Archived: Melbourne House

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.

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 there were 12 people living at the home. One of those people was in hospital at the time of our visit.

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

Lessons had not been learned, because the provider continued to fail to ensure people living at Melbourne House always received safe, high-quality care. Whilst some progress had been made since our last inspection to benefit people, progress to implement all the required improvements was too slow. The provider remains in breach of the regulations and as a result people remained at risk of harm.

Some of the provider’s quality assurance systems remained ineffective and had failed to identify the concerns we found. In addition, the continued lack of managerial oversight meant the provider nor registered manager could assure themselves people had received the care they needed to keep them safe. Some known risks associated with people’s care had not been assessed and care records had not been updated to ensure staff had the accurate information they needed to provide safe care, consistently. Environmental risks had not always been identified and managed well, and aspects of fire safety continued to require improvement. Immediately after our inspection visit the management team took some reactive action to improve safety.

Areas of medicines management including prescribed creams still required improvement. Despite our findings people told us they received their medicines when they needed from trained staff. New medication audits were being introduced at the time of our visit in an attempt to improve medicines safety.

Not enough improvement had been made to ensure the risks associated with some people’s nutrition were well managed. However, some improvement had been made in this area because people spoke positively about the quality and availability of food and drinks. Staff knew what people liked to eat and drink and people were supported to eat their meals and consume drinks when needed.

The provider had repeatedly failed to ensure all of their staff had completed all of the training they needed to carry out their roles effectively. The registered manager took action to address this shortfall in response to our feedback. Staff spoke positively about their training and the induction for new staff had improved since our last inspection.

People were happy with the care and support they received. People told us they liked the staff and they felt safe living at Melbourne House. Staff and the management team understood their responsibilities to keep people safe. Enough staff were on duty to meet people’s needs in a timely way and recruitment checks had been strengthened since our last inspection to help ensure staff were suitable to work with people.

People liked their living environment and the design and adaptation of the building met people’s needs. Staff spoke positively about the culture at the home and enjoyed their jobs. Feedback gathered from people was listened to. 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.

Overall, the prevention and control of infection at Melbourne House had improved since our last inspection and visits to the home took place safely. The management team demonstrated their ongoing commitment to working in partnership with other organisations to improve outcomes for people. Feedback from people and their relatives confirmed people had access to health care professionals when needed.

The management team welcomed our inspection. They understood their responsibility to be open and honest when things went wrong.

Rating at last inspection and update

The last rating for this service was inadequate (published 03 November 2021). and there were multiple breaches of regulations. At this inspection not enough improvements had been made and the provider was still in breach of regulations.

Why we inspected

Due to the seriousness of the concerns we had identified during an inspection in April 2021 we imposed conditions on the providers registration to focus their improvement activities. This focussed inspection was carried out to check the provider had made necessary improvements and was compliant with the regulations.

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 the provider needs to make further improvements. Please see the safe, effective 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 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, which will help inform when we next inspect.

Special Measures

The overall rating for the service has remained inadequate based on the findings of this inspection and therefore the service remains in special measures. We will keep the service under review, and we will take action in line with our enforcement procedures. For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. 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.

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

During our inspection visit in April 2021 we found people did not receive safe care. At this inspection we found this continued to be the case. Risks related to people’s health and safety were not consistently managed. This included risks related to infection prevention and control, skin damage, falls, nutrition and management of health conditions. There was a high usage of temporary staff who did not always know about people’s needs. Care records continued to lack detailed information to help staff support people safely. Medicines were not managed safely in line with best practice guidance to ensure people’s healthcare needs were managed effectively.

Whilst there had been an improvement following the last inspection in relation to the cleanliness of the home, infection prevention and control practices continued not to be safe. COVID-19 checks were not completed in line with government guidance. There was no infection, prevention control policy accessible to staff.

Staff training on people’s specialist needs was limited or had not been completed. People were not always supported with their nutritional needs and records lacked information to demonstrate health professional advice was always followed to support people’s needs. People were not supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

Governance systems, and manager and provider oversight of the service, were inadequate. Quality monitoring and audit systems were not fully implemented. The provider’s policies and procedures were either not available or lacked detailed guidance to support staff. Audit checks completed lacked detailed information to be effective. The provider had failed to identify the concerns we found. This demonstrated lessons had not been learnt since our last inspection.

