Melbreck

Updated 5 September 2019

The inspection

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 Care Act 2014.

Inspection team

The inspection team consisted of two inspectors and a specialist nurse with experience of this type of care setting.

Service and service type

Melbreck is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service had a manager registered with the Care Quality Commission. 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.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

Prior to this inspection we reviewed all the information we held about the service, including data about safeguarding and statutory notifications. Statutory notifications are information about important events which the provider is required to send us by law. We used information the provider sent us in the Provider Information Return. Providers are required to send us key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We used all of this information to plan our inspection.

During the inspection

As part of our inspection we observed the care provided to people living at Melbreck. We spoke with the registered manager, clinical operations manager, seven staff members and a visiting health care professional. We reviewed a range of documents about people's care and how the home was managed. We looked at seven care plans, three staff files, medication administration records, risk assessments, policies and procedures and internal audits that had been completed.

After the inspection

Following the inspection, we spoke to three relatives regarding the care their family members received. We also reviewed additional information requested from the provider including staff training records and further audit information.

Updated 5 September 2019

About the service

Melbreck is a nursing home providing personal and nursing care to up to 26 people with learning disabilities and complex needs in one adapted building. At the time of our inspection there were 23 people living at the service. The service was a large home, bigger than most domestic style properties and situated in a rural location.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence. The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

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

Risk to people’s safety and well-being were managed although records of healthcare concerns were not always clearly recorded to ensure action taken could be fully monitored. This monitoring was made more difficult by the high use of agency nurses. Although records of people’s care were updated they were not always clearly organised to ensure staff could access information easily. We have made recommendations regarding these concerns.

Staff were aware of their responsibilities in relation to keeping people safe and robust recruitment systems were in place. Contingency plans ensured that people would continue to receive a safe service in the event of an emergency. People lived in a safe and homely environment which was suited to their 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. Choices of foods were available to people and staff were knowledgeable about people’s dietary requirements. People were supported to see healthcare professionals when required. Staff received training, induction and on-going supervision to support them in their roles.

Staff supported people with kindness and respected their privacy. Staff understood the need to maintain and develop people’s independence wherever possible. People and their relatives were fully involved in their care and staff were knowledgeable about people preferences and communication styles. A range of activities were provided to people with an emphasis placed on community activities.

There was an open and positive culture developing within the service. Staff shared the same values and wanted to provide a positive experience for people. People, relatives and staff had the opportunity to contribute to the service and felt their ideas were listened to.

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 with the Well-Led domain rated as Inadequate (18 January 2019).

Following the last inspection we issued warning notices in respect of people’s safe care and treatment and the governance of the service. The provider completed an action plan to show what they would do and by when to improve. At this inspection we found improvements had been made. The requirements of the warning notices had been met and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

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.