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Melbourne House Requires improvement

Reports


Inspection carried out on 7 October 2019

During an inspection to make sure that the improvements required had been made

About the service

Melbourne House is a care home registered to provide personal care and accommodation for up to 33 older people aged 65 and over in one adapted building. At the time of our inspection there were 25 people living at the home.

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

People’s basic care needs were met, and staff knew about people’s preferences for care. People were at ease around staff demonstrating they felt safe being supported by them.

Risks associated with people’s care were known by staff, but records continued to require improvement to ensure there was a consistent and safe approach in meeting people’s needs. This included improvement to records related to nutrition and hydration to demonstrate people received sufficient to eat and drink.

Risks related to the environment were being identified but actions were ongoing in ensuring these were met consistently.

Staff were aware of their responsibilities regarding the reporting of potential abuse. Systems were in place for safeguarding concerns to be referred to the local safeguarding authorities for follow up as appropriate.

Electronic care planning systems continued to present problems with internet signals, but the provider was working with staff and the management team to address this. This included using written records where appropriate.

People received their medicines from staff trained in medicine management. There had been improvements made to medicine management since the last inspection. Arrangements were also in place for further improvements to be made so that these were managed safely consistently.

There were sufficient numbers of staff to support people’s needs; no new staff had been recruited since the last inspection.

New quality monitoring systems were in the process of being introduced to help improve the quality of care and services people experienced.

People were encouraged to share their experiences of living at the home at periodic meetings and within satisfaction surveys. People also felt at ease to discuss their needs with the management team.

Rating at last inspection (and update)

The last rating for this service was Requires Improvement (published 3 September 2019) and there were multiple breaches of the regulations. 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 improvements had been made and the provider was no longer in breach of the regulations. However, the service remains rated requires improvement.

Why we inspected

During our last inspection we issued a Warning Notice as the provider had not taken sufficient action to address breaches in the regulations. We carried out this focused inspection to check that improvements to meet legal requirements planned by the provider after our comprehensive inspection on 12 and 16 July 2018 had been taken. The provider completed an action plan following the last inspection to show what they would do and by when to improve. This report only covers our findings in relation to the key questions of 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 remained the same. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Melbourne House 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.

Inspection carried out on 12 July 2019

During a routine inspection

About the service

Melbourne House is a care home registered to provide personal care and accommodation for up to 33 older people aged 65 and over in one adapted building. At the time of our inspection there were 25 people living at the home.

Peoples experience of using the service

Risks associated with people’s care were not always fully assessed and care plans lacked detail to support staff in keeping people safe. This included management of nutritional risks that could impact on people’s health. Where there were health and safety risks associated with the environment, equipment and infection control, quality monitoring systems had not been effective in identifying these.

There were enough staff to meet people’s basic needs, but people spoke of delays in receiving support sometimes suggesting staff deployment was not effective. Processes followed to recruit new staff were not always managed safely. Staff files lacked information to demonstrate risks associated with staff recruitment had been identified, discussed and assessed.

People said they received their medicines when required but discrepancies in medicines counts demonstrated they were not effectively audited to confirm medicines had been managed safely.

People were not always supported to have maximum choice and control of their lives. Staff lacked understanding of the Mental Capacity Act. Some Deprivation of Liberty Safeguard authorisations to authorise restrictions placed on people’s care had expired. Although people spoke positively of living at Melbourne House and of the staff that supported them, we saw people were not always treated with dignity and respect. Sometimes staff instructed people on what to do instead of asking people to ensure they consented to the care and support they were about to provide.

Whilst staff gave assurances that people received the care they needed, records did not demonstrate this consistently. This also applied to information about access to healthcare professionals. Information did not always show they were accessed in a timely manner to help maintain people’s health.

People had been involved in planning and discussions about their care when they started to use the service. Some people’s wishes about how their end of life care was to be managed had been obtained.

