Background to this inspection
Updated
6 April 2017
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
The inspection took place on 7 and 19 October 2016, it was an unannounced inspection and took place in response to people’s relatives and healthcare professionals who shared their concerns about the service with us.
The team who carried out this inspection consisted of three inspectors.
Before the inspection we reviewed the information we held about the service by looking at notifications received from the provider. This refers specifically to incidents, events and changes the provider and manager are required to notify us about by law. We also spoke with the local Authority who shared concerns that had also been raised with them.
Over the two days of our inspection we carried out observations and spoke with 13 people who used the service, six relatives, eight members of staff and the manager, their deputy manager. We also spoke with two healthcare professionals and one medical professional. During the inspection the manager was supported by the organisation’s regional manager.
We reviewed ten people’s care plans and care records. We looked at staff training, recruitment and support records for five members of staff. We also looked at the service’s arrangements for the management of medicines and looked at 12 people’s medicine records. We also looked at the complaints and compliments information, safeguarding alerts and quality monitoring and audit information.
Updated
6 April 2017
We inspected this service on 7 and 19 October 2016 and the inspection was unannounced. Melford Court Care Home is a nursing home that provides accommodation and personal care for up to 52 older people. At the time of our inspection there were 25 people living at the service.
During our inspection the service was in transition between one manager leaving and another one taking up their post. The manager leaving had not made any application to become the registered with the Care Quality Commission (CQC). This meant that the provider had failed to register a manager for this service since 6 June 2014. A registered manager is a person who has registered with CQC 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.
During our inspection of the service in June 2015 we rated the service as Inadequate. During our last inspection on 4 February 2016 We found that the providers still needed to make improvements in the way the service managed people’s medicines, ensured the nurses kept their clinical knowledge updated and in the way they monitored the quality of service they offered people. But overall we found that the service had made improvements in the quality of care offered to people and we rated the service as Requires Improvement.
During this inspection we found that this improvement had not always been maintained and further improvements were needed to ensure the service was meeting the fundamental standards.
There were not enough properly trained or skilled staff to support people safely and staff were not always clear about their roles for which they were employed. The service had a high dependency on agency staff, in particular agency nurses. There were only two permanent nurses employed, neither of whom worked at night. This meant people did not receive consistent care from staff who knew the care and treatment needs of the people they cared for.
Staff had received the training they needed to understand how to meet people’s needs and what to do if they suspected someone may be being abused or harmed. They understood the importance of gaining consent from people before delivering their care. But where people were not able to give informed consent, staff and the manager did not always ensure their rights were protected.
Medicines were not managed properly or safely so that people received them as the prescriber intended. Audits of the medicines carried out by the provider did not always identify the shortfalls we had identified and action was not always taken to deal with these concerns to keep people safe.
People had enough to eat and drink to meet their needs. However, records kept to ensure that people who needed assistance to maintain their nutritional needs were not accurate or up to date.
People were not supported to express their views about the care they received or to be involved in making decisions about their care, they took no part in their care plan reviews. Staff treated people with warmth and compassion. They were respectful of people’s privacy and dignity. Staff also made sure that people received support from healthcare professionals in response to the need for treatment and advice about their health and welfare if they became unwell.
People’s opinions as to the quality of activities and entertainment they were offered was mixed. People who were mobile and able to take part in those activities offered said they were ‘alright’ but would like to be consulted in the planning with more activities based on their individual preferences. Those that were not mobile or stayed in their bedrooms did not receive similar levels of interaction as those people who were more active.
Outings and outside entertainment was offered to people. Care staff were limited to the support they could offer people in the way of activities because of their work load, especially at the weekend when there were no activity staff on duty and they were required to provide this level of support.
The service was not well led. Staff morale was low and people did not always receive care that was person centred. Quality assurance systems were not robust and action was not taken to address areas that were not meeting the requirements of the regulations.
During this inspection we identified a number of breaches 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.