Melody Lodge

Melody Lodge is a care home that provides accommodation and support for up to 11 people who live with a learning disability and/or autistic spectrum disorder. Seven people were living there at the time of our inspection.

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

People were supported to stay safe by staff who were trained to identify and report any issues of concern. Risks had been identified and actions taken to keep people safe whilst supporting their independence.

Staff had been recruited and introduced to the service in a safe way. There were enough staff to ensure people’s needs and wishes were met in a timely way.

Medicines were managed safely and staff worked with health and social care professionals to help people maintain their health and well-being. The environment was clean and good infection control procedures were followed.

Staff received training and support to ensure people’s care was focused on their individual needs and wishes. People were supported to enjoy the food and drinks they liked and staff encouraged them to maintain a well-balanced diet.

People were 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 supported this practice.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture. People were involved in planning their own care so that the way they lived their life reflected their choices and wishes.

Staff were kind and caring towards people and upheld their privacy and dignity. People were respected as individuals and their views and opinions were valued. They were supported to engage in meaningful activities both in their home and within the local community, COVID-19 restrictions permitting.

There were systems in place to ensure good oversight of the quality of the services provided, and clear plans were in place to address any shortfalls. The registered manager promoted an open and inclusive culture within Melody Lodge and worked in partnership with relatives and external professionals to achieve good outcomes for people.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 15 October 2020).

At the last inspection the provider had positive and restrictive conditions applied to their registration. At this inspection we found they had sustained previous improvements and were meeting the conditions of their registration.

Why we inspected

This was a planned inspection based on the previous rating.

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.

Follow up

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

The home had been developed and designed before the principles and values that underpin Registering the Right Support (RRS) had been published. This guidance aims to ensure that people who use the service can live as full a life as possible and achieve the best outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice and independence.

The home is registered to provide support for up to 11 people and there were seven people living there at the time of our inspection. The service is larger than recommended by best practice guidance. However, the service had applied the principles and values of RRS and had mitigated against environmental factors that would otherwise reduce the likelihood of being able to provide truly person-centred care. The outcomes for people living at Melody Lodge reflected the principles and values of Registering the Right Support by promoting choice and control, independence.

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

Improved systems were in place to ensure risks to people’s health, safety and welfare were minimised. Material improvements to the environment had a positive impact on people’s privacy and dignity.

Staff had been trained to manage behaviours people displayed when they were distressed. Staff were more effectively supported to implement their skills and knowledge to benefit the people who lived in the home.

Staffing levels had been reviewed and reflected people’s support needs.

Staff followed infection prevention and control procedures. This included following up to date national guidance regarding the Covid-19 pandemic.

Governance systems had been improved and operated more effectively. This enabled issues and shortfalls to be identified and addressed in a timely way.

Incidents and events that occurred within the home were reviewed. Lessons were learned and led to improvements in the quality of the support provided for people.

People were 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 supported this practice.

Rating at last inspection and update

The last rating for this service was inadequate (published 1 February 2020) and there were multiple breaches of regulations. The provider created an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

This service has been in Special Measures since 1 April 2019. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall. Therefore, this service is no longer in Special Measures.

Why we inspected

We carried out this focused inspection to check the provider had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the key questions safe and well-led. The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from inadequate to requires improvement. This is based on the findings at this inspection.

You can read the full report from out last comprehensive inspection by selecting the ‘all reports’ link for Melody Lodge on our website at www.cqc.org.uk

Follow up

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

The home had been developed and designed before the principles and values that underpin Registering the Right Support had been published. This guidance aims to ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence.

The outcomes for people did not fully reflect the principles and values of Registering the Right Support. People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

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

The service provided was not safe. People's health and safety was at risk due to a failure to identify and address issues and poor practices.

Risks associated with people's care and support arising from needs such as epilepsy and distressed behaviour were not managed safely.

Poor management of environmental risks arising from substantial and on-going exterior building work and fire safety arrangements placed people at risk of harm.

There were not enough staff to ensure people's safety at all times.

Not all of the staff had the training or knowledge to ensure people were provided with safe care and support. Staff did not always recognise when people were at risk of experiencing abusive practice.

People were at risk of inconsistent and unsafe care as their needs were not appropriately assessed or planned for.

People's right to dignity and privacy was not always respected.

The service was not well led. Ineffective quality monitoring systems meant there was no oversight of the risks associated with people’s health safety and welfare. Opportunities to learn lessons and drive improvements when concerns were raised had been missed.

People were provided with support to take part in the local community and supported to keep in touch with family and friends.

Improvements had been made to staff recruitment systems and management of complaints. Some improvements had been made to the ways in which the principles of the Mental Capacity Act 2005 (MCA) were applied. However further work was needed to ensure people were supported to make decisions in their lives.