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 18 June 2021) and there were multiple breaches of regulation. At this inspection enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

We carried out a focused inspection of this service on 6 April 2021. Breaches of legal requirements were found. The provider failed to complete an action plan after the last inspection to show what they would do and by when to improve. Following the last inspection, we continued to receive concerns in relation to staffing, people’s health and safety, nutrition and management of the service. As a result, we undertook another focused inspection to review the key questions of Safe, Effective and Well Led which contain those requirements.

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

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 in key question Safe, Effective and Well led. The provider made arrangements to take immediate action to improve high risk areas we found.

The overall rating for the service has remained inadequate on the findings at this inspection.

Enforcement

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 where it is necessary for us to do so.

We identified continued breaches in relation to risks associated with people’s care, management of people’s nutrition, and management oversight of the service. The provider had not ensured effective systems and processes were in place to monitor the quality and safety of the service and drive improvement. As a result, the actions agreed at our last inspection which was to place conditions on the provider’s registration will continue to remain in place.

Please see the additional action we have told the provider to take at the end of this report.

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.

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service therefore remains 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 six 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 rating, 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.

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 lift.

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

People did not receive safe care. Staff did not always know about people’s needs and had not completed all the training they needed to provide safe care. Staff competency had not been sufficiently assessed following training to confirm their learning and understanding.

Risks associated with people's care were not promptly identified and managed. People’s nutritional needs were not effectively managed to ensure people received sufficient nutrition and the support they needed. People’s care plans were either not available, lacked information about people’s needs or did not always contain accurate information to help staff support people safely. Staff did not have full access to information about people on the electronic handheld devices they used to read about people’s needs and record the care and support they provided to people.

Infection prevention and control was not safe. Improvements were needed to maintain cleanliness across the home including equipment.

Medicines were not always managed safely in line with best practice guidance to ensure people’s healthcare needs were managed effectively. Medicine records lacked information and arrangements for the administration of medicines at night were not effective.

Governance systems, and management and provider oversight of the service, were inadequate. Systems and processes designed to identify areas of improvement were ineffective. The provider’s policies and procedures did not always provide staff with the guidance they needed. Audits and checks were either not completed or lacked detailed information. They had not identified the concerns we found. This demonstrated lessons had not been learnt since our last inspection.

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 Requires Improvement (published 9 November 2019).

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 12 July 2019 where a breach of legal requirements was found. The provider completed an action plan after the inspection to show what they would do, and by when, to improve meeting nutritional and hydration needs of people.

This inspection was prompted in part due to concerns received about lack of risk management associated with people’s care, infection control, continence, nutrition, and wound management. There were also concerns raised around staff training and competence. This focused inspection also checked the provider had followed their action plan following the last comprehensive inspection to confirm if they now met legal requirements.

We undertook a focused inspection to review the key questions of Safe, Effective and Well Led only and this report only covers findings in relation to these key questions.

The ratings from the previous comprehensive inspection for those key questions that were not looked at on this occasion, were used in calculating the overall rating at this inspection. The overall rating for the service has changed from Requires Improvement to Inadequate. This is based on the findings at this inspection.

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

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 where it is necessary for us to do so.

We identified breaches in relation to risks associated with people’s care including management of people’s nutrition, and management oversight of the service. The provider had not ensured effective systems and processes were in place to monitor the quality and safety of the service and drive improvement.

Please see the action we have told the provider to take at the end of this report.

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 met with the provider prior to this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Special Measures

The overall rating for this service is Inadequate and the service is therefore 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 six 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 rating, 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.

Melbourne House is a care home registered to provide personal care and accommodation for up to 33 older people aged 65 and over in one adapted building. At the time of our inspection there were 25 people living at the home.

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

People’s basic care needs were met, and staff knew about people’s preferences for care. People were at ease around staff demonstrating they felt safe being supported by them.

