Archived: Melton House Care Home

Melton House is a residential care home providing personal and nursing care to 32 people aged 65 and over, some people were living with dementia, in one adapted building with bedrooms and communal facilities across two floors. At the time of the inspection there were 23 people living at the service, some staying for respite care.

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

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People received their medicines as prescribed, and were supported by staff to maintain their safety, levels of independence and well-being. Arrangements were in place to prevent social isolation, and maintaining people’s contact with their relatives during the pandemic period, including through the use of technology. People were supported to maintain good standards of personal presentation, and were living in a clean and well-maintained environment. People had a choice of meals and snacks to maintain their overall health.

There were sufficient numbers of trained staff, familiar with people’s individual needs and wishes to provide 24-hour care and support. People were supported to access medical input when required to keep them healthy. People and their relatives were encouraged to speak with staff and the registered manager if they had any concerns or wished to give feedback, which encouraged an open, and collaborative working culture within the service.

Rating at last inspection

The service was last inspected 20 May 2019, and was rated requires improvement, with recommendations made regarding areas of the service needing to be improved (published 11 September 2019). At this inspection we found sufficient improvements had been made in response to our recommendations.

Why we inspected

This was a planned inspection based on the previous rating, and in response to concerns identified at other locations under the same provider particularly in relation to infection prevention and control practices. We did not find evidence at this inspection to suggest any concerns in relation to infection control. Please see the safe, effective and well-led sections of this report for further details.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from requires improvement to good. 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 Melton House Care Home 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.

Melton house is a residential care home providing personal care and accommodation. Melton House is registered to accommodate up to 27 people in one adapted building. At the time of our inspection there were 23 people living at the service, the majority of whom were living with dementia. Accommodation is purposed built, spread over two floors, with a lift for people to move between floors.

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

People living in the home told us they felt safe and well cared for. Relatives were complimentary about the care and communication from the home. We found risks were usually but not always assessed and managed appropriately. Staff were aware of how to safeguard people from potential abuse. The provider had robust recruitment procedures and had sufficient staff. However, the provider needed to review how staff were deployed to ensure risks in communal areas were better monitored. The provider was thorough when reviewing incidents to ensure appropriate lessons were learnt. We have made recommendations regarding the management of risks.

The home was purpose-built over two floors with accessible communal spaces and garden. Improvements had been made to the environment, but further work was required to ensure the service was entirely hazard free and dementia friendly, and we have made a recommendation about this.

People’s health and well-being were well supported and monitored. People received their medicines when they should and were enabled to access healthcare whenever required. People’s nutritional intake was well supported.

All the people we spoke with were complimentary about the kindness of staff. We observed compassionate care which demonstrated an understanding of people’s needs and preferences. People’s privacy and independence were promoted. People were regularly asked for feedback on the care and support they received.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People had assessments and care plans in place, detailing their needs and preferences. The provider was in the process of improving personalisation of the care plans. There was a range of activities which promoted health and well-being. The provider was responsive to any concerns or complaints people may have had about the service. The service provided quality end of life care as per people’s wishes.

The feedback from both staff and people using the service regarding the registered manager was unanimously positive. We found the registered manager open and responsive. There were good quality assurance systems in place and people were regularly consulted on the quality of care provided. Staff were provided with appropriate training, support and supervision.

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 21 June 2018) and there were two breaches of regulation. This service has been rated requires improvement for the last two consecutive inspections. 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 regulations. However, the provider continued to be rated as ‘Requires improvements’ with an improving picture.

Why we inspected

This was a planned inspection based on the previous rating. This inspection was carried out to follow up on action we told the provider to take at the last inspection.

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.

Melton House is registered to accommodate up to 32 people in one adapted building. At the time of our inspection there were 21 people living at the service. Accommodation is spread over two floors and there is a lift for people to move between floors.

There was currently no manager registered with the Care Quality Commission (CQC). However, a manager had recently been appointed and in post for three weeks. They told us they had submitted their application to register with CQC. 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 the last inspection in March 2017 the overall rating for this service was ‘Requires Improvement'. At this inspection whilst we have acknowledged some areas of improvement this is the second time we have judged this domain as ‘Requires Improvement’ with an improving picture.

At our last inspection, we identified shortfalls relating to risks to people's safety. This was because the governance system had not identified or addressed certain areas. This included concerns about ineffective fire doors, a risk of burns from a hot water pipe and inconsistent staff knowledge and practice in relation to safe moving and handling practices. These shortfalls meant that risks to people’s safety had not been identified and action had not been taken to mitigate these risks. We also found people were not protected from safe recruitment systems and processes in line with the provider’s policy. There was a failure to gather all the information required to determine, as far as practicable, whether or not staff appointed were suitable for their roles.

