Archived: Melbourne Home

Melbourne Home is a care home providing personal care for up to 17 people aged 65 and over. At the time of the inspection there were 15 people in residence.

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

People were at risk of not receiving their medication as prescribed. Systems to monitor the safe use of medicines were not in place. Staff’s knowledge and competence for the management of medicines could not be evidenced. The interim manager had enrolled staff on a training course.

Potential risks were assessed; however, improvements were needed to the review process in determining the level of risk so that any changes to people’s needs could be identified and implemented. The provider’s policy for the recruitment of staff, and the use of volunteers were not followed, which meant people were supported by people who had not had their suitability to work with them consistently checked, putting people at potential risk.

An interim manager appointed in July 2021 managed the day to day running of the service . The nominated individual regularly visited, speaking with people and staff which included the interim manager. However, they told us they were not involved in the monitoring of the service to ensure good outcomes for people.

Systems and processes for the governance of the service were ineffective. Information as to the quality of the service, its performance, and areas for improvement were not shared with the Board of Trustees. This had restricted the service’s ability to continually learn and improve.

Some of the provider’s policies and procedures had not been implemented, which meant unsafe practices had developed, placing people at potential risk. Systems and processes to provide accessible information and records were not in place.

Systems were in place for regular cleaning of the service to prevent and control infection. Visitors to the service were required to evidence a negative COVID-19 test and were required to wear personal protective equipment (PPE). Staff were seen to be wearing PPE appropriately. People and staff were routinely tested for COVID-19, consistent with government guidance.

People were supported to receive person centred care with regards to their beliefs and preferences. People spoke of their enjoyment of religious services held at Melbourne Home, and opportunities to pray. People were able to engage in activities and events which they enjoyed, which include trips out and activities within the service. People were positive about the caring and supportive approach of staff, and we saw people, staff and volunteers took comfort and enjoyment through laughter and conversation.

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 11 October 2018).

Why we inspected

We received concerns in relation to staffing, the safe care of people and the day to day management of the service. As a result, we undertook a focused inspection to review the key questions of Safe and Well-led only.

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.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them.

Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from Good to Requires Improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. Please see the Safe and Well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

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

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to leadership and governance, medication management and staff recruitment.

Please see the action we have told the provider to take at the end of this report.

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.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and 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.

This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Melbourne Home is a residential care home for up to 17 older people. The home is owned by a charitable trust and has links to the church. The home has 17 bedrooms, with en-suite facilities, over three floors with stairs and lifts. At the time of this inspection there were 17 people using the service.

The service had a registered manager. This 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 home had a welcoming atmosphere. Staff were visible and continually speaking with people they supported. People told us they felt safe at the home and there were enough staff to meet their needs. Staff knew how to minimise risks to people and ensure they had their medicines when they needed them.

Staff were trained, skilled and knowledgeable about how to provide effective care and support.

People were involved in choosing their own meals and records showed people's nutritional needs were identified and met. Meals were varied.

People's healthcare needs were well-managed at the home.

The premises were homely and comfortable apart from paint damage to a small number of bedrooms.

People said the staff cared about them and encouraged them to be independent. Staff communicated with people in the way people wanted including speaking with people and using pictures to make communication easier for some people.

People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible. The policies and systems at the home supported this practice.

Activities were seen as important to people's quality of life at the home and staff ensured people had the opportunity to take part in one-to-one activities. These included social and leisure activities based on people's preferences.

The home was well-led by the registered manager. Staff said there was a culture of openness at the service and the registered manager and senior staff were seen as very supportive to them. People and relatives were involved in how the home was run and their views listened to and respected. The results of the home’s quality assurance survey showed a high level of satisfaction with the service provided.

Further information is in the detailed findings below.

This inspection took place on 31 December 2015 and 4 January 2016. The inspection was unannounced and was carried out by one inspector.

A registered manager was in place. 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 and associated Regulations about how the service is run.

Since our previous inspection in April 2014 where we found the provider had not properly assessed people's capacity to make decisions, we followed up this issue at this inspection. We found proper systems in place, which evidenced that the provider had addressed this issue.

People using the service and the relatives we spoke with said they thought the home was safe. Staff were trained in safeguarding (protecting people from abuse) and understood their responsibilities in this area.

