Melton House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Melton House is registered to accommodate up to 32 people in one adapted building. At the time of our inspection there were 21 people living at the service. Accommodation is spread over two floors and there is a lift for people to move between floors.

There was currently no manager registered with the Care Quality Commission (CQC). However, a manager had recently been appointed and in post for three weeks. They told us they had submitted their application to register with CQC. 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.

At the last inspection in March 2017 the overall rating for this service was ‘Requires Improvement'. At this inspection whilst we have acknowledged some areas of improvement this is the second time we have judged this domain as ‘Requires Improvement’ with an improving picture.

At our last inspection, we identified shortfalls relating to risks to people's safety. This was because the governance system had not identified or addressed certain areas. This included concerns about ineffective fire doors, a risk of burns from a hot water pipe and inconsistent staff knowledge and practice in relation to safe moving and handling practices. These shortfalls meant that risks to people’s safety had not been identified and action had not been taken to mitigate these risks. We also found people were not protected from safe recruitment systems and processes in line with the provider’s policy. There was a failure to gather all the information required to determine, as far as practicable, whether or not staff appointed were suitable for their roles.

Following the last inspection, we asked the provider to complete an action plan to show us what they would do and by when to improve.

We carried out this unannounced comprehensive inspection on the 09 and 10 May 2018. We found two continued breaches of Regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Whilst we have acknowledged some areas of improvement, we found further work was needed to safeguard people from risks to their health, welfare and safety. Risks to people’s safety associated with improper operation of the premises and the lack of investigations instigated from the monitoring of incidents had not always taken place. For example, where people had sustained unexplained bruising and skin tears management audits did not always prompt further investigations.

Whilst staff were kind and caring in their interactions with people, there was a lack of effective system in place for the laundering of people’s clothing. This demonstrated a lack of care and respect for people’s belongings.

During our visits there were sufficient numbers of staff to meet people’s assessed needs and the provider had improved and now operated safe recruitment procedures. However, further work was required to ensure the dependency tool used to determine the numbers of staff allocated to meet people’s needs contained accurate information as to people’s level of dependency. This meant that staffing levels may not always be matched to the level of need.

There were safe systems in place to safely store and ensure people received their medicines as prescribed. Staff were trained in medicines management and regularly had their competency assessed.

Staff received training and induction to their work. Further work was needed to ensure staff competency checks and training be provided in areas such as mee

The inspection took place on 15 and 20 March 2017 and was unannounced.

Melton House Care Home provides accommodation and support for a maximum of 32 people. There may be people supported who are under 65 but the majority of people using the service are older people, some of whom may be living with dementia. People using the service may also have a physical disability. Accommodation is spread over two floors and there is a lift for people to move between floors. At the time of our inspection, there were 28 people at the home.

There was a registered manager in post. 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. The registered manager completed their registration with us in June 2016.

At this inspection, there were three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

There were some risks to people's safety, which had not been robustly identified and addressed. This included concerns about fire doors, a risk of burns from a hot water pipe and inconsistent staff knowledge about moving and handling practices. These issues potentially placed people at risk while they were receiving care.

There were enough staff to meet people's needs safely but recruitment processes were not sufficiently robust. They did not gather all the information required to determine, as far as practicable, whether staff appointed were suitable for their roles.

There was a wide range of audit tools and checking systems being used but they were not fully effective in identifying where the service needed to improve. The provider's oversight of the systems applied within the service was also not robust and supportive of the registered manager. This compromised the consistency and effectiveness of leadership at the home.

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

Where staff took responsibility for administering medicines, the process was largely safe although there was some inconsistent practice in ensuring people took their medicines promptly.

Staff were trained to recognise concerns that people may be at risk of harm or abuse and were clear about their obligations to report any such concerns so that people could be properly protected. Staff understood how to manage individual risks to people, for example to their skin integrity, from falls and while eating or drinking and received relevant training. The registered manager monitored the completion of training and supported staff to discuss their performance, understanding and training or development needs.

