CQC report explained · a residential care home
What the CQC found at Melba Lodge Limited
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Good
- Inspectors found that risks to people's health and welfare were assessed and reviewed. They also found robust recruitment checks, enough staff, safe medicines arrangements and emergency procedures.
- Effective?
- Good
- People had assessments before moving in, and staff received induction, training and supervision. People were supported with food, daily choices and access to health professionals.
- Caring?
- Good
- Staff were observed treating people respectfully and with dignity. People and relatives, where appropriate, were involved in care planning, although one person said staff had sometimes entered without knocking.
- Responsive?
- Good
- Care plans and risk assessments were kept up to date and reflected people's individual and diverse needs. People had activities, support to remain independent and access to a complaints process.
- Well-led?
- Good
- The home had a registered manager and regular checks covering areas such as medicines, safety, training, complaints and care plans. People, relatives and staff were asked for their views through surveys and meetings.
What inspectors found, August 2018
Rated Good across all five areas; inspectors found safe, kind and well-organised care, with earlier safety and recruitment concerns addressed.
The inspection was unannounced and took place on 8 August 2018. One inspector reviewed care records, staff recruitment and management records. They spoke with all four people living at the home, managers and support workers.
The home supported up to four people with mental health needs. Inspectors found suitable risk assessments, safe recruitment checks, enough staff and appropriate medicines arrangements. People had access to health professionals, activities and support to make their own choices.
The home was rated Good for Safe, Effective, Caring, Responsive and Well-led. At the previous inspection in July 2017, there had been breaches about managing risks and staff recruitment. Inspectors found these issues had been addressed at this inspection.
Risks were managed
Inspectors found that earlier safety concerns had been addressed. Fire safety, hot surfaces and guidance for managing medical conditions had been improved.
“At this inspection we found appropriate procedures were in place to support people where risks to their health and welfare had been identified.” from the report
Safe recruitment
The home was carrying out checks before staff started work. Records included employment history, references, identification and criminal record checks.
“At this inspection we found that robust recruitment checks took place before staff started working at the home.” from the report
Choice and independence
People were supported to make choices, cook, take part in activities and do things for themselves. Staff were expected to use the least restrictive approach.
“People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible” from the report
Up-to-date care planning
Care plans and risk assessments gave staff current guidance about people's mental and physical health needs.
“We saw that care plans and risk assessments had been kept up to date so that staff were fully aware of and could meet people's current needs.” from the report
Respectful care
Inspectors observed staff speaking to people respectfully and treating them with dignity. People said staff were kind and caring.
“Throughout the course of our inspection we observed staff speaking with and treating people in a respectful and dignified manner.” from the report
Staff sometimes entered without knocking
minorOne person said staff had entered their room without knocking on a couple of occasions. The registered manager said this would be discussed with staff in supervision and at a team meeting.
“Nearly all of the time the staff knock on my door but there have been a couple of times when they didn't knock before coming in.” from the report
- 01How do you check that risk assessments and guidance for mental health changes remain up to date?
- 02What action was taken to make sure staff always knock before entering people's rooms?
- 03How do you decide when extra staff are needed for appointments, activities or other support?
- 04How are medicines competency checks and weekly medicines audits carried out now?
- 05What activities and opportunities for independence are available for people with similar mental health needs?
This unannounced inspection looked at the accommodation and personal care and assessed all five CQC questions. This explanation was written from the published report of 29 August 2018 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, August 2017
Melba Lodge Limited is rated Requires Improvement; inspectors found kind, person-centred care, but safety, recruitment and oversight needed improvement.
The inspection was unannounced and took place on 03 July 2017. Inspectors spoke with all four people living at the home, a relative, a staff member and the registered manager. They also checked care plans, staff recruitment files, medicine records, training records and quality checks.
People generally felt safe and said there were enough staff. Staff were kind, respected people's privacy and choices, and supported people with meals, healthcare, activities and relationships. Care plans were personal and people were involved in decisions about their support.
Inspectors found problems with managing some risks. These included a fire door being wedged open, missing guidance about some health risks, incomplete recruitment checks and inaccurate monitoring of the medicines storage temperature. The home was also not identifying these problems through its own checks.
The overall rating changed from Good at the previous inspection in May 2015 to Requires Improvement. Effective, caring and responsive care were rated Good. Safe and well-led were rated Requires Improvement.
Kind and respectful staff
People described staff as caring and considerate. Inspectors saw staff treating people politely, respecting privacy and supporting their choices.
“Staff treated people with care and consideration.” from the report
Good staff support and training
Staff had induction training, regular training and supervision. Records also showed appraisals for staff employed for more than 12 months.
“Staff were supported in their roles through regular training and supervision.” from the report
Person-centred support
Care plans included people's needs, preferences, views and goals. People were involved in reviewing their care and were encouraged to remain independent.
“Care plans were person centred and contained details of people's views about the support they received in each area” from the report
Activities and relationships
People could take part in activities linked to their interests and were supported to maintain important relationships. Visitors were welcome.
“People were supported to maintain the relationships that were important to them.” from the report
Risks were not always safely managed
seriousA fire door had been wedged open, and some environmental risks had not been assessed. Risk plans did not always explain clearly how staff should keep people safe, including for anxiety and diabetes.
“Risks to people were not always managed safely.” from the report
Recruitment checks were incomplete
seriousSome staff files did not contain full employment histories or explanations for gaps. References did not always match the listed employers, and evidence about one person's right to work was not available during the inspection.
“Appropriate recruitment checks had not always taken place before staff started work” from the report
Medicines storage temperature
needs fixingMedicines were stored securely and records showed people received them as prescribed. However, the storage temperature was not accurately monitored, so inspectors could not confirm it stayed within the appropriate range.
“We were unable to determine whether the storage area remained within the appropriate temperature range for the safe storage of medicines.” from the report
Quality checks missed problems
needs fixingThe home had monitoring systems, but these checks did not identify the recruitment and medicines storage issues found by inspectors.
“Improvement was required to ensure these were consistent in identifying issues and driving improvements.” from the report
- 01What has been done to make sure fire doors and other environmental risks are checked and managed safely?
- 02How are people's risk plans now updated, including guidance for anxiety and diabetes?
- 03How do you check full employment histories, references, identity and right to work before staff start?
- 04How is the medicines storage temperature recorded and checked now?
- 05How do your quality checks make sure these problems are found and corrected promptly?
This was an unannounced inspection of the overall service, covering all five key questions and checking records, people's experiences, staffing and management systems. This explanation was written from the published report of 12 August 2017 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of Melba Lodge Limited
3 rated inspections over 3 years: the service has held its Good rating throughout.
- August 2018Goodcurrent ratingup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- August 2017Requires improvementdown from GoodSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- July 2015GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- January 2014
Report published without a new overall rating.
- July 2013
Registered with the Care Quality Commission on 22 July 2013.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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