Melbreck

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question requires improvement. At this assessment the rating has changed to good.

This meant people were safe and protected from avoidable harm.

This service scored 72 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

For example, where a person had sustained an unexplained injury, the registered manager had taken prompt action to investigate this and explore all areas of the person’s care, to help identify the reason. They told us, “The physio came round and observed our practices. They were more than happy with this and gave advice on how we can make the person’s bedroom better and position the hoist better to benefit them. We got some specialist satin roll sheets which are better for repositioning the person.” They added, “The team are good at saying when things are not right. I have an open-door policy. I have integrity and honesty. We always need to learn when things go wrong.”

The managers had regular quality assurance monitoring meetings to share good practice, what worked well, and to identify trends and analyse where improvements were needed.

Incidents and accidents, safeguarding concerns and complaints were recorded. These were reviewed, discussed and analysed to determine any underlying causes or trends and to identify any actions required to improve the service.

The registered manager understood their responsibility under the Duty of Candour and was able to demonstrate how they had acted on this.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

People were unable to tell us if the staff were available when they needed support. However, relatives stated they thought their family members’ needs were met. Relatives stated they were informed when their family members required support or treatment from different healthcare services.

The staff team and registered manager told us they worked well with other professionals to ensure continuity of care. Healthcare professionals told us they had a good working relationship with the service and communication was good.

The registered manager told us they assessed people prior to them moving into the service and worked with the local authority to introduce people to the service. One person had lived in residential care before and had spent 7 months in hospital before moving into the home. The registered manager told us, “We have worked very hard to keep [person] out of hospital, keep [their] weight stable, and [they are] now thriving.”

Staff told us they received good information about a person before they were admitted to the home, so they could understand and meet their needs and wishes.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

Relatives felt their family members were safe from harm and abuse. A relative told us, “I do feel [family member] is safe and very well looked after” and another said, “[Family member] is very safe. And I'm very impressed.” Staff were aware of their responsibility to safeguard people and who to contact in the event of any safeguarding concerns. One staff member told us, “I have received safeguarding training. I would normally complete an incident form, and the manager would make the decision to raise a safeguarding.”

The staff received safeguarding training and regular refresher training to ensure they kept their knowledge up to date. Staff were able to describe how they would recognise signs that someone was being abused, and what actions they would take.

The provider was proactive in raising safeguarding concerns with the local authority and CQC. They worked with the relevant professionals to investigate concerns when incidents occurred. For example, where there had been a safeguarding concern, a meeting was taking place during our visit to review a person’s needs. The registered manager told us, “They were very happy with the person’s care and placement. They were also happy with the investigation and action plan in place.”

The provider understood their responsibilities under the Mental Capacity Act 2005 in ensuring Deprivation of Liberty safeguards (DoLS) applications were submitted as required. At the time of our inspection, nobody was being deprived of their liberty unlawfully.

The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Relatives said staff knew their family members’ needs and met these safely. They felt the staff knew how to protect people from avoidable harm. One relative told us, “They're very good. I'm very pleased at how they're looking after [Family member]. [They] had a problem swallowing and they changed [their] meds to liquid and sorted out all the foods for [them]. I was able to be involved.” A healthcare professional added, “From what I have seen I currently have no concerns.”

There were effective processes in place to help ensure risks to people were assessed and mitigated. Risks assessed included, falls, skin integrity and choking. Risk assessments were detailed and analysed all areas of the person’s daily life, what may cause the risk, and how to mitigate this. The risk assessments were reviewed yearly or more often if necessary, for example, if the person’s needs had changed. The registered manager told us, “[Person] is involved in managing [their] risks. We discussed everything with [them] so [they] understand the impact of these.” External professionals were pleased about how well the service had managed the person’s needs.

Care plans contained detailed information about people’s medical conditions, signs to indicate they were becoming unwell and what actions to take. For example, some people were living with chronic conditions managed by medicines. Care plans provided examples of signs and symptoms to look out for, to help ensure staff would be able to identify a person was becoming unwell.

Incidents and accidents were recorded and contained details such as a description of events leading up to the incident, action and response and a post incident analysis. Each report also highlighted what had been put in place to prevent re-occurrence. Following the incident, an action plan was put in place and care plans and risk assessments were reviewed.

Personal emergency evacuation plans were in place for each person. These contained detailed information about each person and the support they required to safely evacuate the building in the event of a fire or other emergency.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

People were supported in a safe and well-maintained environment that met their needs. The environment was clean and well adapted for people’s needs. For example, bathrooms were large so they could accommodate wheelchairs. There were ceiling hoists in bedrooms, so people could be assisted with moving between bed to chair or wheelchair. A relative told us, “I'm dealing with one of the managers at the moment with an application to have the room painted and decorated. As soon as I get the go ahead, we'll get lots of new furniture. It's not that bad at all. It just would be nice to have a refresh. It's in the process of being sorted out.”

There were effective systems in place to monitor and regularly check the safety and upkeep of the premises. The management team and staff worked together to help ensure any potential risks were identified and addressed promptly such as faulty equipment or trip hazards.

Safety checks were completed daily and weekly in all areas of the home to ensure safe systems were in place. These included water temperatures, window restrictors, fire safety checks and kitchen equipment.