People had a choice of food and drink and enough to eat and drink to ensure their wellbeing. They were also supported to access health professionals for advice about their health and welfare so the service supported them effectively to recover when they were unwell. Staff supported people with some significant health needs and understood when they needed additional advice and guidance. Where people were not able to make specific, informed decisions about their health or wellbeing, staff took their best interests into account.

Although there were isolated lapses in the professionalism of staff, they supported people in a way that promoted their privacy and dignity. They showed concern for people's wellbeing and offered encouragement, support and reassurance when it was needed. People valued their approach and the kindness that staff showed.

People's needs were assessed and staff kept people's information up to date. They understood people's backgrounds and interests so that they could engage with people about the things that were important to them. However, people's individual preferences for their personal care we

This inspection took place on 16 June 2015 and was unannounced. Melton House Care Home is a residential care home providing personal care and support for up to 32 older people, some of whom may live with dementia. There were 23 people living at the home at the time of our inspection.

The home had a registered manager who had been in post since April 2015. 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.

At the last inspection in April 2014, we asked the provider to take action to make improvements to the support that staff members received, and action had been completed to do this.

People told us they felt safe and that staff supported them in a way that they liked. Staff were aware of safeguarding people from abuse and they knew how to report concerns to the relevant agencies.

Individual risks to people were assessed by staff and reduced or removed. There was adequate servicing and maintenance checks to equipment and systems in the home to ensure people’s safety.

There were usually enough staff available to meet people’s needs.

Medicines were safely stored and administered, and staff members who administered medicines had been trained to do so.

Staff members received other training, which provided them with the skills and knowledge to carry out their roles.

The CQC is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) Deprivation of Liberty Safeguards (DoLS) and to report on what we find. The service was meeting the requirements of DoLS. The manager had acted on the requirements of the safeguards to ensure that people were protected.

Staff members understood the MCA and presumed people had the capacity to make decisions first. Where someone lacked capacity, best interest decisions to guide staff about how to support the person to be able to make the decision were available, although clearer details about who else could make the decision were needed.

People enjoyed their meals and were given choices about what they ate. Drinks were readily available to ensure people were hydrated. Staff members worked together with health professionals in the community to ensure suitable health provision was in place for people.

Staff were caring, kind, respectful and courteous. Staff members knew people well, what they liked and how they wanted to be treated. People’s needs were responded to well and care tasks were carried out thoroughly by staff. Care plans contained enough information to support individual people with their needs and records that supported the care given were completed properly.

A complaints procedure was available and people were happy that they did not need to make a complaint. The manager was supportive and approachable, and people or their relatives could speak with him at any time.

The home monitored care and other records to assess the risks to people and ensure that these were reduced as much as possible.

Our inspection team consisted of two inspectors. We considered our inspection findings to answer the following questions: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led? This is a summary of what we found.

Is the service caring?

People said that most staff members were polite, kind and respectful. They confirmed that their privacy and dignity was usually respected. However, prior to our visit we had received information alleging that not all staff treated people with respect. They told us that staff did not like people ringing their call bells too often. This was confirmed by a person who used the service that we spoke with during this inspection.

We received information during this inspection that a person who used the service had been dealt with in a humiliating way by staff. We were also told that this abuse had been raised with a senior manager within the organisation. However we had not received notification of this matter from the provider. Therefore we requested further information from the provider regarding this allegation, plus any further action they had taken. We received a response that showed the service took most of the appropriate actions, including notifying the local authority safeguarding team.

Is the service responsive?

We found that the service was responsive to people’s needs as identified in their care plans and when feedback was received. For example through annual surveys that were sent to people to ask their views on the service provided.

A timetable showed that activities, such as quizzes and exercise sessions were provided. We observed some of these activities during our inspection and saw that they were tailored in response to the participants’ needs and abilities.

Is the service safe?

People using the service told us that they felt safe and happy.

