Archived: Melbourne House

Melbourne House is registered to accommodate up to 48 people who require nursing or personal care in one building over two floors, accessed by a passenger lift. On the day of our inspection, 37 people were present at the service. People had either nursing or residential care needs and some people were living with dementia.

We found the following examples of good practice:

The home had ample supplies of personal protective equipment (PPE) and staff were observed wearing it correctly.

Staff were trained in infection prevention and control, they had supervisions and meetings to keep them up to date with the IPC guidance. Staff and people engaged in a programme of regular Covid-19 testing.

During the outbreak of COVID-19 regular visits were postponed, however visits for the essential care givers were encouraged. Alternative forms of maintaining social contact, for example phone calls were arranged for the relatives who wished to speak to their loved ones during the outbreak.

Safe admission processes were in place to reduce the risk of catching and spreading COVID-19 infection. Risks to people had been assessed which considered the impact of Covid-19. People were risk assessed regarding the testing and vaccinations, and best interest procedures were followed.

A designated lounge had been used to support people who were unable to isolate in their bedroom so they could remain safe, feel less isolated and could be supported by staff.

We conducted an unannounced inspection at Melbourne House on 9 May 2019. Melbourne House is registered to accommodate up to 48 people who require nursing or personal care in one building over two floors, accessed by a passenger lift. On the day of our inspection, 31 people were present at the service. People had either nursing or residential care needs and some people were living with dementia.

People’s experience of using this service:

People received safe care and treatment. People were protected as far as possible from the risk of avoidable harm or abuse. Staff had received safeguarding training and action had been taken to report safeguarding concerns. Risks associated with people’s needs had been assessed and were monitored and reviewed to ensure staff had up to date information for people’s care.

Staffing levels and deployment of staff were sufficient and effective in providing safe and responsive care and treatment. People received their prescribed medicines safely and medicines were managed following best practice guidance. The prevention and control of infections were minimised due to infection control best practice being followed. Health and safety checks were completed regularly on the premises, environment and care equipment. Incidents were reviewed for themes and patterns and action was taken to reduce further risks.

People received effective care and treatment from staff who were trained, supported and knew them well. People received a choice of meals and drinks and their nutritional needs had been assessed and were regularly reviewed. Where people required support from staff with eating and drinking, this was provided in a caring, patient and sensitive way. This supported people to have a positive mealtime experience.

Staff worked effectively with external health professionals in assessing, monitoring and managing people’s health conditions and needs. Where people were unable to make specific decisions regarding their care, the Mental Capacity Act 2005 principles were applied. People were consistently supported to have maximum choice and control of their lives and had been supported in the least restrictive way possible.

People received care and treatment from staff who had a kind, caring and person-centred approach. Staff treated people with dignity and respect and they had time to spend with people. People’s communication needs were known and understood by staff. People were invited to participate in a variety of social activities and opportunities for their social inclusion had been developed. People had access to the provider’s complaint policy and procedure. The service had received positive feedback from relatives about end of life care and treatment. However, the end of life care plans reviewed lacked specific personalised detail. The registered manager agreed to review this.

Staff were positive about their role and shared the registered manager’s values in providing person centred, open and transparent care. Staff were clear about their role and responsibilities; accountability and oversight structures and good governance systems were in place that continually monitored the quality and safety of the service. People, relatives and staff received opportunities to give feedback and this was used to develop the service. The provider and registered manager had met their registration regulatory requirements.

Rating of last inspection:

Requires Improvement (published 20 April 2018)

Why we inspected:

This was a scheduled planned inspection based on the previous rating. The service has changed to a rating of ‘Good’.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit at the next scheduled inspection. If any concerning information is received we may inspect sooner.

Melbourne 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. At the time of the inspection there were 47 people using the service.

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

Melbourne House was last inspected on 1 and 2 December 2015 and the service was rated as Good. On this inspection the service has been rated as Requires Improvement. Providers should be aiming to achieve and sustain a rating of ‘Good’ or ‘Outstanding’. Good care is the minimum that people receiving services should expect and deserve to receive and we found systems in place to ensure improvements were made and sustained were not effective.

This is the first time the service has been rated Requires Improvement. This was because staff were not always available to support people in the different areas of the home, or had the opportunity to regularly engage with them. People felt the staff were kind and treated them with dignity and respect. However, some interactions were not dignified or respectful. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. People were able to make decisions about their care and staff knew how to respond if people no longer had capacity to make some specific decisions. However, assessments to determine whether people could make decisions did not always identify how this decision had been reached. We have made a recommendation about this.

There were arrangements in place to keep people safe from harm. Staff understood how to recognise abuse and their responsibility to report it as required. People’s risks associated with their care were identified, assessed and managed to reduce the risk.

People’s medicines were managed to ensure they received their prescribed treatments safely. Staff had access to training and support to improve their knowledge of care and enhance their skills. People were provided with a choice of food and drinks throughout the day.

People maintained important relationships, as relatives and friends could visit at any time. People were able to regularly review their care to ensure it was still relevant for them. People enjoyed a varied programme of entertainment and support with their hobbies to prevent them from becoming socially isolated. People knew who to speak with if they wanted to discuss a concern or complaint.

