Melbury House

Melbury House is a residential care home providing accommodation and personal care to up to 34 older people, including people who may live with dementia, or a dementia related condition. At the time of our inspection there were 29 people using the service in one adapted building.

People’s experience of using this service and what we found

Staff knew people well, but people were not always consulted or involved in daily decision making.

People were not always supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service did not always support this practice.

Improvements were needed to some systems including to people’s care records to ensure more person-centred care was provided. We discussed with the management team, care plans should be more person-centred detailing how staff were to provide care in the way the person wanted and needed support to be provided.

We have made a recommendation about ensuring systems are in place to provide choice and promote people’s involvement in their daily living requirements, whatever the level of need.

Medicines were managed safely. Medicines records required more information for the use of ‘when required’ medicines.

We have made a recommendation about protocols being available for the use of ‘when required’ medicines.

There was a welcoming and cheerful atmosphere in the service. A person told us, “It’s just like being at home. We all get along with each other.”

Risks were assessed and mitigated to keep people safe. Staff recruitment was carried out safely and effectively.

People and relatives were complimentary about the care provided by staff. They trusted the staff who supported them. They said staff were kind, caring and supportive of people and their families. A person told us, “I love it here. I love everything about it, I couldn’t ask to be better looked after.”

Staff were following safe infection prevention and control procedures to keep people safe. Staffing capacity was sufficient and staff deployment was effective to ensure people's needs were met in a safe, timely way. A person told us, “There are lots of staff always buzzing around.”

There was evidence of collaborative working and communication with other professionals to help meet people's needs. A visiting professional commented, “Staff are very responsive, they always follow our advice, any referrals are made without delay.”

Staff spoke very positively about working at the home and the people they cared for. They said communication was effective to ensure they were kept up-to-date about any changes in people’s care and support needs.

A quality assurance system was in place to check the quality of service provision. A person told us, “I think it’s run very well. They [staff] do what they say they are going to do. This is the best one I’ve been in, I’ve been lucky.”

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 14 September 2017).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained good based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Melbury House on our website at www.cqc.org.uk.

Recommendations

We have made a recommendation about ensuring systems are in place to provide choice and promote people’s involvement in their daily living requirements, whatever the level of need.

We have made a recommendation about protocols being available for the use of ‘when required’ medicines.

We have made a recommendation that the locking of all bedroom doors, when people are not in them, should be reviewed, so people can easily access their bedrooms.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

Systems were in place to manage and prevent people, staff, and visitors from spreading infections. The home supported staff and people with social distancing. Enhanced cleaning has been in place throughout the COVID-19 pandemic.

Staff had undertaken training in putting on and taking off PPE, hand hygiene and other Covid-19 related training. Managers observed staff practices to ensure the correct IPC procedures were being followed. Additional cleaning of all frequent touch surfaces was being carried out. Areas of the home were set aside for staff to change PPE. Information was displayed throughout the home to remind staff what PPE they needed to use and their responsibilities.

Due to the current outbreak in the home, visiting had been reduced in line with both national and local guidance. People were being supported to keep in contact with friends and relatives through a variety of means which included telephone calls and social media.

Staff supported people’s emotional and social wellbeing. Activities had been planned within the home to positively support people through this period of change to their routines. Outdoor garden space was being used to its maximum potential where appropriate.

The home was following national guidance for anyone moving into the home from the community or hospital. Staff worked with people and their relatives to ensure they were aware of isolation procedures should they be needed. People were supported by a dedicated staff team who ensured any feelings of isolation and loneliness reduced.

Infection control audits and checks were carried out. The registered manager spoke positively about the hard work and dedication which staff had shown, which had helped to minimise the impact of this outbreak on people’s health and wellbeing. The provider continuously shared important information about Covid-19 to staff.

At the last inspection in July 2015, the service was rated 'Good'. At this inspection we found the service remained 'Good'.

The service had 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Staff understood the procedure they needed to follow if they suspected abuse might be taking place. Risks to people were identified and plans were put in place to help manage the risk and minimise them occurring. The manager and staff had assessed and monitored one person who stayed on their own when they visited church; however, there wasn’t a formal risk assessment for this. The manager told us they would take immediate action to address this. In addition the leads on the call system to summon the help of staff were long and as such posed a risk of strangulation. The manager told us they would immediately undertake a risk assessment on all people who used the service to determine safety.

Medicines were managed safely with an effective system in place. We did note that the room temperature in which medicines were stored was monitored daily and on a number of occasions the room temperature was too hot. The provider took immediate action to address this and had a thermostatically controlled fan installed and they were to monitor this temperature to ensure it didn’t exceed the maximum limit. At the time of the inspection the service did not have separate guidance for the administration of ‘as required’ medicines, creams or other topical applications. After the inspection the pharmacist the service used contacted us and told us they were to supply both documents to the service.

