This unannounced inspection took place on 20 November 2018. At the last inspection on 05 and 07 September 2017, breaches of legal requirements were found. This was because the provider’s processes were not consistently effective at identifying shortfalls when monitoring the quality of the service relating to the welfare of people.

Madeleine House is a care home registered to accommodate up to 41 people, some of which were living with dementia. The home also provides short stay interim beds (EAB) for people discharged from hospital, who may require further assessment of their care and support needs before returning to their own home or another care home. Madeleine House is a purpose-built home with bedrooms situated across two levels with lift access to the first floor. At the time of our inspection 40 people were living at the home. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided and both were looked at during this inspection.

There was a registered manager in post at the time of the inspection. 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.

At our previous inspection in September 2017, we had rated the service under the key questions is the service safe, effective, caring, responsive and well-led as ‘requires improvement’ and found they were not meeting fundamental standards. At this inspection, there had been sufficient improvements to improve the rating to ‘good’.

People were protected from the risk of abuse and avoidable harm because staff knew what action to take and the provider had safeguarding systems and processes in place to keep people safe. People were supported by sufficient numbers of staff who were kind and respectful and had the knowledge they required to care for people safely. The provider’s recruitment processes were robust and ensured the necessary security checks were completed to make sure persons employed by the provider were safe and appropriate to provide care and support to people living at the home. People received support from staff to take their prescribed medicines. Systems and processes were in place to ensure medicines were managed safely and only staff who had undergone training were permitted to administer medicines.

Staff received supervision and appraisals, providing them with the appropriate support to carry out their roles.

People and their relatives were involved as much as practicably possible alongside healthcare professionals, to ensure that any decisions made in respect of their care and support needs, were done so within their best interest’s and in accordance with the Mental Capacity Act 2005.

Where people were assessed to lack the capacity to consent to the support they received, the provider followed key processes to ensure the care being provided was in the least restrictive way possible. Applications had been made to safeguard people against the unlawful deprivation of their liberty, where necessary. People’s privacy, dignity and independence were respected.

People were supported to maintain a healthy diet with choices of different foods available and all their health needs were met with the support from staff and healthcare professionals. Staff knew people well and people felt they received care and support from staff that had the skills to meet their needs. There was a complaints process in place and where there had been complaints, these had been addressed. Appropriate action had been taken to reduce risk of reoccurrences. People and relatives were complimentary about the management and staff.

People were relaxed and were suppo

This inspection took place on 05 and 07 September 2017 and was unannounced on both days. At the last inspection on 08 and 09 June 2015, we found that the provider had met all the legal requirements of the Regulations we inspected.

Madeleine House is a residential care home providing accommodation and personal care for up to 41 people, some of which were living with dementia. The home also provides short stay interim beds (EAB) for people discharged from hospital, who may require further assessment of their care and support needs before returning to their own home or another care home. At the time of our inspection 40 people were living at the home.

It is a legal requirement that the home has a registered manager in post. 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.

At our previous inspection in June 2015, we found that for the questions is the service safe, effective, caring, responsive and well-led, we rated the provider as ‘good.’ At this recent inspection, we identified areas of the service that required some improvement.

Systems in place to monitor and improve the quality of the service were not consistently effective in ensuring people received a good and continually improving quality of service. The audits had not identified the issues we found. They had not always been consistently applied to ensure where shortfalls had been identified, they were investigated thoroughly and appropriate action plans put into place to reduce risk of reoccurrences.

Staff were trained to identify signs of abuse and supported by the provider’s processes to keep people safe. However, staff did not always follow the provider’s own safeguarding procedures when unexplained bruising or marks were noted on people’s bodies. Potential risks to people had been identified and appropriate measures had been put in place to reduce the risk of harm, although the information contained within some risk assessments was not always effectively communicated to staff. People were supported by sufficient numbers of staff but they were not always effectively deployed around the home. People were supported to receive their medicines as prescribed. Although protocols to support staff on when to administer medicine that was required on an ‘as and when’ basis were not consistently in place.

Where people lacked the mental capacity to make informed decisions about their care, relatives, friends and relevant professionals were involved in best interest's decision making. However, mental capacity assessments and best interest decisions were not always applied consistently to clearly show what decisions people were being supported or asked to make in relation to their care. Applications had been submitted to deprive people of their liberty, in their best interests; therefore, the provider had acted in accordance with the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).

We saw staff treated people as individuals, offering them choices whenever they engaged with people. Where people had the capacity to make their own decisions, staff sought people's consent for care and treatment and ensured people were supported to make as many decisions as possible.

People spoke positively about the choice of food available. People were supported to eat and drink enough to maintain their health and wellbeing, although the overall meal experience required some improvement. People were supported to access health care professionals to maintain their overall health and wellbeing. People’s health care needs were assessed and regularly reviewed. Relatives told us the management team were good at keeping them

The inspection team was led by a CQC inspector joined by an "expert by experience". An expert is a person who have experience of using services and who can provide that perspective of what people say about the service and what it may mean. During our inspection, the expert by experience spent the majority of their time speaking with people using the service to gain their view about living there. We spoke with five people who lived there, four staff two relatives and the manager.

All of the staff spoken with was able to tell us about people's needs so that they received care in a way that they preferred. Both relatives told us they were consulted about their relative’s care and kept informed about their relative’s health so they felt involved in their care. One person told us, “The food is nice, my flat is clean and staff are nice so I am ok ‘’.

