CQC report explained · a residential care home
What the CQC found at Melba Lodge Limited
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
- Safe?
- Requires improvement
- People told inspectors they felt safe and there were enough staff. However, medicines instructions and some safety risk records were not always complete or in line with best practice.
- Effective?
- Good
- People received suitable assessments, staff had training and support, and the home worked with health professionals. Inspectors recommended using nationally recognised assessment tools to make assessments more comprehensive.
- Caring?
- Good
- Staff treated people with kindness, dignity and respect. People were involved in decisions and encouraged to be independent.
- Responsive?
- Good
- Care plans were personalised and reflected people's needs, preferences and goals. People were supported with activities, community involvement, communication and complaints.
- Well-led?
- Requires improvement
- There was a person-centred culture and visible management. However, quality checks were not consistently effective and had not identified several safety and medicines problems.
What inspectors found, March 2020
Rated Requires Improvement; inspectors found kind, personalised support, but medicines management and quality checks were not always safe or effective.
This was an unannounced inspection on 20 January 2020. The inspector spoke with all four people living at the home, staff and managers. They reviewed care records, staff records and records about safety and how the home was run. They also spoke with a relative and health professionals after the visit.
People told inspectors they felt safe, were treated kindly and had choice in their daily lives. Staff knew people's needs, supported their independence and worked well with health professionals. The home provided personalised care, community activities and support with healthcare, food and communication.
The main shortfalls were medicines management and quality monitoring. Some medicines did not have clear enough instructions, and audits had not identified problems with medicines, water temperature records, legionella checks or fire drill records. The overall rating fell from Good at the previous inspection to Requires Improvement. Effective, Caring and Responsive were rated Good, while Safe and Well-led were rated Requires Improvement.
Kind and respectful care
People said staff were kind and respectful. Inspectors saw staff support people calmly and help them make choices.
“People were treated with dignity and respect and their independence promoted.” from the report
Personalised support
Care plans covered people's needs, preferences and life histories. Staff supported people to build skills, make choices and take part in the community.
“People had personalised care plans that described their health care and support needs and preferences across all aspects of their care.” from the report
Health support
The home helped people attend health appointments and responded to changing health needs. Health professionals gave positive feedback about the staff's work.
“We saw where people's health needs had changed the registered manager had referred them to appropriate health professionals in a timely way to ask for support.” from the report
Staffing and recruitment
Inspectors found enough staff to meet people's needs and safe recruitment checks were in place.
“There were enough staff to meet people's needs.” from the report
Positive culture
People and staff described an open, person-centred culture. Managers sought views through meetings and surveys and worked with outside professionals.
“There was a person-centred culture at the home.” from the report
Medicines instructions
seriousSome medicines were not supported by clear enough instructions for staff, including when to give different doses of medicines taken when needed. There was also no agreed policy for some over-the-counter medicines.
“Some improvements were needed to ensure all medicines were safely managed.” from the report
Safety risk records
needs fixingThe home did not have a complete legionella risk assessment at the inspection. Water temperature records and fire drill records were also incomplete, and one person's breathing-related health risk had no assessment.
“Some environmental risks were not always robustly managed.” from the report
Quality monitoring
needs fixingManagers said checks were completed, but there were no records showing what medicines audits covered. The checks had not identified the medicines and safety-record problems found by inspectors.
“Systems to monitor the quality and safety of the service needed some improvement to ensure they were consistently effective to identify improvements.” from the report
- 01What changes have been made to the instructions and protocols for medicines taken when needed?
- 02How are medicines audits now recorded, and how do managers check that they identify problems?
- 03Has the legionella risk assessment been replaced or updated, and are all required water checks now recorded?
- 04How do you make sure every staff member completes and is recorded as attending fire drills?
- 05What risk assessment is now in place for the person's breathing-related health condition?
This was an unannounced comprehensive inspection covering all five CQC questions, with CQC reviewing the care provided and the home itself. This explanation was written from the published report of 10 March 2020 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, July 2017
Rated Good; inspectors found safe, kind and well-organised care, but medicines competency records were incomplete.
This was an unannounced inspection on 26 June 2017. One inspector observed care, checked records and spoke with all three people living in the home, three staff members and the registered manager. Feedback was also obtained from the local authority.
The home supported up to four people with mental health needs and was supporting three people at the visit. Inspectors found enough staff, clear care plans, suitable medicines management and access to health professionals. People said they felt safe, were treated well and had their privacy respected.
All five areas were rated Good: Safe, Effective, Caring, Responsive and Well-led. The overall rating was also Good. The previous inspection on 13 May 2015 had the same ratings.
People felt safe
People told inspectors they felt safe and that staff treated them well. There were safeguarding and whistle-blowing procedures, which staff understood.
“I feel safe living here, I don't need any protecting. We all get on well together.” from the report
Enough staff
Inspectors found staffing levels matched people's needs. Extra staff cover was arranged for appointments and activities when needed.
“There are plenty of staff here day and night to look after us.” from the report
Respectful care
Staff knew people well and respected their privacy, dignity and choices. People could spend time alone when they wanted to.
“The staff always knock on the door if they want to come into my room. If I tell them I want to spend some time alone they don't disturb me.” from the report
Activities and support
People had individual activity plans covering daily living skills, work placements and social activities both inside and outside the home.
“I go out all the time. I go to local shops and a café.” from the report
Quality checks
The registered manager carried out regular checks covering medicines, safety, activities, training and other parts of the service. Residents' suggestions were recorded and acted upon where possible.
“There were appropriate arrangements in place for monitoring the quality and safety of the service that people received.” from the report
Medicines competency records
needs fixingInspectors found no records confirming that staff had been fully assessed as competent to administer medicines. The manager introduced a new assessment form and said assessments would be completed, with the impact to be checked at the next inspection.
“However we found there were no records to confirm that staff had been fully assessed as competent to administer medicines to people using the service.” from the report
One missing written reference
minorOne of the five recruitment files did not contain two written employment references at the inspection. A second reference was obtained after the inspection, and a new criminal record check was also planned.
“All but one of the staff recruitment records included two employment references.” from the report
- 01How were all staff assessed as competent to administer medicines after the inspection?
- 02How do you keep medicines competency assessments up to date?
- 03What checks are completed before new staff start work, including written references and criminal record checks?
- 04How are care plans and risk assessments reviewed when a person's mental health needs change?
- 05How are residents' suggestions from meetings followed up and recorded?
This was an unannounced inspection of the overall service and all five key questions, including care records, staffing, medicines, training and management systems. This explanation was written from the published report of 26 July 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 5 years: the service has slipped, from Good to Requires improvement.
- March 2020Requires improvementcurrent ratingdown from GoodSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- July 2017Goodstayed GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- July 2015GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- 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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