This was an unannounced inspection carried out on 7 February 2018.

Madeira Lodge is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. Madeira Lodge is registered to accommodate care and support for up to 28 older people. At the time of the inspection there were 25 people living at the service.

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.

We last inspected the service on 8 and 9 January 2017, the service was rated as requires improvement. There were three breaches of regulations at this inspection. These were the lack of information written in the care plans which did not always reflect people’s assessed needs and preferences. Risks had been assessed but not always mitigated to keep people as safe as possible and the systems in place to monitor the care being provided were not effective.

At this inspection new personalised care plans had been implemented with additional information; however these had not always been updated to reflect the care being provided. Detailed risk assessments were in place but lacked information about how to manage the risk and what further action should be taken to keep people safe.

Checks and audits were being carried out regularly by the registered manager and staff but these audits had not identified the shortfalls found at this inspection. Therefore, the breaches identified at the last inspection had only been partially met.

The registered manager worked in partnership with other professionals, such as people’s care managers and the mental health team. However they had not informed the local authority safeguarding team of an incident which occurred at the service. We have made a recommendation about consulting the local authority safeguarding protocols.

Medicines were not always managed safely. Accidents and incidents were recorded and analysed by the registered manager. However further analysis was required to show that previous falls and incidents were taken into account to reduce the risk of them happening again.

People’s needs had not always been assessed when they came into the service for a short period of time (known as respite care) and detailed care plans were not in place for these individuals. People were supported to eat and drink, however. records of people’s fluid charts were not clear to confirm that people were receiving enough fluids to keep them hydrated.

People’s preferences of how they wished to be cared for at the end of their life were not consistently recorded. We have made a recommendation about seeking advice and guidance from a reputable source about end of life care planning in line with current guidance.

All staff had completed ‘on line’ training courses, however there was no practical face to face training for topics such as moving and handling, challenging behaviour and first aid, to show the practical element and assess staff competency. There was a lack of detail in the complaint records to confirm what action the provider had taken and whether complaints were resolved in a satisfactory manner.

Checks on the premises had been made to ensure it was safe and the provider had ensured that the environment was suitable for people living with dementia.

The registered manager had not always notified the Care Quality Commission, as required by law of events that happened in the service such as safeguarding and when serious incidents occurred.

Staffing levels were sufficient at the time of the inspection an

This was an unannounced inspection carried out on 9 and 10 January 2017. The previous inspection on 9 June 2014 found no breaches in legislation.

Madeira Lodge Care Home provides accommodation and personal care for up to 28 older people who may have dementia. At the time of the inspection 27 people were living at the service, although two were temporarily in hospital. Where vacancies occurred the service will take people for respite care. The premises are detached and accommodation is provided over two floors. To the rear of the building is a well maintained enclosed garden. Bedrooms are set over two floors with access via a passenger lift. Each person has a single room, with three rooms having ensuite facilities (toilet and wash hand basin). There are three shower/wet rooms and an assisted bathroom. People tend to access the main lounge/diner/conservatory although there are further quiet seating areas and another lounge. There is limited parking, with additional on street parking at the end of the driveway. Madeira Lodge is close to the sea front, local bus routes and shops.

The service is run by a registered manager. 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.

People and relatives all spoke positively about the service received and were happy with the quality of care and support provided.

Risks associated with people’s care and support had been assessed, but there was not always sufficient information recorded in assessments to show how staff kept people safe.

People and/or relatives were involved in the assessment and the initial planning of their care and support. However the level of detail in people’s care plans needed to be improved to ensure people received care and support consistently and according to their wishes. People told us their independence was encouraged wherever possible, but this was not always supported by the care plan.

There were audits and checks undertaken to ensure the service was effective. However shortfalls identified during the inspection had not been identified as requiring improvement and action was not always taken in a timely way to address shortfalls that had been identified.

People received their medicines when they should. People’s health was monitored and they had access to appropriate health professionals to ensure good health. People had a varied and healthy diet.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Where people were restricted DoLS authorisations were in place or had been applied for. People were supported to make their own decisions and choices and these were respected by staff. Staff had received training in the Mental Capacity Act (MCA) 2005. The MCA provides the legal framework to assess people’s capacity to make certain decisions, at a certain time. When people are assessed as not having the capacity to make a decision, a best interest decision is made involving people who know the person well and other professionals, where relevant. The registered manager demonstrated they understood this process.

