Archived: Melville House

Updated 22 June 2019

The inspection:

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. This inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Act, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

Inspection team:

The inspection team consisted of two inspectors, an assistant inspector and an expert-by-experience (ExE). An ExE is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type:

Melville House 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.

The service did not have a manager registered with the Care Quality Commission. A manager had been appointed and they were in the process of applying to become the registered manager. The registered manager and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection:

The inspection took place on 30 April, 01 May and 09 May 2019. The first day of the inspection was unannounced and the provider was aware we would returning on 01 May 2019. We completed a third, unannounced day of inspection to check to see if the provider had carried out specific actions they told us they would make to keep people safe from harm.

What we did:

As part of the inspection we reviewed the information we held about the service. We looked to see if statutory notifications had been sent by the provider. A statutory notification contains information about important events which the provider is required to send to us by law. We reviewed information that had been sent to us by the public. We used this information to help us plan our inspection.

During the inspection we spoke with seven people who used the service and two relatives. Many people who lived in the service were unable to share their views regarding the care they received. To help us understand the experiences of these people we used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people living at the service. We also carried out further observations across the service regarding the quality of care people received. We spoke with the provider, the manager and nine staff members including the cook, activities co-ordinator, nursing staff, senior care staff and care staff. We reviewed records relating to people’s medicines, people’s care records, including nine people’s care records in detail. We also reviewed records relating to the management of the service; including staff recruitment records, complaints and quality assurance records.

Updated 22 June 2019

About the service: Melville House is a nursing and residential care home that provides personal and nursing care to up to 29 people. There were 26 people living at the service at the time of the inspection. Most of whom were older people living with dementia.

People’s experience of using this service:

People were not sufficiently protected from the risk of harm; including potential abuse, the behaviour of others, health concerns or accidents and injury. The provider’s risk management systems were inadequate. People were not protected by safe medicines management systems.

People were not being supported by sufficient numbers of staff with the right skills that were being deployed effectively.

People’s rights were not upheld with the effective use of the Mental Capacity Act 2005. People’s needs were not being accurately assessed, understood and communicated. Care provided did not consistently meet people’s needs. People were not receiving care that was truly person-centred and met all of their needs; including religious needs and leisure.

People did not receive support that was consistently caring and respectful that upheld and promoted their dignity and independence.

People were not protected by robust quality assurance and governance systems. The provider failed to ensure the systems they had in place identified risk to people and areas of improvement needed. The provider failed to make sufficient improvements and as a result people were living in a deteriorating service and were exposed to the risk of harm.

Rating at last inspection: At the last inspection the service was rated ‘requires improvement’ (inspection completed 22 February 2019 and report published 01 May 2019). The service has been rated as requires improvement seven times prior to this inspection.

Why we inspected: We completed this inspection due to our previous inspection findings and ratings in addition to concerns that were received from the public and local authority. The inspection was brought forward due to information of concern regarding the quality of care being provided to people.

Enforcement: Full information about CQC’s regulatory response to the more serious concerns found in inspections and appeals is added to reports after any representations and appeals have been concluded.

Follow up: Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

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