People's risk assessments provided staff with information of how to support people safely.

Staff used an appropriate moving and handling techniques to safely transfer people.

People using the service and a relative told us they thought medicines were given safely and on time and systems in place provided evidence of this.

The premises appeared safe with no tripping hazards observed.

Staff were safety recruited to help ensure they were appropriate to work with the people who used the service.

Staff needed some additional training to ensure they had the skills and knowledge to be able to fully meet people's needs.

Staff understood their responsibilities under the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) to allow, as much as possible, people to have an effective choice about how they lived their lives, and the service had obtained legal approval for limiting people's choices when necessary for their best interests.

People had plenty to eat and drink, everyone told us they liked the food served and people were assisted to eat when they needed help.

People's health care needs had been protected by timely referral to health care professionals when necessary.

People and relatives we spoke with told us they liked the staff and got on well with them, and we saw many examples of staff working with people in a friendly and caring way.

People were involved in making decisions about their care, treatment and support.

Care plans were individual to the people using the service and covered their health and social care needs.

People were satisfied with the activities provided which met their needs.

People and relatives told us they would tell staff if they had any concerns and were confident they would be followed up to meet people's needs.

People, relatives, staff and professionals were satisfied with how the home was run by the registered manager and her management team.

Management carried out audits and checks to ensure the home was running properly to meet people's needs, though these needed extended to provide comprehensive checks to ensure that people's needs were comprehensively met.

Is the service safe?

There were systems in place to ensure that people were safe in terms of their care and treatment at the home. People had risk assessments in place to ensure their safety and well-being and these were regularly reviewed and updated.

We found that people were being cared for in a clean and safe environment which was well maintained.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. We saw evidence that where applications have needed to be submitted, proper policies and procedures were in place. However, staff knowledge and understanding in this area was not always as good as it should be. This has been reflected and addressed within the report.

We found that there were adequate numbers of staff to meet people's needs safely and that staff had the training to deliver safe and appropriate care to people.

Is the service effective?

We spoke with people who used the service and they were all satisfied with the delivery of their care. One person told us, 'Everything about this home is lovely."

Care plans were individualised to people and contained information in relation to their personal preferences and needs. People were supported to maintain good health by on-going monitoring and referral to appropriate health professionals when necessary. Our observations showed that people's care was delivered in a way that reflected this information. We found that staff had a good understanding of the needs of people who used the service

Is the service caring?

People were being cared for by kind and compassionate staff who understood their individual needs and who treated them with respect. People were listened to and equality and diversity was recognised and respected by the service.

Staff understood equality and diversity and had positive relationships with people using the service.

People using the service were able to express their views and opinions about how the service was being run and these were listened to and documented.

Is the service responsive?

The service was responsive to people's changing needs and people using the service were supported to remain as independent as possible.

People were involved in their care and treatment and their concerns and views were respected and acted upon where necessary. People were involved in reviews of their care planning and delivery and were able to express their views about how the service was being run.

There was a clear complaints policy in place and people were given information on how to complain should they wish to.

Is the service well-led?

We found that there was strong, positive leadership in place at the service which encouraged an open and inclusive culture for staff to work in. There were systems in place to assess the quality of the service and to ensure people's safety.

None of the staff we spoke with had any issues or concerns about how the service was being run and were very positive about the leadership in place.

We found staff to be motivated, caring and trained to an appropriate standard, to meet the needs of people using the service. However, there was a gap in staff training in relation to the Mental Capacity Act 2005. Staff performance was monitored in order to assess the quality of care being delivered.

We spoke with three people they told us they were well cared for and staff were kind and caring. One person told us: "There is excellent care here, and we have a wonderful cook." Another person told us: "The staff are so kind, your family members are greeted well." All the people we spoke with told us about service users meetings and the organised monthly trips with the next trip planned to a local garden centre. One person told us their family had visited and liked the bedroom as there was a lovely view outside. We saw the home was well maintained warm, clean and homely. We saw the housekeeper cleaned and chatting to people who use services as she entered their bedrooms to clean. We saw bedrooms were personalised with peoples furniture and belongings, and bedroom doors identified people's names.