Archived: Melbourne House

Updated 19 January 2023

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection team consisted of 2 inspectors and an expert by experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

Melbourne House is a 'care home'. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Melbourne House is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

At the time of our inspection there was not a registered manager in post.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection, and we sought feedback from the local authority who work closely with the service. The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report. We used all of this information to plan our inspection.

During the inspection

We spoke with 5 people who lived at Melbourne House and 4 people's relatives to gather their experiences of the care provided. We spoke with 8 members of staff including the manager, a domestic assistant, care assistants, senior care assistants, and the activities coordinator. We also spoke with the care consultant who was supporting the provider to run the service. We observed the care and support provided to help us understand the experience of people who could not talk to us.

We reviewed a range of records. This included 3 people's care records and multiple medication records. We looked at 2 staff files in relation to recruitment and training data. We viewed a variety of records relating to the management of the service.

Updated 19 January 2023

About the service

Melbourne House is a residential care home providing personal care for up to 33 older people aged 65 and over including those living with dementia. Accommodation is spread over three floors which are accessible by a passenger lift. At the time of our inspection 10 people lived at the home.

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

Leadership and governance of the service remained inadequate. The provider has not made enough improvements to demonstrate compliance with regulatory requirements. Their lack of oversight, the slow pace of improvements and the failure to learn lessons meant opportunities to keep people safe had been missed.

Aspects of the providers quality assurance systems and processes continued to be ineffective despite low occupancy at the home. Some processes and checks such as, medicines audits were not yet effectively embedded into practice.

People remained at risk of harm because some risks associated with their care and support continued not to be well managed. We found similar concerns at our last and at previous inspections. Despite our finding’s people felt safe and relatives spoke positively about risk management.

Information staff needed to help them provide safe care was not always available and staff did not always follow instructions to manage risks. The management of risks associated with the environment and fire safety had improved.

Aspects of medicines management continued to require improvement and some of the improvements we found at our last inspection had not been sustained. People told us they received their medicines when they needed them.

The manager and staff understood their responsibilities to protect people from the risk of harm. Staff had been recruited safely and the staff on duty during our visit were attentive and responsive to people’s needs.

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 liked living at Melbourne House and had opportunities to do things they enjoyed and were important to them. Feedback confirmed the homes culture was inclusive and relatives told us communication had improved since our last inspection. Staff felt supported, spoke positively about the new manager and enjoyed their jobs.

The home was clean, and visitors were welcomed. Staff worked in partnership with health professionals which supported people's health and wellbeing.

The new manager welcomed our inspection and understood their responsibility to be open and honest when things had gone wrong. The manager and care consultant were working hard to drive forward improvements and demonstrated their commitment to continually improve outcomes for people.

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 inadequate (published 04 August 2022) and there were 2 breaches of the regulations. At this inspection not enough improvement had been made and the provider was still in breach of the regulations.

Why we inspected

Due to the seriousness of the concerns identified during our last inspection we inspected the service to determine if improvements had been made and whether the conditions, we had imposed on the providers registration in 2021 had been complied with. In addition, we wanted to check the proposed enforcement action following our last inspection remained proportionate.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

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.

We have found evidence that the provider needs to make improvements. Please see the safe, and well-led sections of this full report. For key questions not inspected, we used the ratings awarded at previous inspections to calculate the overall rating.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Melbourne House on our website at www.cqc.org.uk.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering

what enforcement action was necessary and proportionate to keep people safe as a result of this inspection.

We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account when it is necessary for us to do so.

We identified continued breaches in relation to safety and governance. As a result, the conditions we had imposed on the provider's registration in 2021 remain in place.

Full information about CQC's regulatory response to the more serious concerns found during inspections is

added to reports after any representations and appeals have been concluded.

Follow up

We will work alongside the provider and local authority to monitor progress. We will continue to monitor

information we receive about the service.

The overall rating for this service is ‘Requires improvement’. However, the service remains in 'special measures'. We do this when services have been rated as 'Inadequate' in any Key Question over two consecutive comprehensive inspections. The ‘Inadequate’ rating does not need to be in the same question at each of these inspections for us to place services in special measures. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.