Madelayne Court is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Madelayne Court provides care and accommodation to up to 112 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 and at the time of our visit there were 111 people at Madelayne Court.

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.

The inspection took place on 3 August 2016 and was unannounced.

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 inspection took place on 9 and 11 June 2015 and was unannounced.

Madelayne Court is one of a number of services owned by Runwood Homes Ltd. The service provides care and accommodation for up to 112 people who may need assistance with personal care and may have care needs associated with living with dementia. The service is split into seven units located over three floors.

The service had 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.

People at the service were not always safe as there were not always sufficient staff to meet their needs. Risk assessments were carried out and measures put in place to manage and minimise any risk identified. Recruitment processes were in place prior to people being appointed. Medicines were stored safely and administered safely. However staff did not consistently record the administration of prescribed creams.

The Care Quality Commission monitors the operation of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS) and is required to report on what we find. The registered manager had a good understanding of the MCA and DoLS and appropriate documentation had been completed.

People were supported to have a balanced diet to meet their individual needs and to make choices about the food and drink on offer. People’s health needs were managed by staff with input from relevant health care professionals.

Staff knew the people they cared for and spoke to them in a way which they understood. Staff did not always treat them with respect. People were supported to make decisions about their care, with input from their families as appropriate.

Assessments had been carried out and care plans were developed which reflected individual’s needs and preferences. People were not always supported to take part in activities of their choice. People were encouraged to share their views. People knew how to complain and the service had a clear system to manage complaints.

Systems were not in place to effectively address concerns and risks arising from inadequate staffing. There were systems in place to check and audit the quality of the service but these did not always result in improvements. The views of people and their relatives were sought and feedback was used to make improvements and develop the service.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the provider to take at the back of the full version of this report.

At our last inspection on 27 September 2013, we had moderate concerns in relation to the lack of appropriate arrangements in place to deal with care and welfare of people who use services, safeguarding and safety, supporting workers and assessing and monitoring the quality of service provision

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.

People who were able to provide us with feedback told us that they were happy living in the home, that the care staff had a caring approach and that they were good at letting them be as independent as they could be. People also spoke positively about social events in the home but there were mixed comments about the food and mealtime experience.

Those people with whom we spoke were happy with the care they received at Madelyane Court. They did not raise any concerns and provided positive comments about the staff and the care they received. They confirmed that they had been involved in decisions on how their care was to be provided.

The people with whom we spoke were complimentary about the food. Comments included “It is nice”, “I don't like too much on my plate and this is just right” and “Very nice.” One group of people confirmed the meal was hot.

People were happy with the cleanliness and decoration of the home. They were positive about the staff who worked at Madelayne Court and said that staff were kind and provided the help they needed.

During our inspection, we spoke with some relatives and people who used the service. They told us they were mostly happy with the care and treatment people received.

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.