The provider had an up-to-date emergency plan in place to help ensure people were supported in the event of an emergency or adverse event.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

Most relatives thought there were enough staff to meet people’s needs. However, one thought this was not always the case and said, “They could do with a few more staff; they're a bit stretched, but I don't feel [family member] is particularly unsafe.” Another relative told us, “They have had staffing issues, but they don’t like using agency.” However, they added, “I'm now beginning to have more confidence because of the new manager. He has put it right. He's worked hard to put it right.”

The registered manager acknowledged they had worked hard to ensure they recruited the right staff. They had recently appointed bank nurses, 2 of whom were undergoing an induction. They told us, “Having our own bank nurses will enable us to have continuity of care, from nurses who know the residents well.” Some people were involved in the staff interview process to ensure they had the opportunity to give their opinion about the suitability of the candidates.

The provider carried out checks on the suitability of staff before they started working at the service. Systems in place included checks on new staff’s identity, eligibility to work in the United Kingdom and Disclosure and Barring Service (DBS) checks. DBS checks provide information including details about convictions and cautions held on the Police National Computer. This information helps employers make safer recruitment decisions.

Staff told us they were happy working at the home and felt supported and listened to. They said they received training that equipped them to do their job well and care for people who used the service. However, a staff member told us, “It would be nice if staff were offered more face-to-face training.” We told the registered manager who said, “I will feed this back to our training and development team for them to review.”

Newly recruited staff received an induction which included a welcome and introduction to the different services and people who lived there, health and safety and training the provider identified as mandatory, such as safeguarding, infection control, moving and positioning, communication and health and safety.

Throughout the induction process, new staff were introduced to training specific to the needs of people using the service, such as dysphagia and awareness of mental health, dementia and learning disabilities. Dysphagia is the medical term fordifficulty swallowing. Staff also undertook Oliver McGowan training. This is a specialised training course to assist health and care staff caring and supporting people with a learning disability and autistic people.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

People were safe from the risk of infection because premises and equipment were kept clean and hygienic, and relatives confirmed they did not have any issues with cleanliness of the service.

The home was kept clean and well maintained. Care staff wore appropriate protective personal equipment (PPE) when supporting people to help protect them from cross infection. There were robust cleaning schedules for day and night and staff followed these.

Appropriate systems were in place in relation to infection control. The provider’s infection prevention and control policy was up to date. Information about the risk of infection was shared appropriately with people using the service and visitors. The registered manager and senior staff carried out audits to ensure high standards of cleanliness.

Although the provider had systems in place to make sure that medicines and treatments were safe and met people’s needs, capacities and preferences, we found some shortfalls during our inspection.

Some people were prescribed medicines to be administered on a when-required basis. We found the protocols in place for these medicines to be administered were not always detailed or person-centred.

We found medicines to be given via a Percutaneous Endoscopic Gastrostomy (PEG) were not always labelled correctly. Label regulations state the route of administration must be specified. PEG feeding involvesplacing a soft, flexible tube directly into the stomach through the abdominal wall to provide long-term nutrition, hydration, and medication. It is used for people with swallowing difficulties, chronic illness, or neurological conditions.Some care plans lacked guidance in relation to medicines administered via PEG.

People did not always receive their medicines in line with the prescriber’s instructions. For example, one person’s medicine was to be used within 28 days of opening. However, records showed they had been given this medicine for 3 days after this.

Another person was prescribed a cream to be applied twice a day. The medicines administration record (MAR) chart from 25 January to 21 February had not been signed by staff on 11 occasions. This meant we could not be sure this medicine had been applied. Another person’s MAR chart was also missing 5 signatures for a medicine to be administered 4 times a day.

There was a process in place to keep a record of people’s medicines when they went on social leave. However, records showed this process was not always followed correctly. For example, for one person, records showed the date, medicines and amount taken out, and initials of the staff members involved. However, there were no records of when these medicines were returned, who received them and the amount returned.

One person had been prescribed an antibiotic to take for 5 days. A handwritten MAR had been put in place. However, the information for this was not transcribed correctly. The strength of the medicine was not recorded. In addition, the medicine was recorded to be given at 8am, 12pm and 6pm, but on one occasion was signed at 10pm. The clinical nurse manager confirmed nursing staff had recently completed transcribing standards workbook.

We discussed these findings with the registered manager, who took immediate action on the day of our first visit. An action plan was put in place, and all areas of concerns were addressed and corrected. For example, the registered manager put in place a performance management plan for the nurses where issues had been identified, PRN protocols were reviewed, and work was in place to ensure these were person centred. The GP surgery was contacted to request that all medicines administered via PEG were corrected labelled on MAR charts. The registered manager told us, “[Clinical lead] will now do monthly audits for medication going forward to ensure clinical oversight.”

Staff received medicines administration training and had their competencies assessed regularly to ensure they kept up their knowledge and skills. They also received STOMP training. STOMP stands for ‘Stopping Over Medication of People with a learning disability and autistic people’.

Medicines were stored securely and at appropriate temperatures. There was an adequate stock of prescribed medicines.

There was a medicines policy in place. There was a process in place to report and investigate medicines errors and incidents.