Melbury House is registered to provide care and accommodation to a maximum number of 34 older people and older people who are living with a dementia. At the time of the inspection there were 33 people who used the service.

At the last inspection in July 2015, the service was rated 'Good'. At this inspection we found the service remained 'Good'.

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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Staff understood the procedure they needed to follow if they suspected abuse might be taking place. Risks to people were identified and plans were put in place to help manage the risk and minimise them occurring. The manager and staff had assessed and monitored one person who stayed on their own when they visited church; however, there wasn’t a formal risk assessment for this. The manager told us they would take immediate action to address this. In addition the leads on the call system to summon the help of staff were long and as such posed a risk of strangulation. The manager told us they would immediately undertake a risk assessment on all people who used the service to determine safety.

Medicines were managed safely with an effective system in place. We did note that the room temperature in which medicines were stored was monitored daily and on a number of occasions the room temperature was too hot. The provider took immediate action to address this and had a thermostatically controlled fan installed and they were to monitor this temperature to ensure it didn’t exceed the maximum limit. At the time of the inspection the service did not have separate guidance for the administration of ‘as required’ medicines, creams or other topical applications. After the inspection the pharmacist the service used contacted us and told us they were to supply both documents to the service.

Appropriate checks of the building and maintenance systems were undertaken to ensure health and safety was maintained.

People and relatives told us there was enough staff on duty to meet the needs of people. We found that safe recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work.

People were supported by a regular team of staff who were knowledgeable about people’s likes, dislikes and preferences. A training plan was in place and all staff had completed up to date training.

Staff had an understanding of the Mental Capacity Act 2005 and acted in the best interest of people they supported. Staff clearly understood their role in supporting people with communication to help them make as many of their own decisions as possible. Staff told us about people’s care preferences, which were also recorded in their care plans. However, at the time of the inspection, processes had not been followed to formally record this. Information was supplied to us after the inspection to confirm that this process had commenced.

People were provided with a choice of healthy food and drinks, which helped to ensure that their nutritional needs were met. People were supported to maintain good health and had access to healthcare professionals and services.

There were positive interactions between people and staff. We saw staff treated people with dignity and respect. Staff were kind, caring and interacted well with people. Observation of the staff showed that they knew the people very well and could anticipate their needs.

Care plans detailed people’s needs and preferences. Care plans were reviewed on a regular basis to ensure they contained up to date information that was meeting people’s care needs. People were actively involved in care planning and decision making. People who used th

During our visit we found people were asked for their consent before they received any care or treatment and the provider acted in accordance with their wishes. We spoke with several people who used the service. They said staff respected their choices make informed decisions and have control of their lives. One person told us, “There are meetings where I can decide to be involved or not.” And, “They do ask me for my views, I have no complaints about that.”

We found care and treatment was planned and delivered in a way which ensured people’s safety and welfare. One person who lived at the home told us, “I get my own way. I prefer to spend time in my room and they find that’s acceptable.”

The provider had made suitable arrangements to protect vulnerable people and respond appropriately to any allegation of abuse. We spoke with a visiting social worker who told us she did not have any concerns and felt the people at the home were protected from abuse.

The provider had taken steps to make sure people at the home were protected from staff who were unsuitable to work with vulnerable people by carrying out thorough background checks.

We found the provider had an effective system in place to identify, assess and manage risks to the health, safety and welfare of people using the service and promote their health and wellbeing.

During our visit we spoke with several people who used the service and with their relatives.

One person told us, “They look after me well.”

Another person said, “That’s the smell of good home cooking for you.”

One relative said, “I talk to the staff or the manager if I have any concerns about my (relative).”

The manager had carried out a survey with all of the people who lived at the home and their relatives.

One relative said, “We have nothing but thanks and praise.”

Another said, “Excellent care and attention given to my (relative).”

During our visit we spoke with people who used the service and with their relatives. They said staff respected their privacy and dignity. They told us staff knocked on their bedroom doors before entering and were polite in the way that they were talked to.

