. They are just so busy.”

Systems were in place to ensure there were suitably qualified, skilled and experienced staff. Safe recruitment practices were followed. We checked the recruitment records for 4 members of staff and all the required pre-employment checks had been completed. This included disclosure and barring service (DBS) checks and obtaining up to date references. We did find a gap in 1 person’s employment history which had not been fully explored, however the administrator rectified this immediately with a telephone call to the member of staff and a file note added to their personnel file.

The home was clean and tidy throughout. People’s bedrooms, communal areas and bathrooms were free of malodours. Personal protective equipment was readily available for staff. We noted a set of broken drawers in 1 person’s bedroom. The registered manager was aware and advised a replacement had been ordered and was awaiting delivery.

The provider had infection prevention and control policies and procedures in place. Staff had undertaken infection prevention and control training. The housekeeping lead told us, “The housekeeping team have cleaning schedules, I review these to check they have been completed, they have received health and safety and COSHH (control of substances hazardous to health) training. We are all aware about infection control colour coding system for mops and buckets. We have a deep cleaning schedule. Staff have a list of things that they sign when completed. Our monthly deep cleans consist of changing curtains, cleaning paintwork and steam cleaning carpets.”

The care team leaders were responsible for administering people’s medicines with the support of the 2 deputy managers if required. Both deputy managers spoke of the external agencies who also provided medication training support and were complimentary of the training provided for staff.

The providers medicine policies and procedures were in place and regular audits were carried out. The registered manager told us, “Both deputy managers share the role. Weekly and monthly audits are undertaken, and spot checks are carried out."

People told us they received their medicines on time and in their preferred way, one person told us, “I take 3 tablets in the morning, they (staff) give them to me in a pot and I take them myself. I always get my tablets on time.” Another person told us, “I get my tablets on time every day.”