CQC report explained · a nursing home
What the CQC found at Melbreck
Rated Good: inspectors found the home performing well and meeting their expectations.
What inspectors found, September 2019
Rated Requires Improvement; inspectors found kind, person-centred care, but healthcare records, nurse continuity and management systems still needed improvement.
Inspectors made an unannounced visit on 10 July 2019. They observed care, spoke with staff, relatives and a healthcare professional, and checked care plans, medicines records, risk assessments, staff files and management audits.
People were supported with kindness and respect. Inspectors found good support with healthcare, training, food, communication, activities and independence. There was a strong emphasis on community activities and involving relatives in care.
The overall rating was Requires Improvement. Safe and Well-led were rated Requires Improvement because healthcare records were not always clear, agency nurses affected continuity, and some care guidance was difficult to find. Effective, Caring and Responsive were rated Good.
Kind and respectful staff
Staff knew people well, supported them at their own pace and respected their privacy, dignity and choices.
“They are caring with him. It's the way they are with him and how they talk to him.” from the report
Better access to healthcare
People were supported to see a range of healthcare professionals when needed. Staff responded to changes in people's health.
“People were supported to access healthcare professionals when required.” from the report
Personalised communication
Care plans explained how each person communicated, including through facial expressions, movement, sounds or pictorial aids.
“Communication care plans were in place for each person which were in line with AIS standards.” from the report
Activities and community life
People had activities matched to their interests, including trips and opportunities to use community facilities.
“There was strong emphasis on people taking part in community activities.” from the report
Healthcare records were unclear
seriousRecords did not always clearly show healthcare support, follow-up tests and monitoring. This could make it harder for staff and health professionals to share information or respond quickly.
“records did not always clearly reflect the support people had received.” from the report
Agency nurse continuity
needs fixingThe home was continuing to use agency nurses. Staff said this sometimes affected continuity and made it harder to know whether checks had been completed.
“Things can get missed such as messages being recorded in the wrong place.” from the report
Current guidance was not always clear
needs fixingSome records contained several versions of guidance, and it was not always clear which version was current. This could cause confusion when staff needed information quickly.
“it was not clear from the persons records which guidance was current which may have caused confusion if staff needed to access the information quickly.” from the report
End-of-life plans needed more detail
minorEnd-of-life care plans contained basic information. Managers agreed they should be more personal and planned to seek support with this.
“Care plans contained basic details regarding the care people wanted at the end of their life.” from the report
- 01How are healthcare appointments, tests and follow-up actions now recorded and checked?
- 02How many regular nurses are now in post, and how is continuity managed when agency nurses are used?
- 03How do staff know which version of a person's care or nutritional guidance is current?
- 04How will you involve our family member and us in making end-of-life plans more personal?
- 05What checks show that the improvements from the previous inspection are now being maintained?
This was an unannounced planned inspection of the care, nursing and management of the home, including observations, discussions and reviews of care, medicines, staffing and audit records. This explanation was written from the published report of 5 September 2019 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, January 2019
Rated Requires Improvement, with an Inadequate well-led rating; inspectors found unsafe gaps in health monitoring, records, complaints and family involvement.
The unannounced inspection took place on 30 October 2018. Two inspectors and a specialist nursing adviser reviewed information, watched care, spoke with staff and relatives, and checked care plans, medicines records, risk assessments, complaints and audits.
Inspectors found continued problems with monitoring people's health risks. Seizures and other health conditions were not always recorded or followed up properly. Some staff did not have enough clinical supervision or understanding of people's health needs. These issues meant people could be at risk of harm.
There were also problems with involving relatives, keeping care records accurate, recording complaints and checking the quality of the service. Inspectors found kind staff, safe medicines processes, enough staff and major improvements in activities. However, the home was rated Requires Improvement in all five areas, and Inadequate for being well-led.
Kind and respectful staff
Staff were observed treating people gently and positively. They understood people's communication needs and respected privacy and dignity.
“Staff knew people well and treated them with kindness. Staff used a gentle approach when supporting people.” from the report
Safer staffing arrangements
Inspectors found enough staff to meet people's needs. Recruitment checks were completed, and the home had reduced its use of agency care staff.
“Sufficient staff members were deployed to meet people's needs.” from the report
Medicines and environment
Medicines were stored, administered and checked safely. The home was clean, infection control procedures were followed and safety checks were completed.
“People's medicines were managed safely. Each person had a medicines administration record (MAR) in place” from the report
Improved activities
People had much more access to community activities and activities at home than at previous inspections.
“We found that significant improvements had been made to the activities available to people which had had a positive impact on people's lives.” from the report
Health risks were not reliably monitored
seriousRecords did not consistently show seizures, fluid intake or signs of illness being monitored and reviewed. Inspectors said this created a significant risk of harm for one person.
“The failure to ensure that risks to people's safety and health were robustly monitored was a continued breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.” from the report
Healthcare follow-up and staff skills
seriousSome appointments were delayed or difficult to track. Nursing staff had received little clinical supervision, and staff did not always understand the reasons for particular care instructions.
“The failure to ensure that people had access to healthcare involvement was a breach of Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.” from the report
Families were not always involved
needs fixingSome relatives were prevented from viewing care records and were not consistently told about health appointments. This caused distress and reduced trust in the home.
“The failure to involve relevant persons in decisions relating to people's care or treatment and ensure that care records are up to date and accurate is a breach of Regulation 9” from the report
Complaints and records
needs fixingSeveral concerns raised by relatives had not been recorded as complaints, so they were not investigated or answered systematically. Some care records were also out of date or inaccurate.
“The failure to record and respond to complaints is a breach of Regulation 16 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.” from the report
Weak management checks
seriousQuality audits failed to identify important problems. The provider had not given the registered manager enough support, and governance systems had not produced lasting improvement.
“The failure to ensure good governance of the service was a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.” from the report
- 01How are seizures and other specific health conditions monitored now, including when people spend time alone in their rooms?
- 02How do you make sure health appointments, recommendations and follow-up actions are recorded in one place and completed on time?
- 03How are relatives involved in care planning, reviewing records and being told about health appointments?
- 04How are complaints and concerns recorded, investigated and answered within the provider's policy timescales?
- 05What clinical supervision and competence checks do nurses and care staff now receive?
This was an unannounced inspection of all five key questions, covering the home, care and management systems, including records, medicines, staffing, complaints and audits. This explanation was written from the published report of 18 January 2019 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 Melbreck
5 rated inspections over 4 years: the service has slipped, from Good to Requires improvement.
- September 2019Requires improvementcurrent ratingstayed Requires improvementSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- January 2019Requires improvementstayed Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Inadequate
- July 2018Requires improvementstayed Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- October 2017Requires improvementdown from GoodSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- December 2015GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Outstanding
- June 2014
Registered with the Care Quality Commission on 3 June 2014.
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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77 live-in carers within about an hour of Surrey
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Most charge £980 to £1,250 a week. 66 can care for a couple. 11 years' experience on average.
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