People received support from health care professionals where they needed this to keep well. Staff supported people to attend healthcare appointments and liaised with their GP and other healthcare professionals as required to meet people’s needs. Infection control standards had been reviewed to ensure suitable hygiene standards were maintained in the home. People felt the registered manager was approachable and keen to listen to their views and they were able to share their views about how the service was managed.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service, their relatives and the staff told us.

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

Prior to our inspection we reviewed all the information we had received from the provider. We used a number of different methods to help us understand the experiences of people who used the service. We undertook conversations with three of the forty three people who used the service and two people's relatives. We spoke with representatives from the management team, two care staff and the activities coordinator. We looked at some of the records held at the home which included people's care plans and supplementary documentation.

The home does not currently have a registered manager. A new manager has been in place since March 2014 and they have applied to become registered with the CQC. We will monitor the new manager's application.

Is the service safe?

We asked people who used the service and their relatives whether they or their family member felt safe at the home. One person who used the service said, 'I feel safe here.' Another said, 'I have no problems at all, it is lovely here.' A relative we spoke with said, 'The staff try so hard to help people.'

Staff were aware of the process to report allegations of abuse or other incidents to the multi-agency safeguarding hub (MASH) and ourselves, the CQC. Staff had received training in the safeguarding of vulnerable adults, however some did require refresher training.

Improvements had been since the previous inspection in relation to people's pressure care management. A new system of recording when a person had been repositioned was in place and staff spoken with were aware of their responsibilities to ensure people received the appropriate level care as recorded in their care plan.

There were enough trained, skilled and suitably qualified staff to meet people's needs. We saw registered nurses, care assistant and activities co-ordinators attend to people's needs in a timely manner.

Care plan records and other records relevant to the running of the service were up to date and reflected people's current needs. However more descriptive information within care plans was sometimes required in relation to guidance received from external professionals.

The CQC monitors the operation of the deprivation of liberty safeguards (DoLS) in place which applies to care homes. DoLS are part of the Mental Capacity Act 2005. Correctly applied DoLS make sure that people in care homes are looked after in a way that does not inappropriately restrict their freedom. One DoLS was currently in place and the documentation had been correctly completed.

Is the service effective?

The new process for assessing and monitoring people's pressure care management had ensured that staff now had an effective way to identify any concerns regarding people's skin integrity quickly. People were monitored regularly in line with their individual care plan and where appropriate external health and social care professionals were consulted.

Food and fluid recording charts were used to monitor people's food and drink intake. During the inspection we raised concerns that people had not been assigned a recommended daily target so staff would be unable to assess whether people's intake had improved. However, this was rectified by the manager and we have now seen new recording charts in place, with clear daily targets for each person.

We checked the weight monitoring charts for people who had recently lost or gained weight and saw the processes the manager had put in place had been effective in assisting them with maintaining a healthy weight.

Is the service caring?

We observed staff interactions with people who used the service. Staff were caring and friendly and took the time to talk with people. We saw staff attend to people's needs, treating them with respect and dignity.

People who used the service spoke highly of the staff and responded well to them throughout the day.

Is the service responsive?

Staff responded to people's needs in a timely manner. They responded to call bells within a reasonable time frame. People were not left for long periods of time on their own or waiting for assistance. When people requested assistance to go the toilet, go to their room or to move chairs staff responded quickly to their needs. One person who used the service said, 'If I press my buzzer, they (staff) are there to help me quickly.'

We observed some people sitting outside enjoying the sunshine. One person who used the service had not brought a hat outside with them. A member of staff noticed this and offered to bring a hat out for them to protect them from the sun. The person thanked the member of staff and a happy, light hearted conversation then took place.

Is the service well-led?

We asked people who used the service, their relatives and staff whether they felt the service was well led by the manager. We received a positive response. A person who used the service told us, 'The manager is new but she seems lovely.' A relative we spoke with said, 'I haven't spoken to the new manager yet, but the home seems run well.' A staff member said, 'The new manager is really nice. If you need help, she will try and help you, she is very approachable.'

The manager had processes in place to monitor the quality of the service people received and to regularly assess and manage risks to people's health.

Accidents and incidents were recorded and where appropriate reported to the relevant bodies. At the time of the inspection the manager did not have a process in place to record whether the recommendations they had made following an accident or incident had been effective. Following the inspection the manager forwarded us their new process, which now ensured this would be done.

People told us they were very happy with the food and drinks on offer. They felt well supported by staff and knew how to complain if they needed to.

We found that before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. We also found that where people did not have the capacity to consent, the provider acted in accordance with legal requirements.

However, we found that people did not always experience care, treatment and support that met their needs.

We found that people were protected from the risks of inadequate nutrition and dehydration. We also found that people were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard and there was an effective complaints system available.

However, we found that people were not fully protected from the risks of unsafe or inappropriate care and treatment because accurate records were not maintained at all times.

People told us they received their medication when they needed it and they had no concerns with the safety of the premises. They were happy with the levels of staff working at the service and were happy that they could raise any issues of concern.

We found that people did not always experience care, treatment and support that met their needs and protected their rights. We found that medicines were appropriately stored and given.

We found that people were protected against the risks of unsafe or unsuitable premises. We found that there were sufficient staff to meet people's needs and the provider assessed the quality of the service provided.