Risks associated with people’s care were known by staff, but records continued to require improvement to ensure there was a consistent and safe approach in meeting people’s needs. This included improvement to records related to nutrition and hydration to demonstrate people received sufficient to eat and drink.

Risks related to the environment were being identified but actions were ongoing in ensuring these were met consistently.

Staff were aware of their responsibilities regarding the reporting of potential abuse. Systems were in place for safeguarding concerns to be referred to the local safeguarding authorities for follow up as appropriate.

Electronic care planning systems continued to present problems with internet signals, but the provider was working with staff and the management team to address this. This included using written records where appropriate.

People received their medicines from staff trained in medicine management. There had been improvements made to medicine management since the last inspection. Arrangements were also in place for further improvements to be made so that these were managed safely consistently.

There were sufficient numbers of staff to support people’s needs; no new staff had been recruited since the last inspection.

New quality monitoring systems were in the process of being introduced to help improve the quality of care and services people experienced.

People were encouraged to share their experiences of living at the home at periodic meetings and within satisfaction surveys. People also felt at ease to discuss their needs with the management team.

Rating at last inspection (and update)

The last rating for this service was Requires Improvement (published 3 September 2019) and there were multiple breaches of the regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of the regulations. However, the service remains rated requires improvement.

Why we inspected

During our last inspection we issued a Warning Notice as the provider had not taken sufficient action to address breaches in the regulations. We carried out this focused inspection to check that improvements to meet legal requirements planned by the provider after our comprehensive inspection on 12 and 16 July 2018 had been taken. The provider completed an action plan following the last inspection to show what they would do and by when to improve. This report only covers our findings in relation to the key questions of Safe and Well Led.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has remained the same. This is based on the findings at this inspection.

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.

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.

Melbourne House is a care home registered to provide personal care and accommodation for up to 33 older people aged 65 and over in one adapted building. At the time of our inspection there were 25 people living at the home.

Peoples experience of using the service

Risks associated with people’s care were not always fully assessed and care plans lacked detail to support staff in keeping people safe. This included management of nutritional risks that could impact on people’s health. Where there were health and safety risks associated with the environment, equipment and infection control, quality monitoring systems had not been effective in identifying these.

There were enough staff to meet people’s basic needs, but people spoke of delays in receiving support sometimes suggesting staff deployment was not effective. Processes followed to recruit new staff were not always managed safely. Staff files lacked information to demonstrate risks associated with staff recruitment had been identified, discussed and assessed.

People said they received their medicines when required but discrepancies in medicines counts demonstrated they were not effectively audited to confirm medicines had been managed safely.

People were not always supported to have maximum choice and control of their lives. Staff lacked understanding of the Mental Capacity Act. Some Deprivation of Liberty Safeguard authorisations to authorise restrictions placed on people’s care had expired. Although people spoke positively of living at Melbourne House and of the staff that supported them, we saw people were not always treated with dignity and respect. Sometimes staff instructed people on what to do instead of asking people to ensure they consented to the care and support they were about to provide.

Whilst staff gave assurances that people received the care they needed, records did not demonstrate this consistently. This also applied to information about access to healthcare professionals. Information did not always show they were accessed in a timely manner to help maintain people’s health.

People had been involved in planning and discussions about their care when they started to use the service. Some people’s wishes about how their end of life care was to be managed had been obtained.

Electronic care plans were in use but sometimes signals around the home prevented staff from accessing and recording information when needed which presented a risk in managing people’s care safely and effectively.

Staff had not completed all of the training considered essential to update their skills and knowledge.

There were systems to check the quality of the service. However, these systems were not effective as they had not identified the concerns we identified such as those in relation to risk management. Some of the concerns we found had also been identified at our previous inspection.

Accidents and incidents were recorded, investigated and action taken to reduce risk.

Staff understood their responsibility to report concerns or potential abuse to the registered manager. The registered manager had ensured these were reported to us and the local authority where appropriate. This was an improvement following the last inspection.

People told us that felt at ease to raise concerns with the registered manager. A complaints policy was in place, but this did not contain all of the information people would need to escalate their concerns if they were not happy with how their complaint had been managed.