One person said, “I’m treated with respect, there would be (trouble) if I wasn’t.”

People at the home said that they felt involved in decisions about their care.

One person told us, ““Nobody tells us what we have to do; we can please ourselves”

People said that staff helped them to take medicines safely.

One person said, “They come round every day with the tablets, they get them from the doctors for you.”

Another said, “Sorting out your tablets is all part of the staffs job here.”

But we found that the provider did not make sure that people were protected from the risks of unsafe use and management of medicines.

People at the home were happy with the support they received from staff. One person said, “The staff are very good, they give me everything I ask for when I press the bell and they call in (to the room) all the time to make sure I’m alright.”

During our visit we spoke with people who use the service and with their relatives. They said staff respected their privacy and dignity. They told us staff knocked on their bedroom doors before entering and were polite in the way that they were talked to.

One person said, “Staff have a lot of time for you here.”

People at the home said that they felt involved in decisions about their care.

One person told us, “Staff write important things down in your file in the office – you can see it if you want.”

People said that staff helped them to take medicines safely.

One person said, “They help me out (with medicines), they’re very organised.”

People at the home were happy with the support they received from staff. One person said, “The staff here are very efficient and caring; you couldn’t want any better.”

People said that their care was monitored by the provider and the manager to make sure that it was good enough.

One person said, “We’ve filled in surveys.”

The inspection was unannounced. This meant the provider or staff did not know about our inspection visit.

Melbury House provides accommodation and personal care for up to 34 older people. The home is set in its own grounds in a residential area near to public transport routes, shops and local facilities.

There was a registered manager in place who had been in post at the home for over eight years.

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 2008 and associated regulations about how the service is run.

People who used the service, and family members, were extremely complimentary about the standard of care provided. They told us they liked living at the home and that the staff were kind and helped them a lot. We saw staff supporting and helping to maintain people’s independence. We saw staff treated people with dignity, compassion and respect and people were encouraged to remain as independent as possible.

The interactions between people and staff that were jovial and supportive. Staff were kind and respectful; we saw that they were aware of how to respect people’s privacy and dignity.

People were supported to maintain good health and had access to healthcare professionals and services. People were supported and encouraged to have regular health checks and were accompanied by staff to hospital appointments.

There was information about how to make a complaint at the home which was displayed in people’s rooms and notice boards around the home. People we spoke with told us that they knew how to complain and but did not have any concerns about the service.

There were robust procedures in place to make sure people were protected from abuse and staff had received training about the actions they must take if they saw or suspected that abuse was taking place.

People told us they were offered plenty to eat and assisted to select healthy food and drinks which helped to ensure that their nutritional needs were met. We saw that each individual’s preference was catered for and people were supported to manage their weight and nutritional needs.

There were sufficient numbers of staff on duty in order to meet the needs of people using the service. The provider had an effective recruitment and selection procedure in place and carried out robust checks when they employed staff to make sure they were suitable to work with vulnerable people.

Staff training records were up to date and staff received regular supervisions, appraisals and a training / development plan was also completed, which meant that staff were properly supported to provide care to people who used the service.

We saw comprehensive medication audits were carried out regularly by the management team to make sure people received the treatment they needed.

The home was clean, spacious and suitably built / adapted for the people who used the service.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The Deprivation of Liberty Safeguards (DoLS) are part of the Mental Capacity Act 2005. They aim to make sure that people in care homes, hospitals and supported living are looked after in a way that does not inappropriately restrict their freedom. We found the provider was following legal requirements in the DoLS.

We saw that the home had an interesting programme of activities in place for people who used the service, including meaningful activities for people living with dementia.

All the care records we looked at showed people’s needs were assessed before they moved into the home and we saw care plans were written in a person centred way.

The provider had a robust quality assurance system in place and gathered information about the quality of their service from a variety of sources including people who used the service and their family and friends.