Electronic care plans were in use but sometimes signals around the home prevented staff from accessing and recording information when needed which presented a risk in managing people’s care safely and effectively.

Staff had not completed all of the training considered essential to update their skills and knowledge.

There were systems to check the quality of the service. However, these systems were not effective as they had not identified the concerns we identified such as those in relation to risk management. Some of the concerns we found had also been identified at our previous inspection.

Accidents and incidents were recorded, investigated and action taken to reduce risk.

Staff understood their responsibility to report concerns or potential abuse to the registered manager. The registered manager had ensured these were reported to us and the local authority where appropriate. This was an improvement following the last inspection.

People told us that felt at ease to raise concerns with the registered manager. A complaints policy was in place, but this did not contain all of the information people would need to escalate their concerns if they were not happy with how their complaint had been managed.

Staff spoke positively about working at the home and felt well supported by the management team which consisted of the registered manager and deputy manager.

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 on 10 July 2019) and there were two breaches of the regulations. The provider completed an acti

Inspection carried out on 28 June 2018

During a routine inspection

This inspection took place on 28 June and 2 July 2018. The inspection was unannounced.

Melbourne house is a care home registered to provide personal care and accommodation for up to 33 older people. People in care homes receive accommodation and personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The accommodation for people is spread over three floors with the main lounge and dining room that people used on the ground floor. There were 26 people living at the home at the time of the inspection.

We last inspected Melbourne House in February 2017 when we rated the service as 'Requires Improvement' in the key question of safe and responsive. We had found risk management was not always effective to keep people safe and people didn’t always have access to social activities to maintain their wellbeing.

At this inspection visit, we found these areas continued to need improvement. At the time of our visit the provider was in the process of changing over to a computerised care planning system, but neither set of records was completed in full. This meant records were not sufficiently clear for the registered manager to be assured risks were managed and people’s needs were safely met. People had access to limited social activities and these were not always centred on individual needs and preferences to support person centred care. At times, people’s privacy and dignity was compromised.

The service had a registered manager. This is a requirement of the provider's registration. 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.

There were sufficient care staff to meet people’s basic needs and staff spoke positively of working at the home and the management support they received. Staff received ongoing training to ensure they met people’s needs safely. They understood their roles and responsibilities to protect people from avoidable harm, and people said they felt safe with staff. Staff followed the provider’s policies and procedures to ensure people were protected from the risks of infection.

People's ability to make decisions was assessed in line with the Mental Capacity Act 2005. Staff offered people choices and respected the decisions they made. Where restrictions on people’s liberty had been identified as necessary in their care plans, Deprivation of Liberty Safeguards authorisations had been applied for, or were in place, to lawfully deprive people of their liberty for their own safety.

People were able to access a GP when needed and were referred to external healthcare professionals where appropriate to maintain their health. We identified some improvements were needed regarding medicine management as procedures for safe medicine management were not always followed.

Staff were caring and supportive in their approach to people and offered encouragement and reassurance to people when they needed it. People were encouraged and supported to eat and drink enough and were positive about the quality and variety of their meals.

People, relatives and staff said communication was good at Melbourne House and they felt at ease to approach the registered manager with any concerns if they needed to. Where accidents and incidents had occurred, learning was taken from these to help improve the service. However, we found some incidents had not been reported to the local authority or us as required in line with the safeguarding procedures in place. We could not be assured all actions to safeguard people at the time had been taken as systems in place to safeguard people had not been followed. This was a breach of the Reg

Inspection carried out on 14 March 2017

During a routine inspection

We carried out this inspection on 14 March 2017 and it was unannounced.

Melbourne House provides care for up to 33 older people in Coventry. At the time of our inspection there were 29 people living at the home. The building was divided over three floors. Some people stayed at the home for short term ‘respite’ care.

A registered manager was in post and had been for five years. 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.

