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Inspection carried out on 9 May 2019

During a routine inspection

About the service:

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.

Inspection carried out on 28 February 2018

During a routine inspection

The inspection took place on 28 February 2018 and was unannounced. Melbourne House is a care home that provides accommodation with personal care and nursing and is registered to accommodate 48 people. The service supports older people who may have nursing needs or are living with dementia. The accommodation at Melbourne House is on the ground floor and first floor. There are four lounge areas and dining room for people to use. The home is located in Nottingham and public transport services and facilities are within easy reach of the home.

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

Inspection carried out on 1 and 2 December 2015

During a routine inspection

This inspection took place on 1 and 2 December 2015 and was unannounced.

Accommodation for up to 48 people is provided in the home over two floors. The service is designed to meet the needs of older people. There were 46 people using the service at the time of our inspection.

At the previous inspection on 20 January 2015, we asked the provider to take action to make improvements to the area of management of medicines. We received an action plan in which the provider told us the actions they had taken to meet the relevant legal requirement. At this inspection we found that improvements had been made in this area.

There is a registered manager and she was available during the inspection. 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.

People felt safe in the home and staff knew how to identify potential signs of abuse. Systems were in place for staff to identify and manage risks and respond to accidents and incidents. The premises were managed to keep people safe. Sufficient staff were on duty to meet people’s needs and they were recruited through safe recruitment practices. Safe medicines practices were followed.

Staff received appropriate induction, training, supervision and appraisal. People’s rights were protected under the Mental Capacity Act 2005. People received sufficient to eat and drink. External professionals were involved in people’s care as appropriate. People’s needs were met by the adaptation, design and decoration of the service.

Staff were caring and treated people with dignity and respect. People and their relatives were involved in decisions about their care.

People received personalised care that was responsive to their needs. Care records contained information to support staff to meet people’s individual needs. A complaints process was in place and staff knew how to respond to complaints.

People and their relatives were involved or had opportunities to be involved in the development of the service. Staff told us they would be confident raising any concerns with the registered manager and that they would take action. There were systems in place to monitor and improve the quality of the service provided. The provider was meeting their regulatory responsibilities.

Inspection carried out on 20 January 2015

During a routine inspection

This inspection took place on 20 January 2015 and was unannounced.

Accommodation for up to 48 people is provided in the home over two floors. The service is designed to meet the needs of older people.

There is not a registered manager in place. The previous manager had left in October 2014. The new manager had been promoted from deputy manager and she was available throughout the inspection. The new manager would be applying to become registered manager; however, an application had not been received at the time of the inspection.

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.

People had mixed views of how their medicines were managed and we found that safe medicines management procedures were not always followed.

People told us they were safe. People told us their belongings and the premises were safe. We found that the premises and equipment were safely maintained. Systems were in place for staff to identify and manage risks, however, staff had not followed guidance to minimise risks for one person.

People had mixed views on whether there were enough staff on duty. However, we found that there were sufficient staff on duty to keep people safe and meet their needs and staff were recruited through safe recruitment practices.

People told us that staff knew what they were doing and we found that staff received appropriate induction and training, though supervision and appraisal was not regularly taking place for all staff.

People told us that their choices were respected and we saw that staff obtained people’s consent before providing care. However, people’s rights were not always fully protected where they lacked capacity.

People had mixed views on the quality of the food but told us they had sufficient to eat and drink. We found that people were supported to eat and drink enough. People told us and we found that they saw external health and social care professionals when they needed to.

People told us and we saw that staff were kind. People had mixed views on whether they had been involved in their care and records supported that not all people and their relatives were involved in their care as appropriate. People told us and we saw that they were treated with dignity and respect; however, we saw that information contained in a care record did not respect a person’s dignity.

People told us that staff responded to most of their needs well, however, some people told us and we found that activities were not taking place at the time of the inspection. People who used the service told us they knew who to complain to if they needed to and we saw that complaints had been handled appropriately by the home.

There were systems in place to monitor and improve the quality of the service provided; however, the provider had not identified some of the issues that we found at this inspection. People were positive about the atmosphere of the home and we found the home had a positive culture. People told us that the manager was approachable and responded well to issues.

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 this report.

Inspection carried out on 10 July 2014

During a routine inspection

The inspection team who carried out this inspection consisted of one inspector to answer five key questions; is the service safe, effective, caring, responsive and well-led?

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.

Inspection carried out on 6 December 2013

During a routine inspection

We spoke with six people using the service. They were happy with the care provided by the service. They felt safe and told us that staff asked before providing care.

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.

Inspection carried out on 16 January 2013

During a routine inspection

We spoke with two people using the service. They were happy with the care provided by the service. They felt safe and told us that staff asked before providing care.

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.

Inspection carried out on 19 December 2011

During an inspection in response to concerns

People told us that they were encouraged to make decisions about their care. Comments included �They suggest what I might want to wear and then I chose. They tell me when to have clothes washed.� and �They always ask me what help I need.� One person spoken with told us they felt able to tell care workers if they were not happy with any aspect of their care.

People told us that the care workers were very good and they felt well cared for. One person told us �You can�t fault the staff or the place.� Another person commented �Staff are very good here. They know what help I need with washing. They help me when I need it.�

People told us that they felt safe and well looked after. One person told us �I feel very safe here.� A relative spoken with told us �They keep them all safe here.�

People told us they thought enough staff were on duty to meet their needs. One person commented �There are usually enough staff and we look out for one another and tell staff is someone wants something.� Another person told us they were assisted to get up in the morning at the time they wished.

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