Archived: Melford Court Care Home

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.

During our previous inspection on 9 June 2015 this service was rated as ‘Inadequate’ and we instructed them to take action to improve the service they gave people who lived in the service and they sent us an action plan telling us what action they were going to take and set time scales for when they expected the improvements to be made. This inspection was carried out to judge whether they had improved the quality of care they offered people sufficiently.

There was no registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (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. There was a newly appointed manager in the service, they had taken up their position in December 2015. They told us that they were planning to submit their registered manager application to the CQC, and that they had already started the process to get it done.

During the inspection on 9 June 2015 it was found that improvements were needed in how the service protected people in relation to medicines management and administration. We found during this inspection that the service had made some improvements, but that they still needed to take action to become fully compliant with the law.

People’s care was assessed and reviewed and changes to their needs and preferences were identified and acted upon. However, this was not consistently reflected in their records. Medicines were managed and recorded safely so that people received them as the prescriber intended, but there were concerns found in the retention of drugs needing to be returned and the storage and stock rotation of sterile dressings and prescribed nutrition supplementary drinks.

There were procedures in place which guided staff in how to safeguard the people who used the service from the potential risk of abuse. Staff understood the various types of abuse and they were aware of how to report these internally, as well as how to report them to relevant agencies.

There were enough staff to support people safely and they were clear about their roles. Recruitment practices were robust in contributing to protecting people from staff who were unsuitable to work within the care profession. Staff were trained to meet people’s needs and they were supported and supervised by the management team to ensure that they were provided with the opportunity to discuss their work and to receive feedback on their work practice.

There were procedures and systems in place to guide staff in keeping people who live in the service safe. These included checks on the environment and risk assessments which identified how the risks to people could be minimised without unduly restricting their freedom to make choices. Action had been taken to maintain a clean, safe and hygienic environment.

Staff understood the importance of gaining consent from people before delivering their care or treatment. Where people were not able to give informed consent, staff and the manager ensured their rights were protected. The Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS) were understood by the manager and staff. Where people lacked capacity, the correct processes were in place so that decisions could be made in the person’s best interests.

People had enough to eat and drink to meet their needs and staff assisted or prompted people with meals and fluids if they needed support.

Staff treated people with warmth and compassion. They were respectful of people’s privacy and dignity and offered comfort and reassurance when people were distressed or unsettled. Staff also made sure that people who became unwell were referred promptly to healthcare professionals for treatment and advice about their health and welfare.

Staff showed commitment to understanding and responding to each person’s preferences and needs so that they could engage meaningfully with people on an individual basis. The service offered people a chance to take part in activities and pastimes that were tailored to their preferences and wishes. Outings and outside entertainment was offered to people, and staff offered people activities and supported them on a daily basis. People were asked for their views so that improvements identified were made where possible.

Staff understood their roles and responsibilities in providing safe and good quality care to the people who used the service. Staff understood the importance of responding to and resolving concerns quickly if they were able to do so. Staff also ensured that more serious complaints were passed on to the management team for investigation. People and their representatives told us that they were confident that complaints they made would be addressed by the manager.

The service had good leadership; we found an open and positive culture that supported people in a person centred way. The staff told us that the manager was supportive and easy to talk to. The newly appointed manager was responsible for monitoring the quality and safety of the service and was still learning his role, but was being supported by a mentor, a fellow manager of another service within the organisation. The organisation had also made changes to the senior managers overseeing and auditing the service and the manager told us that they felt well supported to do their job.

All six people we spoke with said that they felt well cared for and safe. We found that daily records and care plans were up to date and that these had been reviewed since the last inspection took place. Staff received regular supervision and had been provided with suitable training in order to carry out their role effectively and safely.

We found that the service reviews and monitors the quality of care provided to people and consults with the people who used the service through resident meetings. We noted overall improvement in the way medicines were managed and recorded which showed people received their medicines safely and as intended by prescribers.

We re-inspected the service in February 2013 and found improvements had been made across all areas.

We found that daily records and the fluid and dietary intake charts had improved and were now accurately completed for each person. Staffing levels had been increased by an extra two members of staff per shift. Care planning and risk assessments had also improved. All care plans had been signed by the person who used the service or their representative.

As part of this inspection we spoke with four people who used the service and five staff. One person told us that "I am much happier now as the staff have more time to help me.' Another person told us that they "I thoroughly enjoy the food and choices offered and I really enjoyed the felt craft activity we did recently."

Five staff we spoke with all confirmed that morale had greatly improved since the last inspection took place. They credited this with increased staffing levels and the new manager who had made several positive changes since they had been appointed. These included improvements to training, record keeping, additional supervision time with the manager and an increase in the choice of activities being provided to people.

We found that the service did not have sufficient numbers of staff employed that ensured people's health and welfare was maintained at all times. People's preferences and choices were therefore not always upheld because of the shortfall in staffing. Despite this we observed staff being caring and professional. We saw that care staff worked hard to provide the support people required.

People had not always been consulted or given their consent with regard to the care, treatment and support they received. This meant the service was not evidencing that they were ensring decsions about care were the person's own choice?

We found that the service was not maintaining accurate records that related to the care and welfare of the people who used the service. There was a lack of information provided within some records that could place people at risk of harm and compromise their health and safety.