Following the last inspection, we asked the provider to complete an action plan to show us what they would do and by when to improve.

We carried out this unannounced comprehensive inspection on the 09 and 10 May 2018. We found two continued breaches of Regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Whilst we have acknowledged some areas of improvement, we found further work was needed to safeguard people from risks to their health, welfare and safety. Risks to people’s safety associated with improper operation of the premises and the lack of investigations instigated from the monitoring of incidents had not always taken place. For example, where people had sustained unexplained bruising and skin tears management audits did not always prompt further investigations.

Whilst staff were kind and caring in their interactions with people, there was a lack of effective system in place for the laundering of people’s clothing. This demonstrated a lack of care and respect for people’s belongings.

During our visits there were sufficient numbers of staff to meet people’s assessed needs and the provider had improved and now operated safe recruitment procedures. However, further work was required to ensure the dependency tool used to determine the numbers of staff allocated to meet people’s needs contained accurate information as to people’s level of dependency. This meant that staffing levels may not always be matched to the level of need.

There were safe systems in place to safely store and ensure people received their medicines as prescribed. Staff were trained in medicines management and regularly had their competency assessed.

Staff received training and induction to their work. Further work was needed to ensure staff competency checks and training be provided in areas such as meeting the needs of people diagnosed with Parkinson’s, those with in-dwelling catheters, people at risk of choking, pressure ulcer prevention and support of people living with dementia.

People spoke positively about the food and drinks they were provided with. People were given choice on a daily basis and were given food and drinks which they met their preferences. People who were at risk of not having enough to eat and drink were being supported and monitored. However, it was not always clear if this information was being analysed effectively, to ensure people's hydration needs were being fully met.

People and or their representatives, where appropriate, were involved in making decisions about their care and support. People’s care plans had been tailored to the individual and contained information about how they communicated and their ability to make decisions about their everyday lives. However, care records did not always provide sufficient guidance to staff when people had indwelling urinary catheters and where specialist moving and handling equipment was required to ensure the care provided was safe, effective and met their needs.

The provider had a system in place to respond to people’s concerns and complaints.

Staff, people who used the service and their relatives were all complimentary about the management team. They told us they found them approachable, engaging and had clear, person centred vision and values. People were comfortable to air their views and, provide honest feedback.

Following recent senior management structural changes we found there was a more open, transparent culture. There was now a clear and supportive management structure in place. Whilst we identified some shortfalls at this inspection, the provider had a vision for improving systems which evidenced their learning from incidents in their other services. They demonstrated they had clear plans to improve, innovate and ensure sustainability of the service.

Melton House Care Home provides accommodation and support for a maximum of 32 people. There may be people supported who are under 65 but the majority of people using the service are older people, some of whom may be living with dementia. People using the service may also have a physical disability. Accommodation is spread over two floors and there is a lift for people to move between floors. At the time of our inspection, there were 28 people at the home.

There was a registered manager in post. 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. The registered manager completed their registration with us in June 2016.

At this inspection, there were three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

There were some risks to people's safety, which had not been robustly identified and addressed. This included concerns about fire doors, a risk of burns from a hot water pipe and inconsistent staff knowledge about moving and handling practices. These issues potentially placed people at risk while they were receiving care.

There were enough staff to meet people's needs safely but recruitment processes were not sufficiently robust. They did not gather all the information required to determine, as far as practicable, whether staff appointed were suitable for their roles.

There was a wide range of audit tools and checking systems being used but they were not fully effective in identifying where the service needed to improve. The provider's oversight of the systems applied within the service was also not robust and supportive of the registered manager. This compromised the consistency and effectiveness of leadership at the home.

You can see the action we told the provider to take at the back of the full version of the report.

Where staff took responsibility for administering medicines, the process was largely safe although there was some inconsistent practice in ensuring people took their medicines promptly.

Staff were trained to recognise concerns that people may be at risk of harm or abuse and were clear about their obligations to report any such concerns so that people could be properly protected. Staff understood how to manage individual risks to people, for example to their skin integrity, from falls and while eating or drinking and received relevant training. The registered manager monitored the completion of training and supported staff to discuss their performance, understanding and training or development needs.

People had a choice of food and drink and enough to eat and drink to ensure their wellbeing. They were also supported to access health professionals for advice about their health and welfare so the service supported them effectively to recover when they were unwell. Staff supported people with some significant health needs and understood when they needed additional advice and guidance. Where people were not able to make specific, informed decisions about their health or wellbeing, staff took their best interests into account.

Although there were isolated lapses in the professionalism of staff, they supported people in a way that promoted their privacy and dignity. They showed concern for people's wellbeing and offered encouragement, support and reassurance when it was needed. People valued their approach and the kindness that staff showed.

