Archived: Melling Acres

Updated 1 November 2016

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This focused inspection took place on 15, 16 and 19 September 2016 and was unannounced. The inspection was completed in response to the receipt of information of concern and to check that improvements to meet legal requirements identified at the comprehensive inspection on 12 and 15 July and 1 August 2016 had been met. The inspection was undertaken by two adult social care inspectors.

We inspected the service against two of the five questions we ask about the service; Is the service safe and is the service well-led? This was because the information of concern and notifications submitted by the provider indicated that the service was not meeting legal requirements in relation to these questions.

Before our inspection we reviewed the information we held about the service. At the visit we spoke with one person living at the home, the interim manager, the regional manager and three other staff members. We looked at four care records and other records relating to the management of the home. On each of the three days we walked around the home and completed observations.

Updated 1 November 2016

We carried out an unannounced comprehensive inspection of this service on 12 & 15 July and 1 August 2016. After that inspection we received concerns in relation to the management of risk, the administration of medicines and the response of managers when issues had been raised. As a result we undertook a focused inspection on the 15, 16 and 19 September 2016 to look into those concerns and the progress of the provider’s action plan. This report only covers our findings in relation to those topics. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Melling Acres on our website at www.cqc.org.uk.

Melling Acres is a residential service that provides specialist intensive support and rehabilitation facilities for up to 16 people with a learning disability and autistic spectrum conditions. The accommodation is provided in several properties on one site, which is located in a rural location of Melling. It is set in three acres of private gardens and woodlands.

A registered manager was not in post. The home was being managed by in interim manager with support from a regional manager.

Prior to the inspection we received information indicating that risk was not being safely managed. In particular, we were concerned that risk assessments were not being followed or appropriately reviewed following incidents.

We found multiple examples of risk assessments that had not been reviewed following incidents. In one case we saw that a person had been involved in numerous incidents which followed a similar pattern. The person’s risk assessment clearly indicated this risk and provided basic strategies for diffusing situations. The incident forms demonstrated that staff had deployed these strategies with varying degrees of success. It was clear that the behaviours were more likely to occur with younger female staff. However, the risk assessment had not been reviewed following these incidents and the person continued to be supported by young females on a regular basis.

At the previous inspection we identified that specific unsafe behaviours (putting liquids in eyes & cutting wrists) a person presented with were not being managed effectively, which meant the person’s health and wellbeing was at risk. Since the previous inspection, we identified that there had been a further eight occasions whereby incidents had occurred involving these unsafe behaviours. The incidents had happened even though the person had continuous staff support.

We saw that the care records for a person with epilepsy were incomplete. We were unable to locate a risk assessment or management plan and staff equally could not find these documents.

Staff had not always followed people’s care plans. Failures to follow care plans had exposed people living at the home, staff and members of the public to risk of harm.

People were exposed to risk of harm because the safety of the physical environment was not adequately managed. We saw that fire doors were wedged open or not fully operational. We also saw that access to dangerous chemicals and materials was not adequately restricted.

At the previous inspection we identified a breach of regulation in relation to the safe management of medicines. The errors were in relation to stock control, missed doses and recording. However, additional staff had received training from an external pharmacy and the overall level of medicine’s errors had reduced since the last inspection.

At the previous inspection we saw evidence that restraint was being used inappropriately by staff who were not trained in the relevant techniques. At this inspection we saw evidence that additional staff had been trained and that other training had been arranged. None of the records that we saw indicated that restraint had been used unsafely or inappropriately since the last inspection.

Following our inspection on 12 and 15 July and 1 August the provider produced an action plan which detailed actions would be undertaken to improve safety and quality at the home. We used this as a point of reference in discussions with the interim manager and regional manager and looked at other sources of evidence to see what progress had been made towards the objectives.

We saw that a number of important elements of the action plan had not been completed as planned. These included; daily checks at the home, the recruitment of nurses to cover all scheduled administration of medicines, the provision of personal alarms to staff and an urgent review of health and safety. The failure to complete the action plan compromised the safety of people living at the home and staff.

Prior to the inspection we received information of concern relating to the quality and effectiveness of management responses when issues were raised by staff. We saw evidence that records and care practice had not been reviewed and updated as required when staff reported concerns.

At the last comprehensive inspection this provider was placed into special measures by CQC. This inspection found that there was not enough improvement to take the provider out of special measures.

You can see what action we told the provider to take at the back of the full version of the report.