What life is like for people using this service:

Systems and processes were in place to safeguarded people from the risk of abuse. People had their risk of harm assessed and reviewed. There were sufficient numbers of staff on duty to look after people. People received their medicine from staff who were competent to do so. The service was clean. Lessons were learnt when things went wrong.

Staff delivered care in line with national guidance. Staff are supported to develop and maintain their knowledge and skills. People are provided with a nutritious, varied and balanced diet. People are enabled to access their GP, dentist and optician. All areas of the service are accessible. People’s rights were maintained under the Mental Capacity Act 2005.

People were looked after by kind, caring and compassionate staff. People were enabled to have a say in their care and the running of the service. Staff treated people with dignity and respect.

People received person centred care. Staff enabled people to maintain their hobbies, interests and pastimes. There were systems in place to manage complaints. People at the end of their life were supported to have a dignified and pain free death.

The manager is an approachable and visible leader. The manager and their team were committed to improving the quality and standards of care people received. Links are being built with the local community and partner agencies. There is a good governance framework, leading to improvements in the service.

The service met the characteristics of Good in all areas that we inspected. More information is in the full report.

Rating at last inspection: Good (report published 01 February 2016)

About the service: Madeira House is a residential care home for up to 51 older people or people living with dementia, a sensory impairment or a physical disability. On the day of our inspection 35 people lived there.

Why we inspected: This was a planned inspection based on the rating at the last inspection. The service remained rated Good overall.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

We inspected Madeira House on 20 October 2015. This was an unannounced inspection. The service provides care and support for up to 51 people. When we undertook our inspection there were 50 people living at the home.

People living at the home were older people. Some people required more assistance either because of physical illnesses or because they were experiencing memory loss. The home also provides end of life care.

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.

CQC is required by law to monitor the operation of the Mental Capacity Act 2005 Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way, usually to protect themselves or others. At the time of our inspection there was no one subject to such an authorisation.

We found that there were sufficient staff to meet the needs of people using the service. The provider had taken into consideration the complex needs of each person to ensure their needs could be met through a 24 hour period.

We found that people’s health care needs were assessed, and care planned and delivered in a consistent way through the use of a care plan. People were involved in the planning of their care and had agreed to the care provided. The information and guidance provided to staff in the care plans was clear. Risks associated with people’s care needs were assessed and plans put in place to minimise risk in order to keep people safe.

People were treated with kindness, compassion and respect. The staff in the home took time to speak with the people they were supporting. We saw many positive interactions and people enjoyed talking to the staff in the home. The staff on duty knew the people they were supporting and the choices they had made about their care and their lives. People were supported to maintain their independence and control over their lives.

People had a choice of meals, snacks and drinks. And meals could be taken in a dining room, sitting rooms or people’s own bedrooms. Staff encouraged people to eat their meals and gave assistance to those that required it.

The provider used safe systems when new staff were recruited. All new staff completed training before working in the home. The staff were aware of their responsibilities to protect people from harm or abuse. They knew the action to take if they were concerned about the welfare of an individual.

People had been consulted about the development of the home and quality checks had been completed to ensure services met people’s requirements.

We talked with four people who used the service and they all told us care was very good. One person said, “If you could find anything anywhere that is better, I’d be amazed.” Another said, “All the staff are lovely. We have a good laugh together.”

We observed care being provided and saw people were treated with dignity and their privacy was protected. We saw staff explained what they were doing and sought people’s agreement to the care provided.

We looked at the care records of five people who used the service. We saw they contained the information required to provide safe and appropriate care. In addition, they contained information on people’s preferences and the activities they enjoyed to promote well-being and choice.

We saw medicines were stored and administered safely and there were appropriate systems in place for the safe management of medicines.

The people who used the service told us staff were attentive to their needs and they felt there were normally enough staff on duty to care for them. We saw there were systems in place to review staffing levels and ensure that appropriate staffing levels were maintained.

We saw the premises were appropriately maintained and had suitable facilities for the needs of the people using the service. The provider had systems and process in place to monitor and review the quality of the service provided and to manage complaints.

Everyone we spoke with spoke positively about the staff and felt the staff fully supported their care needs. People told us the staff spoke with them in a calm and respectful manner. One person said, "Staff here respect my daily wishes."

The people we spoke with told us their care was personalised to their needs. They told us they knew staff kept records on them and had seen those records and discussed the content. One person said, "I've been happy for my family to sign my care plan."

People told us they were happy with the standard of cleanliness in the home and their clothes were returned clean and ironed. One person told us, "The cleaning staff are very thorough and clean the top of my wardrobe as well as the rest of the furniture."

People told us they felt safe and that staff appeared well trained. They told us the manager spoke with them on a regular basis. One person said, "Staff seem to know the answers to all my questions."

The people we spoke with confirmed their views were sought through regular meetings with staff, quietly in the privacy of their rooms and by questionnaires. This was confirmed by the records. One person said, "I enjoy the meetings and feel I can give my opinion."