Staff spoke positively about working at the home and felt well supported by the management team which consisted of the registered manager and deputy manager.

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 Requires Improvement (published on 10 July 2019) and there were two breaches of the regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made and the provider was still in breach of the regulations.

The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified four breaches in relation to the Health and Social Care Act 2008 (Regulated Activities) Regulations. Insufficient action had been taken to mitigate risks to keep people safe, to manage people’s nutritional risks, to ensure there were effective quality monitoring systems in place and to notify us of Deprivation of Liberty Safeguards for people. We have found evidence that the provider needs to make improvements across all key questions.

You can see what action we have asked the provider to take at the end of this full report.

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.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Melbourne house is a care home registered to provide personal care and accommodation for up to 33 older people. People in care homes receive accommodation and personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The accommodation for people is spread over three floors with the main lounge and dining room that people used on the ground floor. There were 26 people living at the home at the time of the inspection.

We last inspected Melbourne House in February 2017 when we rated the service as 'Requires Improvement' in the key question of safe and responsive. We had found risk management was not always effective to keep people safe and people didn’t always have access to social activities to maintain their wellbeing.

At this inspection visit, we found these areas continued to need improvement. At the time of our visit the provider was in the process of changing over to a computerised care planning system, but neither set of records was completed in full. This meant records were not sufficiently clear for the registered manager to be assured risks were managed and people’s needs were safely met. People had access to limited social activities and these were not always centred on individual needs and preferences to support person centred care. At times, people’s privacy and dignity was compromised.

The service had a registered manager. This is a requirement of the provider's registration. 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.

There were sufficient care staff to meet people’s basic needs and staff spoke positively of working at the home and the management support they received. Staff received ongoing training to ensure they met people’s needs safely. They understood their roles and responsibilities to protect people from avoidable harm, and people said they felt safe with staff. Staff followed the provider’s policies and procedures to ensure people were protected from the risks of infection.

People's ability to make decisions was assessed in line with the Mental Capacity Act 2005. Staff offered people choices and respected the decisions they made. Where restrictions on people’s liberty had been identified as necessary in their care plans, Deprivation of Liberty Safeguards authorisations had been applied for, or were in place, to lawfully deprive people of their liberty for their own safety.

People were able to access a GP when needed and were referred to external healthcare professionals where appropriate to maintain their health. We identified some improvements were needed regarding medicine management as procedures for safe medicine management were not always followed.

Staff were caring and supportive in their approach to people and offered encouragement and reassurance to people when they needed it. People were encouraged and supported to eat and drink enough and were positive about the quality and variety of their meals.

People, relatives and staff said communication was good at Melbourne House and they felt at ease to approach the registered manager with any concerns if they needed to. Where accidents and incidents had occurred, learning was taken from these to help improve the service. However, we found some incidents had not been reported to the local authority or us as required in line with the safeguarding procedures in place. We could not be assured all actions to safeguard people at the time had been taken as systems in place to safeguard people had not been followed. This was a breach of the Regulations.

The home was spacious with different areas people could use if they wished to sit in a quiet area as opposed to the main lounge which was used by most people at the home. Where people had difficulty walking, there was a lift to the upper floors to enable them to access all areas of the home. Most areas of the home were clean and tidy but some of the furniture was worn and in need of repair. We were told this was to be addressed as part of the refurbishment program that was in progress at the time of our visit, following a recent water leak.

The provider and registered manager completed regular quality monitoring and safety checks. However, these had not consistently identified areas needing improvement. Quality checks included obtaining feedback from people, staff and relatives, to identify where improvements in the service were required so these could be acted upon. Health and safety checks had been undertaken to ensure environmental risks within the home were managed.

The registered manager accepted there were areas for improvement at the home and we saw they encouraged staff to work together to address the improvements needed. The registered manager demonstrated their commitment to ensure improvements were addressed promptly so that the home was run effectively and consistently.

You can see what action we told the provider to take at the back of the full version of the report.

Melbourne House provides care for up to 33 older people in Coventry. At the time of our inspection there were 29 people living at the home. The building was divided over three floors. Some people stayed at the home for short term ‘respite’ care.

