Madeira Lodge

People were not always protected from avoidable harm because risk assessments were not always clear, comprehensive and up to date. They did not always contain enough information about people’s risks and mitigation strategies for staff to provide safe and effective care. This was a continued breach of Regulation 12 (Safe care and treatment). Staff and leaders were able to identify situations that amounted to safeguarding and staff were confident to use the whistleblowing process if needed. Staff knew people well and were able to identify changes to health and identify care and support needs. Lessons were learned when things went wrong, however actions to embedded the lessons learned were not always robust. Medicines were administered and recorded safely. Medicines policies had not always been followed by staff in relation to administering PRN (as and when required medicines). Staff were recruited safely. Some staff had not completed all the relevant training to be able to meet people’s needs safely, this was an area for improvement. There was a plan in place to make sure staff had ongoing support in the form of supervision and appraisal meetings. There were enough staff to support people safely. Accidents and incidents were reviewed and actioned by the management team, safety checks undertaken by staff. The provider worked with people and partners including local authority care managers and health professionals to establish and maintain safe systems of care. The provider had systems and processes in place to detect and control potential risks in the care environment and processes in place to assess and manage the risk of infection. We were assured that the provider was working to improve safety through the layout and hygiene practices of the premises.

People were unable to recall being involved in their assessments and care planning processes. Some relatives told us they had been involved in the assessment and care planning process. Before people moved into the service their needs were assessed. The provider had systems and processes in place to meet people’s nutrition and hydration needs, however these were not always effective. People told us the service worked with GP’s and health professionals to meet their health needs. The provider had a clear process in place to escalate health concerns. Staff had a good understanding of meeting people’s changing needs. Care plans were in place which detailed people’s care and support needs as well as their clinical needs in relation to health conditions. People's choice and consent was not always valued. Staff continually consulted people about their wellbeing and wishes, some people’s wishes were not respected.

People were not always treated with respect and kindness. This was a continued breach of Regulation 10 (Dignity and respect). People’s cultural and religious needs were respected. The provider had systems and processes in place to promote and support staff wellbeing. Staff told us they received appropriate support.

People had care plans in place, they had not always been involved in developing these. Some care plans were not as detailed as they could be to help staff understand people’s care and support needs. This was a continued breach of Regulation 9 (Person-centred care). The provider had systems and processes in place to understand the diverse health and care needs of people living at the service. The service was supported by the Home Visiting Team from the GP surgery and the GP, all of whom conducted regular visits as well as support by telephone. We observed communicating effectively with people. There were way marking signs and information around the service to help people orientate. Menus boards were available but had not been used to tell people what their food options were. People and relatives attended meetings with the management team to feedback about the service.

The management team told us, that they and the service were looking at ways to continually improve. Accident, incidents, complaints or other significant events were logged on an electronic system. The system automatically produced output relating to trends and patterns to support managers to take appropriate actions and to share lessons learned. However, there was little evidence that actions had been taken in response to analysing the trends and patterns. Systems and processes to audit and check the service were in place, however these were not always robust. This was a continued breach of Regulation 17 (Good governance). Leaders proactively supported staff and collaborated with partners to improve the service and improve the quality of care being delivered to ensure it was safe and person-centred.