Melton Short Breaks Service

About the service

Melton Short Breaks Service is a residential care home providing personal care to autistic people and people with a learning disability, physical disability, sensory Impairment and to younger Adults. Melton Short Breaks service is registered to accommodate up to 6 people at any one time in an adapted building. At the time of our inspection 5 people were staying at the service but they supported 42 people who accessed the service for short breaks at various times throughout the year.

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

Right Support: Medicines were not always managed safely and there had been a number of medicine errors. People’s records sometimes contained conflicting information about their care needs. Not all staff had up to date training.

People were not supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

Right Care: The service was caring. Feedback from relatives was positive. They felt their loved ones were well cared for and enjoyed staying at Melton Short Breaks Service.

Right Culture: There was a lack of leadership within the service. This had allowed a culture of some poor practices to develop and continue. Staff felt they could not challenge leaders, even when they knew best practice was not being followed. Staff reported issues were not dealt with correctly.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was requires improvement (published 5 October 2018).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, responsive and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We have identified breaches in relation to the management of medicines, keeping people safe from abuse, staff training, mental capacity assessments and managerial oversight at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The service supports 42 people at various times throughout the year. People are allowed to spend up to 60 nights at the service during the course of a year. Short break stays last between two and 12 nights. At the time of our inspection four people were using the service.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

At the last inspection on 25 May 2017, this service was rated as requires improvement. Improvements were required to the management of medicines, recording of best interest decisions and ensuring that CQC were notified of Deprivation of Liberty Safeguards authorisations. At this inspection, we found that improvements had been made and sustained and the service was rated overall good.

Staff understood their roles and responsibilities to safeguard people from the risk of harm. Risk assessments were in place and were reviewed regularly; people received their care as planned to mitigate their assessed risks.

Safe recruitment processes were in place. People received care from staff that had received training and support to carry out their roles.

People were supported to access relevant health and social care professionals. There were systems in place to manage medicines in a safe way.

Staff demonstrated their understanding of the Mental Capacity Act, 2005 (MCA). Staff gained people's consent before providing personal care. People were involved in the planning of their care which was person centred and updated before they came to the service for their latest stay.

People were supported with their nutritional needs. Special dietary and cultural requirements were met.

People stayed in rooms they had used before unless they requested otherwise. They were supported to bring personal possessions with them to make their stay ‘homely’. People had use of communal areas where they socialised with other people and had use of a sensory room and garden.

People were encouraged to make decisions about how their care was provided and their privacy and dignity were protected and promoted. People had developed positive relationships with staff. Staff had a good understanding of people's needs and preferences.

People were supported to express themselves, their views were acknowledged and acted upon and care and support was delivered in the way that people chose and preferred.

People using the service and their relatives knew how to raise a concern or make a complaint.

The service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

The registered manager was supported by a service improvement manager and, with the provider, they were developing a five-year plan for this and other short break services. The provider had effective arrangements for quality assurance which drove improvement.

Melton Short Breaks Service is a care home that provides short term accommodation and personal care and support for up to six adults with physical and learning disabilities. At the time of our inspection four people were using the service. The service supports 42 people at various times throughout the year.

There was a registered manager in place. It is a requirement that the service has a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People felt safe with the support they received. Staff knew how to support people to remain safe from avoidable harm and abuse. Risks to people’s well-being were not always assessed and guidance on how to mitigate risks was not always available for staff to follow. The provider’s records of accidents and incidents did not always provide details of how these had occurred. Staff took the necessary action following an accident that occurred at the service. The provider had checks in place to support people to remain safe from the environment and the equipment they used.

Staffing numbers were suitable to make sure people received the support they required when they needed it. The provider was currently recruiting more staff. They were following their procedures to make sure this was undertaken safely so that only those suitable were employed.

People received their medicines when they required them. People’s medicines were not always stored according to manufacturing guidelines.

People received support from staff who had received guidance and training relevant to their role. There were plans in place to refresh their knowledge so that it remained up to date.

Where there were concerns about people’s ability to make decisions for themselves, the registered manager had not always undertaken assessments to determine people’s level of understanding. Decisions made in a person’s best interest had not always occurred in line with the Mental Capacity Act 2005 and therefore there was a risk that people’s rights were not upheld.

People were satisfied with the food and drink available to them. They planned their menus for their stay at Melton Short Breaks Service. People had access to health care services to help them to remain healthy.

People were supported by staff who were kind, communicated with them well and involved them in decisions about their support wherever possible. Staff respected people’s privacy and dignity. They knew the things that mattered to people and made sure they had the information they needed to support people by contacting relevant others. People’s independence was usually promoted by staff to make sure that they retained their skills.

People received support that was based on things that mattered to them. They had support plans that were being reviewed to make sure they contained up to date guidance for staff to follow. People’s or their representative’s contribution to the development or review of their support plan was not always documented.

People had opportunities to take part in hobbies and interests that were important to them when they had a short break.

People and their relatives knew how to make a complaint and the provider had a procedure to respond to any received.

Staff received support so that they understood their role and responsibilities.

People and their relatives had opportunities to give feedback on the quality of the service. The registered manager listened to suggestions and took action where required.

The registered manager was aware of their responsibilities although they had not submitted all of the required notification to CQC. Some checks occurred on the quality of the service. However, the range of checks occurring was not sufficient in identifying the areas that required improvement that we did when we visited.

When we visited people were returning from daytime activities for their evening meal. Some people went to their rooms to get changed while others spent time in one of the lounges. One person watched television while another read a book with a member of staff.

Staff were caring and attentive and made sure everybody was included in the home's activities. Plans for the evening were discussed. One person said they were going to walk to the shops with staff because they wanted to buy something.

During our inspection the evening meal was served in one of the lounge/dining rooms. The atmosphere was relaxed and people appeared to enjoy the meal as a social event. One person said, 'The food is nice and I get a choice.' Another person described what they'd had and said they enjoyed it.

Relationships between staff and the people who used the service were good. One person told us, 'The staff are really nice.' We observed staff providing both one to one and group care. They worked with people in a warm and supportive way and were friendly and patient.

We looked at the facilities for people and a person using the service gave us permission to look in their bedroom. We saw that the bedroom, toilet and bathroom doors throughout the home had privacy locks fitted. This in effect promoted people's choice to privacy, dignity and safety.

We observed staff talking with and assisting people throughout the day, this was done with the peoples' privacy and dignity in mind and showed the staffs' awareness of peoples individual support needs.

We looked at the quality assurance questionnaires that were put out following a stay to both to people using the service and their relatives. People were asked to comment if they were satisfied with the services provided in the home and could add comments or return these anonymously if they wished. On our tour around the home we saw people in a relaxed state, though those people in the home did not make specific comments about the home or the staff.

When we spoke with staff they were aware how to support people and this reflected the support plans we viewed at the time. Staff are supplied with various tools to aid communication when people visited, such as pictorial prompts and questionnaires.