A registered manager was in post and had been for five years. 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.

At our previous inspection in October 2014 we rated the service as requires improvement in the areas of ‘safe’ and ‘effective’. We found risk assessments and care plans were not always up to date. Staff did not have an understanding of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). Social stimulation for people could be improved. At this visit we found staff knowledge around MCA and DoLS was improved, however care records and risk assessments continued to require further improvement. There remained little social stimulation for people.

We could not be sure people who used the service were safe. Risks to people’s safety were identified by staff, however ways to manage and reduce these risks were not always documented correctly to ensure a consistent and effective approach was taken.

Care records contained information for staff to help them provide personalised care, however some information was missing about people and how they should receive their care. Staff knew the people they cared for well.

There were enough staff to care for the people they supported. Checks were carried out prior to staff starting work to ensure their suitability to work with people who used the service. Staff received an induction into the organisation, and they completed training to support them in meeting people’s needs effectively.

Staff had a good understanding of what constituted abuse and knew what actions to take if they had any concerns.

People and relatives told us staff were caring and had the right skills and experience to provide the care required. People were supported with dignity and respect and people were given a choice in relation to how they spent their time. Staff encouraged people to be independent.

People received medicines from staff who were trained and competent to do this. Medicines were administered correctly. For medicine taken ‘as required’ (PRN), guidelines were not always recorded to tell staff when people needed this.

Staff understood the principles of the Mental Capacity Act (2005) and how to support people with decision making, which included arranging further support when this was required.

People had enough to eat and drink during the day, were offered choices, and enjoyed the meals provided. Special dietary needs were catered for.

People were assisted to manage their health needs, with referrals to other health professionals where this was required.

There were some social activities to keep people occupied and plans were in place to improve these further.

People were given the opportunity to feedback about the service they received through surveys. Meetings for people and relatives were held.

People knew how to complain and these were recorded and responded to, to people’s satisfaction.

Staff had positive views about the management of the home. Staff told us they could raise concerns or that these would be listened to. There were some formal opportunities for staff to feedback any issues or concerns at team meetings.

There were some processes to monitor the quality and safety of service provided to ensure staff were following policies and procedures.

Checks of the environment were undertaken and staff knew the correct procedures to take in an emergency.

We had received the required notifications to enable us to monitor the service. The provider displayed the ratings from our previous inspection.

People we spoke with said they were fully involved in their care or their relatives care. All the people in the home had capacity to make decisions about their daily routines. We saw that staff asked people about their choices. Staff treated people with dignity and respect. One person told us, 'It's an excellent place to live. If you can't live at home this is the next best thing.'

We asked people what the meals at Melbourne House were like. All the comments we received were positive about the quality of food provided. Comments included, 'There are always two choices. The food is perfect." People living in the home told us they could have a hot drink whenever they wished, one person said 'You just have to ask and it's there.'

We found the home was monitoring and assessing the overall standard of cleanliness and state of repair in the home. On the day of our visit we found the home was clean, warm and well maintained.

We looked at the recruitment practice of the home. Records showed staff had been properly checked before they started working at Melbourne House.

We looked at how complaints were managed. We found there was a procedure in place to make sure concerns and complaints were recorded and looked into. One person told us, 'I've never had to make a complaint I have 100% confidence in the staff here.'

People told us they were well looked after and were generally happy with the care at the home. Their comments included; 'I'm happy here all the care staff are nice and friendly.' We spoke with a visiting family member. We were told they were happy with the home and that staff knew their relative well.

We looked at a sample of care plans which included personal care support, health needs and risk assessments. These documents provided the information staff required to meet people's care and support needs. During our visit we saw that care staff listened to people and responded to their requests. We observed that staff carried out their role in a pleasant and patient manner.

Staff knew what to do to keep people safe. We were told by staff they would have no hesitation reporting concerns or poor practice to the manager. The home had a process for assessing and managing risk associated with people's care.

People were asked for their views about their care and treatment. Returned questionnaires from a recent survey indicated residents and their relatives were satisfied with the care provided by the home.