Warm Melody Retreat

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• 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.

At our last inspection we rated this key question Good. At this inspection the rating has changed to requires improvement. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

This service scored 58 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People told us staff helped them to meet their basic needs, and they did not do long-term planning or set goals for them.

“I can’t remember the last time I went on holiday.” Another person commented, “I would love to go on holiday, it’s been talked about, but it’s never happened.”

The registered manager told us, “I complete a pre-assessment. I look at the local authority’s referral and identify all the risk whether high, medium and low. We must look at how it should be managed. During the first 6 weeks we conduct an observation to see if there any additional risks.”

The registered manager told us, “We have family meetings to assess people’s needs, and we send emails to families to provide and telephone calls.”

The provider did not always do everything reasonably practicable to make sure people received person-centred care and support that was appropriate, met their needs and reflected their preferences.

We asked the registered manager to explain the process of conducting pre-assessments and what information was sought from referral agencies. They told us they did not request additional information from local authorities when people were referred to the service, or for care plans or assessments from previous care homes in which people lived. This prevented them from effectively assessing whether people's care and support requirements could be met and whether they would be a suitable fit for the service.

To assess whether care plans aligned with peoples’ individual preferences and needs, we requested access to completed pre-assessments and observational records. However, the registered manager failed to provide this information to us, both during and after our assessment.

Person-centred care was compromised because care records were not always updated to reflect people’s preferences. For example, we cited a person's key working notes dated 16 August 2024 which documented the person stating they wanted to sleep until after 7am. However, this updated information was not reflected in the person’s care record dated 11 September 2024. This meant people could not be confident their preferences would always be met.

The service’s Statement of Purpose dated 6 July 2024 stated, “Service users, in long term placements, have as part of the basic contract price, the option of a minimum seven-day annual holiday outside the home, which they help choose and plan.” People told us and a view of care records confirmed, they did not always get to participate in activities of choice, did not get the opportunity to go on holidays, or were supported to integrate into their local community, rehabilitate after a period of acute mental ill-health or enhance their daily living skills.

The provider was in breach of regulation relating to person-centred care.

We did not look at Delivering evidence-based care and treatment during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at How staff, teams and services work together during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at Supporting people to live healthier lives during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at Monitoring and improving outcomes during this assessment. The score for this quality statement is based on the previous rating for Effective.

“The [Warm Melody Retreat] staff don’t support me to go out, I organise things myself.”

When talking to us about people who were under Deprivation of Liberty Safeguards (DoLS), the home manager told us, “They can’t go out, they have DoLS." The home manager later stated, “People cannot go out alone under their specific DoLS conditions”.

Staff did not always assess people’s capacity to understand and make some decisions about their care, ensure decisions were made in people’s best interests and did not follow the principle of the least restrictive alternative which are fundamental aspects of the Mental Capacity Act 2005 (MCA). We found this when looking at restraint practices within the service.

Mental capacity assessments were not completed to determine whether people could make specific decisions relating to their finances. A person’s care record stated they had mental capacity, but they were, ‘overly friendly and very trusting’ especially towards women who were being friendly towards them, which placed the person at a high risk of being financially exploited.

Management failed to complete a mental capacity assessment to determine whether the person could make decisions relating to their finances. On 23 October 2024, the service received an email from a social worker about an incident where the person had been financially abused.

The registered manager and home manager did not demonstrate a good understanding of how the MCA could be used to empower people rather than to restrict them. For example, 2 people were subject to Deprivation of Liberty Safeguard (DoLS). The service did not provide enough staff to ensure people were able to leave the service for activities or exercise, when they wished or according to a schedule.

Staff and management did not seem to recognise they could support people to go out safely even with a DoLS in place. We observed a person spending all day in the home for their safety.

The provider was in breach of regulation relating to need for consent.