People's needs were assessed and staff kept people's information up to date. They understood people's backgrounds and interests so that they could engage with people about the things that were important to them. However, people's individual preferences for their personal care were not always met. The way records were kept sometimes compromised how staff could show the support people received matched their needs and preferences. Small attention to detail, such as ensuring clocks worked and were accurate, had the potential to compromise people's ability to orientate themselves to time and day.

The registered manager operated an effective system for receiving and responding to complaints and dealt with these robustly and sensitively to resolve issues. People received a response to their concerns, an explanation of events and the arrangements for ensuring improvements were made in response to complaints. People and their visitors were confident in the way the system worked. They were also encouraged to express their views about the service in surveys, at meetings and through the provider's electronic system.

People and their visitors valued the approachability of the registered manager and his 'open door' approach. Their comments showed a good level of satisfaction with the quality of the service they received.

Is the service caring?

People said that most staff members were polite, kind and respectful. They confirmed that their privacy and dignity was usually respected. However, prior to our visit we had received information alleging that not all staff treated people with respect. They told us that staff did not like people ringing their call bells too often. This was confirmed by a person who used the service that we spoke with during this inspection.

We received information during this inspection that a person who used the service had been dealt with in a humiliating way by staff. We were also told that this abuse had been raised with a senior manager within the organisation. However we had not received notification of this matter from the provider. Therefore we requested further information from the provider regarding this allegation, plus any further action they had taken. We received a response that showed the service took most of the appropriate actions, including notifying the local authority safeguarding team.

Is the service responsive?

We found that the service was responsive to people's needs as identified in their care plans and when feedback was received. For example through annual surveys that were sent to people to ask their views on the service provided.

A timetable showed that activities, such as quizzes and exercise sessions were provided. We observed some of these activities during our inspection and saw that they were tailored in response to the participants' needs and abilities.

Is the service safe?

People using the service told us that they felt safe and happy.

People's care plans generally contained the information needed to provide them with safe care. Assessments were completed to assess people's level of risk for such issues as their mobility, developing pressure ulcers or becoming malnourished. These risk assessments had been reviewed and had appropriately identified the level of risks and stated what action was required to reduce or remove the risks for each person. Evacuation information for each person who used the service was kept with their care records and in a central location to ensure they could be easily accessed in the event of an emergency.

Staff we spoke with displayed awareness of people's rights to refuse care and how to keep them safe and healthy in such circumstances.

We found that staff were trained and knowledgeable about their roles and responsibilities in protecting people from abuse. They demonstrated that they knew how to report any abuse that they witnessed or suspected. However some staff said that they would like the electronic learning that they had received on the safeguarding of vulnerable adults to be supplemented by some face-to-face training.

Is the service effective?

People received the care and support they required to improve their health and well-being. Care records were written in detail and provided clear guidance to staff members, although evaluations of care plans were not always completed.

People were provided with a choice of meals and staff members assisted them appropriately with eating and drinking when this was required. They told us that their meals were always nice and tasty.

Is the service well led?

Staff members received supervision and training from the provider or from external sources. However, due to the manager working away from the home for periods of time, disruption to supervision sessions for staff members meant they did not always feel properly supported. Actions to resolve issues that had been raised by staff or identified through the service monitoring were not always clearly identified.

Systems were in place to regularly check and monitor the way the service was run.

We found that there were detailed assessments and care planning for people using the service, so that staff could meet their needs. However, the provider may wish to note that sometimes changes in people's needs were not reflected in the main body of the care plan, although these were reflected elsewhere. We spoke with people about their care and one person told us, "I'm quite satisfied with my care here, it's a lovely place". Another person told us, "I'm very happy here, I'm looked after".

We found that the home was kept clean and tidy by a team of domestic staff. We spoke with people using the service about the cleanliness of the home. One person told us, "It's a very clean place. It's spotless". Another person told us, "Oh I'm quite satisfied with the cleanliness here".

We found that there was enough suitably qualified staff to care for people using the service. We spoke with people about the staff at Melton House. One person told us, "They're always there when I need them". Another person told us, "Oh yes, there's definitely enough staff. Most of them are great".

During this visit we noted care plan records were centred round the person the plan belonged to. They contained an assessment of need prior to the person being offered a place and a copy of each person's care and support requirements. The people we spoke with and our observations carried out showed people were receiving the individual support they needed.

Part of this visit was to look at the safe management of people's medication. We talked to staff who competently showed us the methods used to store, record and administer medication. Medication audits were carried out by the manager with records seen during this visit.

The people we spoke with who lived in this home were complimentary about the staff. They told us they were suitable as carers and felt they were trained to do the job required. One person said, "I am well looked after by staff who are trained and know what they are doing."

Complaints were taken seriously and dealt with appropriately.