Madelayne Court

People’s experience of using this service:

Overall, people were satisfied with the service they received. However, we received mixed feedback in relation to the availability and quality of the time staff spent with people and the quality and choice of meals available.

We recommended that the provider look at good practice guidance about the quality of staffing levels, offering a choice of meals whilst awaiting the new supplier and review people’s needs in relation to their social isolation.

Risk was well managed at the service. Measures were put in place to keep people safe and risks were balanced so that people had freedom and independence. Staff knew what to do if they had concerns for a person’s safety.

Staff were safely recruited and had the necessary skills to meet people's needs. Training and checks of staff competency were in place.

Staff worked well along with external professionals to maintain people’s physical and emotional wellbeing.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Care plans were clear and written in a respectful person centred way. Care was reviewed and adjusted when changes happened. People were supported to take part in pastimes and interests, however these were restricted due to the staffing levels.

People were given empathy, consideration and respect. Their privacy was protected, and they were treated in a dignified way.

The registered manager and staff worked well with professionals and families to ensure people receiving good end of life care and support.

There was an established management team and a number of long-standing staff who knew people well. The registered manager promoted an open culture where people and staff felt able to have a say in the service. The registered manager developed positive links with external agencies and used feedback to learn from incidents and accidents.

Rating at last inspection:

The last report was a responsive inspection we undertook due to concerns raised. We inspected the service on 5 December 2017 and looked at two key questions Safe and Well led and found the service to be Good in both questions.

Why we inspected:

This was a planned comprehensive inspection based on the rating at the last inspection.

Follow up:

We will continue to monitor Madelayne Court to ensure people receive care which meets their needs. We plan our inspections based on existing ratings and on any new information which we receive about each service.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

The inspection took place on 5 December 2017 and was unannounced.

A registered manager was in post at the service. 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.

The registered manager was passionate ensuring people at the service had a good quality of life and were supported safely. They had worked well with outside professionals and took on board advice and guidance to make a positive difference to the support people received. They used information from mistakes and incidents to learn lessons and improve safety.

There was an open culture at the service which meant staff felt able to raise concerns freely and know that something would be done as a result. People and families told us the registered manager was approachable and visible.

The whole staff team had received refresher training in manual handling and skill levels had improved. We have made a recommendation about staff training in manual handling. Where there were concerns regarding staff practice the registered manager had responded effectively.

Risk was managed well at the service. Care plans had been revised to provide improved and clear guidance to staff about the equipment and support people needed when mobilising.

There were enough staff to meet people’s needs safely. The provider had a number of plans in place to drive improvements and change at the service. This included streamlining and improving checks in place to monitor the quality of the service.

Madelayne Court provides care and accommodation to people who may need assistance with personal care and may have care needs associated with living with dementia. The service does not provide nursing care. The service is split into seven units located over three floors. At the time of our visit there were 112 people living in the service.

A registered manager was in post at the service. 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.

When we had visited in 2015, we had concerns regarding the staffing levels at the service, in particular in one unit. During this visit we found the manager had been pro-active about resolving the concerns we had outlined in our last report and there were sufficient, suitably recruited staff available to meet people's needs safely.

People were supported to remain safe. Where staff had concerns about people’s safety there were measures in place to minimise any risks to their safety. People were protected from the risk of abuse. Staff supported people to take their medicines safely, as prescribed.

The service was meeting the requirements of The Mental Capacity Act 2005 (MCA). Assessments of capacity had been undertaken and applications for Deprivation of Liberty Safeguards (DoLS) had been made to the relevant local authority. People were enabled to make their own decisions about the service they received.

Staff had the skills to help people communicate their preferences. Staff followed processes in place to ensure decisions were made in people’s best interest, involving family and outside professionals as appropriate.

People's nutritional needs were well met. A choice of food and drink was offered, and drinks and snacks were available throughout the day. People's food and liquid intake was recorded and monitored and any concerns addressed promptly. Staff recognised the importance of food to people’s enjoyment of life. Staff worked well with health and social care professionals to support people to maintain good health and wellbeing.

People and their families were treated with warmth, dignity and respect by staff who knew them well. People knew how to complain and the manager responded to people’s concerns. Care plans and risk assessments had been revised since our last visit to provide more personalised guidance about people’s specific needs. Staff supported people to lead fulfilling lives and motivated them to engage in a range of meaningful activities and pastimes.

The systems in place to monitor the care provided were used to improve the quality of life and safety of people at the service. The staff team worked well together. The manager was supportive and approachable. They delegated effectively and had a good oversight of the whole service.

The purpose of this visit was to check that improvements had been made.

Three inspectors were present on this inspection. We spoke with nine staff this included the manager, senior carers and junior carers. Throughout the day we spoke with 14 people who use the service and six relatives.

We used a number of different methods to help us understand the experiences of people who used the service, because some of the people who used the service had complex needs which meant they were not able to tell us their experiences. Those that could told us, "I am okay" and "very nice people."

Staff told us that they worked as a team, and that they felt supported by the management team. One staff member said, "Brilliant place to work."

We found that people who used the service were involved as far as possible in care decisions and in life choices. Care was always delivered in a way that ensured their dignity was promoted. Care plans and delivery of care for some people was more task orientated than person centred.

We identified a number of concerns about if the service was able to meet more complex needs of people. We found improvements needed to be made quickly to improve the safety of people who used the service. However we did find that people were clean, warm and comfortable and on the whole, most of their nutrition needs were being met.

We had concerns about the care and treatment some people received, how decisions were made for people who may have lacked capacity and how people who were at risk of malnutrition were being managed. We found that staff sometimes misinterpreted or did not follow guidance from external health professionals.

We had concerns that staff lacked some skills and knowledge to meet all of the complex needs of people. Staff were not up to date with specific medical condition training to meet people's needs and this had not been made available to them by the provider.