At our previous inspection in October 2014 we rated the service as requires improvement in the areas of ‘safe’ and ‘effective’. We found risk assessments and care plans were not always up to date. Staff did not have an understanding of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). Social stimulation for people could be improved. At this visit we found staff knowledge around MCA and DoLS was improved, however care records and risk assessments continued to require further improvement. There remained little social stimulation for people.

We could not be sure people who used the service were safe. Risks to people’s safety were identified by staff, however ways to manage and reduce these risks were not always documented correctly to ensure a consistent and effective approach was taken.

Care records contained information for staff to help them provide personalised care, however some information was missing about people and how they should receive their care. Staff knew the people they cared for well.

There were enough staff to care for the people they supported. Checks were carried out prior to staff starting work to ensure their suitability to work with people who used the service. Staff received an induction into the organisation, and they completed training to support them in meeting people’s needs effectively.

Staff had a good understanding of what constituted abuse and knew what actions to take if they had any concerns.

People and relatives told us staff were caring and had the right skills and experience to provide the care required. People were supported with dignity and respect and people were given a choice in relation to how they spent their time. Staff encouraged people to be independent.

People received medicines from staff who were trained and competent to do this. Medicines were administered correctly. For medicine taken ‘as required’ (PRN), guidelines were not always recorded to tell staff when people needed this.

Staff understood the principles of the Mental Capacity Act (2005) and how to support people with decision making, which included arranging further support when this was required.

People had enough to eat and drink during the day, were offered choices, and enjoyed the meals provided. Special dietary needs were catered for.

People were assisted to manage their health needs, with referrals to other health professionals where this was required.

There were some social activities to keep people occupied and plans were in place to improve these further.

People were given the opportunity to feedback about the service they received through surveys. Meetings for people and relatives were held.

People knew how to complain and these were recorded and responded to, to people’s satisfaction.

Staff had positive views about the management of the home. Staff told us they could raise concerns or that these would be listened to. There were some formal opportunities for staff to feedback any issues or concerns at team meetings.

There were some processes to monitor the quality and safety of service provided to ensure staff were following policies and procedures.

Checks of the environment were undertaken and staff knew the correct procedures to take in an emer

Inspection carried out on 20 October 2014

During a routine inspection

This was an unannounced inspection carried out on 20 October 2014. 

Melbourne House provides accommodation and personal care for up to 33 older people. There were 29 single bedrooms and four double bedrooms. The building was divided into three floors. There was a lift for people who were unable to use the stairs.

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

People we spoke with told us they felt safe living at the home and with the staff who supported them. Care staff understood their responsibilities around keeping people safe and had an awareness of what constituted abuse or poor practice.

Care staff were knowledgeable about people’s care and support needs and understood the risks associated with their care and welfare. The staff were not always given up to date information about how to manage identified risks as assessments were not always updated when people’s needs changed.

The manager understood their responsibility to comply with the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) but was not aware of the revised Supreme Court judgement for DoLs arrangements. This could result in people being restricted in how they lived their lives without a best interest decision being made. Care staff we spoke with had little understanding of the Mental Capacity Act (MCA). Staff said they had completed training in the MCA but could not remember what this had been about.

We saw people had positive relationships with the care staff. People told us there were enough staff to meet their needs. We saw care staff promptly responded to requests from people for assistance. The staff said they had completed the required training to work with people safely. We found some staff training needed updating.

Everyone we spoke with considered staff to be kind and helpful. Staff we spoke with understood how to treat people with dignity and respect. People told us their relatives and friends could visit at any time.

People told us they would like more things to do during the day. We saw people spent their time in front of the television in the lounge and the dining area. This meant people who were not able to occupy themselves received limited social stimulation.

Care plans did not always provide staff with the information they required to provide safe and effective care to people. Those we looked at had not always been updated when people’s needs had changed. Plans did not contain individualised information about how people liked to receive their care for example there was little information about people’s preferences and choices.