Appropriate checks of the building and maintenance systems were undertaken to ensure health and safety was maintained.

People and relatives told us there was enough staff on duty to meet the needs of people. We found that safe recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work.

People were supported by a regular team of staff who were knowledgeable about people’s likes, dislikes and preferences. A training plan was in place and all staff had completed up to date training.

Staff had an understanding of the Mental Capacity Act 2005 and acted in the best interest of people they supported. Staff clearly understood their role in supporting people with communication to help them make as many of their own decisions as possible. Staff told us about people’s care preferences, which were also recorded in their care plans. However, at the time of the inspection, processes had not been followed to formally record this. Information was supplied to us after the inspection to confirm that this process had commenced.

People were provided with a choice of healthy food and drinks, which helped to ensure that their nutritional needs were met. People were supported to maintain good health and had access to healthcare professionals and services.

There were positive interactions between people and staff. We saw staff treated people with dignity and respect. Staff were kind, caring and interacted well with people. Observation of the staff showed that they knew the people very well and could anticipate their needs.

Care plans detailed people’s needs and preferences. Care plans were reviewed on a regular basis to ensure they contained up to date information that was meeting people’s care needs. People were actively involved in care planning and decision making. People who used the service had access to a range of activities and leisure opportunities. The service had a clear process for handling complaints.

Staff told us they enjoyed working at the service and felt supported by the registered manager. Quality assurance processes were in place and regularly carried out by the manager and provider, to monitor and improve the quality of the service. The service worked with various health and social care agencies and sought professional advice to ensure individual needs were being met.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, and the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People told us they were treated with respect and dignity by the staff. They said they felt safe. We found safeguarding procedures to be robust and staff understood how to safeguard the people they supported.

Systems were in place to make sure that managers and staff learned from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve.

The home had proper policies and procedures in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. The company director responsible for the home told us about an application that had been submitted. We also found relevant staff had been trained to understand when an application should be made, and how to submit one. This meant people were safeguarded as required.

Robust staff support and ongoing specific training was available to make sure staff had the skills and expertise to support the needs of people at the home.

Is the service effective?

There was an advocacy service available if people needed it, this meant people could access additional support when required.

People's health and care needs were assessed with them, and they or their representatives were involved in writing their plans of care. Specialist dietary, social, mobility, equipment and dementia care needs had been identified in care plans where required. Some people and their relatives said they had been involved in writing them and they reflected their current needs.

Visitors confirmed they were able to see people in private and that visiting times were flexible.

Is the service caring?

People told us they were supported by kind and attentive staff. We saw care workers showed patience and gave encouragement when supporting people. People commented, 'The staff are exceptional, they are genuinely nice people who care about us and try to give us the best we can get.' A relative said, 'They will bend over backwards to make you happy here, most of us have never experienced anything like this.'

People using the service, their relatives, friends and other professionals involved with the service completed an annual satisfaction survey. Where comments or concerns were raised, we saw these had been addressed by the provider and feedback used to structure further developments.

People's preferences, interests, aspirations and diverse needs were recorded and care and support was provided in accordance with people's wishes.

Is the service responsive?

People completed a range of activities in and outside the service regularly.

Whilst no one had made any complaints, the people we spoke with told us they knew how to make a complaint if they were unhappy. This meant people were assured that complaints would be investigated and action taken when necessary.

People who lived at the home and their relatives felt the staff and manager were approachable and we saw how they were able to talk freely, ask questions and were satisfied with appropriate responses.

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way.

The service had a quality assurance system. The records we looked at showed any shortfalls were addressed promptly. As a result the quality of the service was continuingly improving.

Staff told us they were clear about their roles and responsibilities. Staff were well trained and had a good understanding of the ethos of the home and the quality assurance systems in place. This helped to ensure that people received a good quality service.

We found care and treatment was planned and delivered in a way which ensured people's safety and welfare. One person who lived at the home told us, 'I get my own way. I prefer to spend time in my room and they find that's acceptable.'

The provider had made suitable arrangements to protect vulnerable people and respond appropriately to any allegation of abuse. We spoke with a visiting social worker who told us she did not have any concerns and felt the people at the home were protected from abuse.

The provider had taken steps to make sure people at the home were protected from staff who were unsuitable to work with vulnerable people by carrying out thorough background checks.

We found the provider had an effective system in place to identify, assess and manage risks to the health, safety and welfare of people using the service and promote their health and wellbeing.