People's care plans generally contained the information needed to provide them with safe care. Assessments were completed to assess people's level of risk for such issues as their mobility, developing pressure ulcers or becoming malnourished. These risk assessments had been reviewed and had appropriately identified the level of risks and stated what action was required to reduce or remove the risks for each person. Evacuation information for each person who used the service was kept with their care records and in a central location to ensure they could be easily accessed in the event of an emergency.

Staff we spoke with displayed awareness of people’s rights to refuse care and how to keep them safe and healthy in such circumstances.

We found that staff were trained and knowledgeable about their roles and responsibilities in protecting people from abuse. They demonstrated that they knew how to report any abuse that they witnessed or suspected. However some staff said that they would like the electronic learning that they had received on the safeguarding of vulnerable adults to be supplemented by some face-to-face training.

Is the service effective?

People received the care and support they required to improve their health and well-being. Care records were written in detail and provided clear guidance to staff members, although evaluations of care plans were not always completed.

People were provided with a choice of meals and staff members assisted them appropriately with eating and drinking when this was required. They told us that their meals were always nice and tasty.

Is the service well led?

Staff members received supervision and training from the provider or from external sources. However, due to the manager working away from the home for periods of time, disruption to supervision sessions for staff members meant they did not always feel properly supported. Actions to resolve issues that had been raised by staff or identified through the service monitoring were not always clearly identified.

Systems were in place to regularly check and monitor the way the service was run.

We found that there were appropriate processes in place to gain the consent of people using the service to their care and treatment. One person told us, "Well I agreed my care when I first arrived. I know what I get and I'm happy with that". Another person told us, "They always knock before coming in. Most of the time they ask my permission before they start doing things".

We found that there were detailed assessments and care planning for people using the service, so that staff could meet their needs. However, the provider may wish to note that sometimes changes in people's needs were not reflected in the main body of the care plan, although these were reflected elsewhere. We spoke with people about their care and one person told us, "I'm quite satisfied with my care here, it's a lovely place". Another person told us, "I'm very happy here, I'm looked after".

We found that the home was kept clean and tidy by a team of domestic staff. We spoke with people using the service about the cleanliness of the home. One person told us, "It's a very clean place. It's spotless". Another person told us, "Oh I'm quite satisfied with the cleanliness here".

We found that there was enough suitably qualified staff to care for people using the service. We spoke with people about the staff at Melton House. One person told us, "They're always there when I need them". Another person told us, "Oh yes, there's definitely enough staff. Most of them are great".

The people we spoke with who lived in Melton House told us they were able to make choices as to how they spent their days. Comments such as, "I can have what I want for my dinner and have plenty of choices of drink." "I think the staff are very good as they know how to care for us. They always ask what we want to do, what we like to wear and food we enjoy." Those people who were having difficulty in making choices were noted to be given time to decide by the staff who were working with them.

During this visit we noted care plan records were centred round the person the plan belonged to. They contained an assessment of need prior to the person being offered a place and a copy of each person's care and support requirements. The people we spoke with and our observations carried out showed people were receiving the individual support they needed.

Part of this visit was to look at the safe management of people's medication. We talked to staff who competently showed us the methods used to store, record and administer medication. Medication audits were carried out by the manager with records seen during this visit.

The people we spoke with who lived in this home were complimentary about the staff. They told us they were suitable as carers and felt they were trained to do the job required. One person said, "I am well looked after by staff who are trained and know what they are doing."

Complaints were taken seriously and dealt with appropriately.

Throughout our visit on 4 January 2012 we were told by people who live in this home how they were happy and contented. Some people told us that although they had no concerns they were not really involved in the decisions about the care support they received.

The people who were able to answer our questions gave very positive comments about the respect and choices offered by the staff team on a day to day basis. We were told how kind and considerate the home staff were.

Throughout the day of this visit people told us they felt safe and have no concerns about the care they received.

A family member spoken with told us the staff were very good and that they had never heard anyone spoken to inappropriately. They told us they feel reassured now their loved one was cared for safely.

Many positive comments were heard during our visit. We were told about the good staff team, the suitable and varied activities, their individual clean and personalised bedrooms, their well laundered clothes, the choice of good meals and the supportive manager.