People told us they were happy with their care and had no complaints about the service they received.  Care staff told us they enjoyed working in the home and felt well supported by the managers. People described the management of the home as open and approachable. Throughout the day we saw that people were comfortable and relaxed with the manager.

Inspection carried out on 2 October 2013

During a routine inspection

There were 27 people living at Melbourne House on the day of our visit. We spoke with the manager, all the staff on duty and several people who lived at the home during our visit. We also spoke with three relatives that visited the home while we were there.

People we spoke with said they were fully involved in their care or their relatives care. All the people in the home had capacity to make decisions about their daily routines. We saw that staff asked people about their choices. Staff treated people with dignity and respect. One person told us, �It�s an excellent place to live. If you can�t live at home this is the next best thing.�

We asked people what the meals at Melbourne House were like. All the comments we received were positive about the quality of food provided. Comments included, �There are always two choices. The food is perfect." People living in the home told us they could have a hot drink whenever they wished, one person said �You just have to ask and it�s there.�

We found the home was monitoring and assessing the overall standard of cleanliness and state of repair in the home. On the day of our visit we found the home was clean, warm and well maintained.

We looked at the recruitment practice of the home. Records showed staff had been properly checked before they started working at Melbourne House.

We looked at how complaints were managed. We found there was a procedure in place to make sure concerns and complaints were recorded and looked into. One person told us, �I�ve never had to make a complaint I have 100% confidence in the staff here.�

Inspection carried out on 30 October 2012

During a routine inspection

During our visit we spent time observing staff and the people living at Melbourne House. Staff had a good understanding of the needs of people living in the home and how they liked to spend their day. One person told us �The care staff do listen to what I say. They ask me everyday what I want to wear and what meal I would like."

People told us they were well looked after and were generally happy with the care at the home. Their comments included; �I�m happy here all the care staff are nice and friendly.� We spoke with a visiting family member. We were told they were happy with the home and that staff knew their relative well.

We looked at a sample of care plans which included personal care support, health needs and risk assessments. These documents provided the information staff required to meet people�s care and support needs. During our visit we saw that care staff listened to people and responded to their requests. We observed that staff carried out their role in a pleasant and patient manner.

Staff knew what to do to keep people safe. We were told by staff they would have no hesitation reporting concerns or poor practice to the manager. The home had a process for assessing and managing risk associated with people�s care.

People were asked for their views about their care and treatment. Returned questionnaires from a recent survey indicated residents and their relatives were satisfied with the care provided by the home.

Inspection carried out on 17 May 2011

During a routine inspection

We asked several residents what it was like living at Melbourne House, one person told us, �There is nothing wrong with the place at all�, and another said �I don�t have any problems and all the staff are ok�.

People had support plans completed but not all identified risks had been assessed, plans didn�t include falls prevention assessments or information about the management of pressure area care, these assessments are important to keep people safe and well.

People we spoke to said staff treated them well and listened to what they said. One person who used a hoist told us, �I feel quite safe when staff hoist me they know how to use it, I�m getting used to it now, it�s comfortable�.

Staff told us they knew what to do to keep people safe and would have no hesitation reporting poor practice to the senior staff and managers.

Although residents said staff knew what they were doing, staff had not completed all the training required to work with people safely. The deputy manager knew about this and is doing something about it.

People told us that staff gave out their medication around the same time each day usually when they are in the dining room.

On the day of our visit there was sufficient staff on duty to meet the needs of residents. However throughout the morning residents were seen sitting in the lounge with very little stimulation. People were falling asleep in the armchairs so we asked one person if it was always as quiet, she told us, �It�s often quiet but not always as quiet as this, it�s as dead as a dodo today�.

People told us they have residents and relatives meetings were they can discuss issues about the home.

People we spoke to were generally happy with the care provided in the home, people told us, � it�s a nice place to live � and � I am here on respite and going home soon. Although there is nothing at all wrong with the home it�s not the same as your own place, but I would definitely come again�.

Reports under our old system of regulation (including those from before CQC was created)