Melton House

We found the following examples of good practice.

The new registered manager had helped more family members to become essential care givers. Care home residents are entitled to an essential care giver, who can provider additional support and care, even during periods of outbreak and isolation.

The registered manager had communicated well with relatives we spoke with regarding visiting systems and restrictions.

Additional cleaning protocols for high-touch areas were in place to reduce the risk of infection.

The registered manager responded promptly to the advice of IPC specialists.

Further information is in the detailed findings below.

Melton House is a residential care home providing personal and nursing care for up to 67 older people some of whom may live with dementia. The care home accommodates people over three floors in a purpose built building. At the time of the inspection there were 26 people living at the service.

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. A new system was being introduced to address this.

Safeguarding systems were in place. There were enough staff to meet people’s needs. Safe recruitment processes were followed. Staff received training appropriate to their role, to develop their skills and knowledge. Staff said they received regular supervision and felt supported.

Care plans contained person-centred information about people’s care needs. Staff had developed caring relationships with people and respected their privacy and dignity.

Arrangements were in place to ensure medicines were managed safely. People had access to appropriate healthcare professionals to support their wellbeing. People were supported to eat and drink sufficient amounts to maintain their health.

Contact between people and relatives had been maintained in a variety of ways during the pandemic and changes in government guidance on visiting had been responded to appropriately. Surveys had been given to relatives during planned visits, but they had not yet been analysed for findings.

A number of staff did not consistently follow government guidance regarding infection prevention and control, including hand washing and the safe doffing of PPE. IPC audits were effective in identifying concerns and action was taken.

Quality assurance and governance processes were in place and various audits were completed. We found some shortfalls in recording which the provider took immediate action to address.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was Good (published 09 January 2018).

Why we inspected

The inspection was prompted in part due to concerns received about safeguarding, infection prevention and control and staffing. A decision was made for us to inspect and examine those risks.

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 COVID-19 and other infection outbreaks effectively.

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 purpose-built care home with accommodation over three floors. It provides nursing and personal care for up to 67 people, some of whom may be living with dementia. At the time of the inspection 35 people were resident.

The service had been identified by the Local Authority as a designated care setting. A designated care setting is intended for people who have tested positive for Covid-19 and are being admitted to a care home from hospital. The provider had designated 22 beds to support people to be able to be discharged from hospital.

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

Staff had completed safeguarding training and said they were confident to raise any concerns. Staff said they thought people were very safe and felt any concerns were appropriately acted on.

Risks were assessed and measures put in place to manage and mitigate hazards. Appropriate checks of equipment and the premises were in place.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 9 January 2018).

The service was also assured as a designated setting (published 24 November 2020).

Why we inspected

The inspection was prompted due to notifications of concern. The incidents are being reviewed under our specific incident guidance. As a result, this inspection did not directly examine the circumstances of those incidents. The information CQC received about the incidents indicated concerns about safeguarding and the management of risk. This inspection examined those risks.

We found no evidence during this inspection that people were at risk of harm from these concerns. Please see the safe sections of this full report.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

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.

nursing and personal care for up to 67 people, some of whom may be living with dementia.

The service had been identified by the Local Authority as a designated care setting. A designated care setting is intended for people who have tested positive for Covid-19 and are being admitted to a care home from hospital. The provider had designated 22 beds to support people to be able to be discharged from hospital.

We found the following examples of good practice.

¿ The provider had identified a self-contained unit within the home to be the designated area. The unit had 22 beds, all with en-suite facilities and some with shower facilities.

¿ There was a separate entrance for this unit so access to this area was safe.

¿ The designated unit was clean and well-decorated. The provider had arranged for extra housekeeping hours to make sure that additional cleaning took place, including surfaces that were frequently touched.

¿ The provider had identified dedicated care and housekeeping staff to work in the unit. They would be led by a designated nurse. The staff team would not work anywhere else in the home during the use of this unit. This helped to minimise the risk of cross infection.

¿ The provider had enough supplies of appropriate personal protective equipment (PPE) such as gloves, aprons and masks. All staff had training in how and when to wear the PPE correctly. There were plenty of PPE stations around the unit so they would be easily accessible by staff.

¿ The provider had up to date infection prevention and control policies and was following national guidance.

We were assured that this service met good infection prevention and control guidelines as a designated care setting.

Further information is in the detailed findings below.

We found the following examples of good practice:

¿ Systems were in place to help prevent people, staff and visitors from catching and spreading infections. We read a copy of the most recent ‘residents’ meeting’ which stated, “The residents wanted it on record that the team at Melton House have managed the Covid-19 situation very well. They have felt as safe as they possibly could, the infection control has been exceptional, well done to all. Residents stressed that they had been kept very well informed with government guidelines and have tried to do their bit with social distancing and keeping the environment safe.”

¿ There was sufficient personal protective equipment (PPE) such as aprons, gloves and masks. Staff were wearing this appropriately when we visited. Staff had undertaken training in putting on and taking off PPE and other Covid-19 related training. Systems were in place to help ensure the health and wellbeing of staff was supported.

¿ Additional cleaning was being carried out and domestic cleaning hours had been extended until 8pm to make sure the home was as clean as possible.

¿ Staff supported people’s emotional and social wellbeing. People kept in contact with their friends and relatives via the phone and various social media outlets. Government guidance relating to visiting was followed. Specific areas outside had been identified so visiting could take place safely.

¿ Infection control audits and checks were carried out. The manager spoke positively about the hard work and dedication staff had shown, which had helped to minimise the impact of the pandemic on people’s health and wellbeing. She told us, “I think the staff have been amazing. The staff have done the things which families would have done, they have filled the gap and morphed into whatever is needed.”

This was the first inspection of Melton House since it was registered with the Care Quality Commission in November 2016.

Melton House accommodates a maximum of 67 older people, including people who live with dementia or a dementia related condition, in one purpose built building. At the time of inspection 44 people were accommodated at the service.

A registered manager was 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 home was well maintained and provided a pleasant, spacious and bright living environment for people. We have made a recommendation about the service following best practice for equipping the environment for people who live with dementia to help them remain orientated.

People and staff appeared happy in the home. There were sufficient staff on duty to provide individual care and to respond to people’s needs in a timely and patient way. Activities and entertainment were available for people

People were protected as staff had received training about safeguarding and knew how to respond to any allegation of abuse. Staff received other appropriate training and they were supervised and supported. When new staff were appointed, thorough vetting checks were carried out to make sure they were suitable to work with people who needed care and support.

Staff had an understanding of the Mental Capacity Act 2005 and best interests decision making, when people were unable to make decisions themselves.

People were involved in decisions about their daily care requirements. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible, the policies and systems in the service supported this practice.

Staff upheld people's human rights and treated everyone with respect and dignity. Efforts were made to help people communicate their needs and wishes, if they did not communicate verbally.

People had access to health care professionals to make sure they received appropriate care and treatment. Staff followed advice given by professionals to make sure people received the care they needed. Systems were in place for people to receive their medicines in a safe way. People received a varied and balanced diet to meet their nutritional needs.

There were some opportunities for people to engage with the local community and all people were supported to maintain relationships that were important to them.

Relatives and staff spoke well of the registered manager and said the service had good leadership. There were effective systems to enable people to raise complaints, and to assess and monitor the quality of the service. People told us they would feel confident to speak to staff about any concerns if they needed to. The provider undertook a range of audits to check on the quality of care provided.