Melbourne House

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

This is the first assessment for this service under the new provider. This key question has been rated Good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

This service scored 75 (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 made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

People and their relatives told us they were involved with planning their or their family members’ care. People and their relatives we spoke with felt they could talk about their or their family members’ care needs and feel confident in the support provided by staff.

People and their relatives were confident that their or their family members’ needs were understood by the staff team. One person said, “The staff really know what they are doing.”

Staff told us they had time to review care planning documents, so they could keep up to date with people’s changing needs. Staff we spoke with showed a good knowledge and understanding of how to support people’s needs, and what action to take if the person’s needs appeared to have changed.

Where people’s needs had changed, care planning documents were updated so staff understood any new guidance. For example, where a person’s mobility had changed, staff had made a referral to an external health team for occupational therapy input for equipment to support their needs. We saw the guidance from the health professional was incorporated into an updated care plan and risk assessment.

People’s communication needs were recorded and understood by staff. This allowed staff to communicate with people, to have a clear understanding of the person’s needs.

The provider planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards.

We observed care being provided by staff who demonstrated good practice, knowledge and skills. For example, where people required assistance with moving and handling. Staff showed a clear understanding of supporting best practice in dementia care. Staff responded with kindness and a calm approach, where people exhibited distress or anxiety.

A range of national assessment tools were used, to understand people’s needs and how best to support them. For example, the malnutrition universal screening tool (MUST) was used for the management of weight loss and nutritional intake. Staff kept records on how they had supported people and at what time. There was consistency in these daily records for food and nutrition, oral care and personal care. The registered manager regularly audited planned care records, to identify and address any concerns or shortfalls. For example, where a persons’ skin management needs may require review by an external health care team.

People’s communication needs were clearly recorded, to enable staff to effectively communicate with people. For example, care plans for people who had specific communication requirements were detailed and personalised. Information for staff to support a person’s spiritual beliefs was included within care plans. Where people spoke other languages or required the use of accessible information in an alternative language this had been fully considered.

The provider worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

People had clear pre-admission documents in place, detailing their individual needs. The management team assessed their capacity to support people based on the overall dependency needs of the service. The service had a positive relationship with their covering GP practice, who visited regularly to carry out review of medicines or any changes in clinical conditions. The visiting GP spoke positively of the relationship with the practice, and the timeliness of requests for review received from the service.

The service worked well with external health and social care partners and implemented guidance from these teams to support people effectively. Staff felt confident in their positive relationships with external partners.

The provider supported people to manage their health and wellbeing to maximise their independence, choice and control. Staff supported people to live healthier lives and where possible, reduce their future needs for care and support.

Individualised care plans were in place for high-risk conditions such as diabetes, epilepsy, and people taking anticoagulation medicines. In addition, the service demonstrated a clear understanding of risk management in relation to individual needs. For example, staff described addressing underlying causes, such as treating infections, as part of the management of falls.

Staff were competent in responding to falls experienced by people. Records showed staff members acted robustly following falls incidents at the service, by increasing their observations for 48 hours. Referrals were made to external teams to help mitigate risks effectively. For example, people who had experienced falls and injuries had been referred to professionals for specialist input to help mitigate this risk. Where referrals had been made, the guidance from these teams had been included within peoples care plans. This ensured people received safe and effective support.

The provider routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

People's needs were robustly assessed, so their care and support could be delivered in line with current standards. This supported people to achieve effective outcomes. Care plans had clear guidance for staff to follow, to ensure people received their planned care and support during the day and at night. Care plans were person-centred, and detailed people’s skills, life experience and strengths. People and relatives we spoke with had been involved in regular reviews of their plans of care. People and their relatives were positive regarding staff being hardworking and understanding of their needs.

People were supported to maintain good nutritional intake and hydration levels. The service had an experienced and knowledgeable kitchen team, who understood where people had been prescribed a specific diet to support with a clinical condition. People and their relatives were positive about the support for dietary needs provided at Melbourne House. One relative told us, “I worked in catering; I can honestly say I give the food full marks.”

We observed people and staff during the lunchtime meal and staff were discreetly attentive and supportive where people required this.

The provider told people about their rights around consent and respected these when delivering person-centred care and treatment.

People we spoke with all told us staff asked for their consent before delivering personal care. A person spoke positively about how respectful the staff team were. They told us, “They do always ask me if I want things and I can tell them what I want.” We saw staff knocking at people’s doors and addressing them by their preferred name, prior to providing any personal care.

We checked whether the service was working within the principles of the Mental Capacity Act, (MCA), whether appropriate legal authorisations were in place when needed to deprive a person of their liberty, and whether any conditions relating to those authorisations were being met. We found the service was working within the principles of the MCA and if needed, appropriate legal authorisations were in place to deprive a person of their liberty. The service had a highly organised ‘tracker’ in place to ensure people who had restrictions imposed were reviewed regularly to ensure these remained appropriate. In addition to this, the electronic system used for care planning contained a Deprivation of Liberty Safeguards (DoLS) ‘flag’ in the critical information section of people’s care plan. Deprivation of Liberty Safeguards are a legal framework designed to protect vulnerable people, who lack the capacity to consent to their care and treatment.

Staff we spoke with understood their responsibility to respect people’s wishes and feelings. Where people did not have family members to support them with decision making, we saw the service had engaged independent advocates. This ensured people’s views were fully respected.