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

Rating at last inspection (and update)

The last rating for this service was inadequate (published 12 April 2019) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found some improvements had been made and the provider was no longer in breach of three regulations. However, enough improvement had not been made in other areas and the provider was still in breach of five regulations. A further breach of regulations was also found at this inspection.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

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

Enforcement

We have identified breaches in relation to dignity and respect, safe care and treatment, safeguarding people from abuse and improper treatment, premises and equipment, staffing and good governance. We took action in line with our enforcement procedures. We added conditions to the provider's registration to drive improvement in the quality of the service provided.

Follow up

We have arranged to meet with the provider to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The overall rating for this service is 'Inadequate' and the service remains in 'special measures'.

The care service had not been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

People's experience of using this service: The culture of the service was poor. The registered manager and staff did not recognise or understand their practice placed restrictions on people.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. Consent to care and treatment was not sought in line with the principles of The Mental Capacity Act 2005 (MCA).

Whistleblowing procedures were ineffective. Staff raised concerns with the registered manager and provider but did not escalate their concerns with other authorities when they failed to act.

Incidents of a safeguarding nature were not reported to CQC.

Timely action had not been taken to address concerns regarding the environment. This placed people at risk of avoidable harm.

Staff had not been recruited safely as all of the relevant checks had not been completed and there were not enough staff employed to meet people needs.

People were not always treated with dignity and respect. Staff did not follow best practice guidelines and positive behaviour support strategies were not used. Punitive practice was embedded within the culture of the home.

The service was not well led. People had experienced restrictions to their liberty because of poor practice and ineffective governance systems and processes.

Why we inspected: This was a planned inspection based on the rating at the last inspection.

Rating at the last inspection: The service was rated as good and the report was published in June 2016.

Follow up: Following the inspection we referred our concerns to the local authority responsible for safeguarding. In addition, we requested an action plan from the provider, and evidence of improvements made in the service. This was requested to help us decide what regulatory action we should take to ensure the safety of the service improves.

The overall rating for this registered provider is 'Inadequate'. This means that it has been placed into 'Special Measures' by the Care Quality Commission (CQC). The purpose of special measures is to:

¿ Ensure that providers found to be providing inadequate care significantly improve.

¿ Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

¿ Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

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. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

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

People living at the home were of mixed ages. Some people required more assistance either because of physical illnesses or because they were experiencing difficulties coping with everyday tasks. The home had a small occupancy and the majority of people had lived together for a long time.

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. 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 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.

Staff had taken care in finding out what people wanted from their lives and had supported them in their choices. They had used family and friends as guides to obtain information and accessed a number of different resources within the community.

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. Some people helped with the preparation of meals and setting tables for meals.

The provider used safe systems when new staff were recruited. All staff completed training courses to update their knowledge about people’s individual health care needs. 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. Since our last inspection the provider had continued with building development at the premises and refurbished many parts of the home. The building work was still on-going.

The views of people who used the service were recorded in care plans on a daily basis and the manager held reviews throughout the year to reassess people's needs. One person told us, "XX (the manager) talks to my family all the time and we have meetings."

Staff recorded in care plans the needs and wishes of people who used the service. These were updated at least monthly or as a need changed. People who used the service told us they knew staff kept notes on them." One person said, "I can read the pictures and staff read the words to me."

Work on the new part of the building was still in progress but areas where work was taking place had been made safe for people who lived on the premises, staff and visitors. Some areas of the home had been refurbished. One person told us, "We were asked what colour carpet we would like in the upstairs corridor, but I wasn't bothered." A revised action plan on work in progress is being sent to us.

The quality assurance audit programme had been reviewed since our last visit. A number of audits had taken place so the provider could see how good the quality of the service was for people who used the service. One person who used the service told us, "I speak to staff each day and don't need a meeting."

The people we spoke with told us their care was personalised to their needs. One person said, "I go through my care plan." Another person told us about the social activities they did each week. Another person told us, "The staff helped me put on some different coloured nail polish so I could go out looking nice today."

Improvements to the refurbishment programme had been made since our list visit. People told us they liked their bedroom area. One person said, "I like staying in my room. Its nice."

We did not ask people whether they thought there was sufficient staff on duty to meet their needs. Staff told us they had time to meet peoples needs with the amount of staff on duty each day and night.

People told us how well staff looked after them. One person said, "Staff are nice here." We saw details of when staff had attended training sessions which included all mandatory training and topics about specific illnesses.

Improvements had been made in the way the manager monitored the quality of service being provided. However a more robust system needed to be in place to ensure all audits were commenced and any actions completed. This would ensure the premises were a safe place to live and peoples needs were being met.