MELM Care Solutions

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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

The principles of the Mental Capacity Act 2005 were not always upheld. Capacity related needs were not fully assessed to ensure people received appropriate care that maintained least restrictive practices. People were supported to make choices around food and drink. Staff demonstrated good understanding of people’s needs and how to record and document care activity. The provider’s systems and processes supported effective monitoring of people’s health and well-being.

This service scored 71 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

One relative told us they were contacted by the provider and felt included in some decisions about their relative’s care. They told us the provider informed them of incidents and responded to concerns.

Staff and leaders knew people well and understood how to best meet their needs. Staff told us people’s needs were discussed during team meetings and daily handovers. The provider considered information from the local authority and other stake holders to inform decisions about people’s care.

Feedback from the local authority indicated there were some short falls in relation to assessing needs. For example, they told us assessments did not always address people’s specific needs and care plans were not always thorough. In one case, they told us a person’s capacity assessments were not decision specific and a positive behaviour support plan did include information about the person’s behaviour responses to certain situations.

We found systems and processes for assessing people’s needs were mostly effective. For example, care reviews were completed regularly, and assessment documents were appropriate for people’s needs. However, there remained to be a lack of decision specific mental capacity assessments in place as highlighted by the local authority. This meant the provider had not fully assessed the person’s abilities in relation to decision making, consent and communication.

People had a choice of food and drink. Staff supported them to make choices and access food and drink appropriate to their needs and preferences. One person told us, “Yes staff ask me what I would like to eat.” People were supported by staff to access their community. Staff provided support in a manner compliant with guidance from the local authority to ensure the people’s safety.

Staff demonstrated good understanding of people’s needs and how to record and document care activity. The provider described how they ensured partnership working with other stakeholders to ensure that care was outcome focused and appropriate for people’s needs.

The provider's systems and processes for recording the delivery of care were effective. For example, records were consistently completed and provided a clear account of support engagement. There was evidence care was meeting people’s needs. Records indicated care was delivered in line with best practice and legislation.

Feedback from people and their relatives about their experience of the service indicated staff worked in partnership with them and other services to deliver effective care. For example, we were told about some incidents at the service and how staff and the provider spoke with the person using the service and the local authority to develop safe support routines.

We spoke with staff and leaders as part of this assessment to gain feedback and consider knowledge and competence. Staff described and demonstrated they worked effectively as a team to ensure the needs of people were met. Leaders supported partnership working.

Feedback from the local authority indicated the provider was not always co-ordinating care to ensure people’s needs were effectively met. For example, the local authority told us people’s care plans were not always kept up to date and sometimes provided misleading guidance to care staff.

Systems and processes on the most part facilitated co-ordination of a team approach with the delivery of care. However, care plans and risk assessments did not always accurately reflect people’s needs.

People and their relatives told us that staff supported them to monitor their wellbeing and schedule health appointments when needed. For example, one person told us if they felt unwell, staff would call the doctor.

Feedback from staff and leaders indicated a dedication to ensuring the health and wellbeing of people living at the service. Staff described how changes in behaviour may indicate when people are feeling unwell.

Feedback from the local authority indicated people’s care plans were not always updated to ensure they reflected people’s needs accurately.

We found the provider’s systems and processes supported effective monitoring of people’s health and well-being. Records indicated that people were supported to attend health appointments where needed. Daily monitoring provided opportunity to identify any health deteriorations. Care plans indicated that there was some level of daily physical activity appropriate to the service users interests and abilities.

People's care needs were monitored consistently to improve outcomes. Relatives had no concerns about the care people received. Feedback from people indicated they felt supported by staff, who were present with them at all times and monitored their wellbeing.

Staff described how they supported the person receiving regulated care throughout the day and explained how extra staff were available when needed to met specific needs. We spoke with the care coordinator who had a good understanding of people’s needs and ensured care provisions were put in place accordingly.

The provider’s systems and processes promoted effective monitoring of people’s care outcomes. Care plans, quality audits, system reviews and daily note taking were in place to ensure that effective outcome monitoring was completed.

Feedback from people indicated they were happy with the support they received felt that they were given choices in relation to their care. A relative we spoke with also did not raise any concerns in relation to consent. However, we found that the provider had not taken sufficient action to ensure people’s capacity related needs were fully understood and care was not always suitably tailored to ensure least restrictive practices were maintained. For example, finance management procedures were not always appropriate or safe, and did not always fully consider people’s needs or wishes.

Care and support staff had suitable knowledge on people’s right to make independent choices and the need to obtain daily consent. Staff described how they sought consent before supporting people with their needs. They described how they supported people to make daily choices, such as choosing their clothing or meals. However, staff did not always have access to assessment documents or suitable guidance on people’s capacity related abilities to ensure their needs were appropriately met.

The principles and application of the Mental Capacity Act 2005 were not fully understood, and people’s rights were not always upheld in relation to consent for care and treatment. The providers systems and processes did not support compliance in this area. For example, there was a lack of decision specific mental capacity assessments in place, and the provider did not have immediate access to assessments completed by external professionals determining a person’s mental capacity related needs. The absence of capacity assessments in this instance meant the provider had failed to ensure people’s needs were adequately assessed and care strategies ensured least restrictive practices were maintained. We raised these concerns with the provider and sign posted them to relevant guidance and legislation.