We saw that people had a choice of meal each day and people religious and cultural needs were being met. One person told us you can have what you want really If you ask they will sort it out for you’’.

Staff told us they had a range of training so that they have up to date knowledge and skills in order to support the people who live there.

The provider was in the process of seeking people views about the service provided. The manager told us when all the information had been collated a analysis would be completed and action would be taken where need.to improve the service for people living there.

We visited the service to follow up improvement from our inspection in July 2011. We did not tell the provider we were coming. We spoke with three people who use the service about their medication. People told us they were given their medication when required and it was explained to them what the medication was for.

We found the provider had taken the necessary steps to ensure people receive their medication safely and as prescribed.

We found the records relating to medication management, and staff training were undertaken regularly. This meant staff had the knowledge and the skills to administer medicine safely to people using the service.

Prior to the review, we had received some information of concern. This had been referred to Birmingham City Council (BCC) safeguarding team. Safeguarding referrals are made to local authorities in order to investigate the concerns further and ensure vulnerable people are protected from the risk of harm.

There were 41 people living at the home on the day of our visit. The provider did not know we were coming. We visited the service as part of our planned review and to follow up improvements needed from our visit in January 2012 and in July 2011.

During our review in July 2011, we found that improvements were needed in relation to care planning and delivery of care, staff supervision and staffing levels, the recording of information and follow up actions taken in relation to protecting people.

People using the service had complex needs, which meant not all people using the service were unable to tell us their experience.

We used a number of different methods to help us understand the experience of people using the service.

We spoke with five people living in the home, five relatives and three care workers. Every one we spoke with was complimentary about the home. We did not receive any negative comments. People told us that they were happy with the care they received. Relatives told us they were kept informed about the progress their relatives were making. They told us they were very happy with the care and support their relatives received.

All five relatives commented about the home being welcoming, friendly, and lively and having a homely atmosphere.

Care workers told us they had the support they needed and training to enable them to meet people’s needs.

We saw records that told us all staff had undertaken training in the delivery of care and protecting people.

The provider had completed an assessment based on the care needs of people that live in the home. Staffing levels were determined based on this assessment and appropriate staff had been appointed to meet the needs of people living in the home.

Comments from people living in the home told us:

“Staff are really very good they do anything you ask them to do, never heard them complain and they are always so friendly.’’

“Very nice food you can have as much as you want when you want.’’

“I love my bedroom, can stay in the lounge and chat or go to my room for peace if I wish.’’

“My family are made to feel very welcome, they come at any time to see me.’’

We spoke to people about the care and support they receive at Madeleine House. We found that people generally like the staff that support them and have positive relationships with them. People told us staff were kind and supportive

People living in the home told us:

“The staff were so kind and cheerful’’.

“The way staff help people even when they are difficult is excellent’’.

“You could not ask for better care and understanding staff’’.

“It is an Excellent home’’.

“It is a very comfortable, warm, and friendly home’’.

Six people told us the food was very good and they had lots of choices.

When asked if the home could improve six people told us, they were happy with the home and staff.

One person told us “how can you improve somewhere that does such a wonderful job of looking after you’’.

We asked the manager to ask relatives and other healthcare workers when they came into the home on the day of the visit if we could speak with them.

Relatives visiting the home told us:

If they raise a concern it is dealt with straight away.

That since their relatives had moved to the home they had noticed improvements with their health.

When their relative moved into the home this was carefully planned.

“We had all the information we needed about the home before we decided to bring our relative for a visit’’.

“We can stay here with our relatives if they are poorly. The staff gave us support too when we were worried. Not only did they look after our relatives they made sure we was ok as well’’.\

“The activities in the home could be improved as there is not that many activities taking place’’.

“Information is not always passed on when there are concerns’’.

“It would be nice if the people living in the home went out more’’.

“Fantastic, event when the donkey came to visit people living in the home, they had so much fun’’.

This was an unannounced inspection which took place on 8 and 9 June 2015. We last inspected this service on 8 October 2013, and found that the provider was meeting the Regulations we inspected.

Madeleine House is a residential care home providing accommodation and residential care for up to 41 people. At the time of our inspection 39 people were living at the home.

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 and associated Regulations about how the service is run.

Some people had different ways of expressing their feelings and were not able to tell us about their experiences. People who could speak with us felt safe and secure in their home. Interactions between people and staff were friendly and polite. Relatives, social care and health professionals and staff felt people were kept safe and cared for. Staff understood their responsibilities to protect people from the risk of harm and abuse.

People’s needs were individually assessed and written in care records that minimised any identified risks so reducing the risk of harm. People received their medicine as prescribed by their doctor although there were missing signatures on some of the recording sheets.

We found there were sufficient staff available to meet people’s identified needs. The provider ensured staff were safely recruited and they received the necessary training to meet the support and care needs of people.

The provider was taking the correct action to protect people’s rights and staff were generally aware of how to protect the rights of people.

People’s health and support needs were met. People were able to choose what they ate and drank and were supported to access health and social care professionals to ensure their health care needs were met. Staff were caring and treated people with respect and dignity.

There were social and leisure activities that people could choose to take part in. There was a complaints process that people and relatives knew about. People and relatives’ concerns were listened to and addressed quickly.

The provider had established management systems to assess and monitor the quality of the service provided. This included gathering feedback from people who used the service and their relatives.