People were protected by safe recruitment procedures and had their needs met by sufficient numbers of staff. People were relaxed in staff’s company and staff listened and acted on what they said. People were treated with dignity and respect and their privacy was respected. Staff were kind and caring in their approach.

New staff underwent an induction programme, which included shadowing experienced staff, until staff were competent. Staff received training relevant to their role. The registered manager worked ‘hands on’ and regularly observed staff working. In addition staff had some oppor

The inspection was carried out by one Inspector for over six hours. We met and talked with three people who were living in the service; talked with one relative; and talked with three of the staff on duty. The registered manager and registered provider were present throughout the day. We observed throughout the day to try to gain an insight into people’s experiences of the service. People told us or indicated that they were happy with the service.

People told us that the staff were kind and that there were enough staff to meet their needs. Staff spoke with people in a calm, positive reassuring manner. The provider had a robust recruitment procedure and suitable checks were carried out on prospective staff prior to them working at the service.

People maintained good health as the service worked closely with health and social care professionals. Activities were provided which were advertised and people had support to take part in meaningful activities in the home and at a day centre run by the provider.

People were treated with respect and their dignity and privacy maintained. A visiting relative told us that they felt their relative was safe and had the care and support they needed.

The provider had systems in place to monitor the quality of care people received.

At this inspection we followed up on compliance actions from the previous inspection on the 21 May 2013. We reviewed care records and the home’s documented procedures. We spoke with staff, but we did not speak to anyone using the service on this occasion.

At our previous inspection we found that there were incidents of potential abuse that the provider had failed to report to the local authority safeguarding team. We also found that the provider had not appropriately recorded some of these incidents in people’s care records.

At this inspection we found that the home had reviewed their local procedures to include and reflect the recording and reporting requirements to protect vulnerable people from the risk of abuse or the possibility of abuse.

We found that care plans contained mental capacity assessments for those people who lacked capacity to make some decisions for themselves.

We used a number of different methods to help us understand the experiences of people using the service, because the majority of people using the service had complex needs, which meant they were not all able to tell us their experiences. We spoke to three people who were using the service and two relatives who were visiting at the time of our inspection.

We spent some time in the lounge and dining area of the home, where most people who used the service spent their time during the day. We made observations of people and the staff who supported them. We spoke to four members of staff, as well as the manager overseeing the service, who was the registered manager of another home owned by the provider. The overseeing manager had been covering the service for some months in the absence of a permanent manager.

People we spoke to all stated that they were happy with the service and relatives told us they were involved in discussions about the care and support provided. People told us they could choose how they spent their time during the day and that the staff knew and understood their needs.

In this report, the name of the registered manager appears who was not in post and not managing the regulatory activities at the home at the time of our inspection. Their name appears because they were still registered with us at the time of our inspection.

People who were using the service were experiencing dementia. The majority of people were not able to engage directly with the inspection process. We spoke with three people who were using the service and a relative who was visiting at the time of our inspection. We spent time making observations in the lounge/dining area where most people spent their day. We also spoke with four staff and the acting manager. The acting manager had been covering the service for some months in the absence of a permanent manager. This was in addition to their substantive post of registered manager at another service owned by the provider nearby.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time.

People told us they were very happy with the care they received at Madeira Lodge. Some people said staff had discussed their care and support needs with them. People told us they could make their own decisions regarding their day to day lives. People said there were enough staff on duty and that staff came when they needed help. They said all the staff were friendly and helpful. Some people told us that staff asked them occasionally if they were happy living at the service.

People who lived in this home were experiencing dementia. The majority of people who lived in the home were not able to engage directly with the inspection process. We spoke with one person who lived in the home. They told us staff were careful to protect their privacy and dignity. They said staff knocked on their bedroom doors before entering. The person who we spoke with told us they were very happy with the care they received at Madeira Lodge. They said all the staff were friendly and helpful. They told us the food was very good and staff made them drinks whenever they wanted one. They said they felt safe in the home and staff came ‘instantly’ if they rang their bell for help.