Mellieha

Updated 13 May 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection, we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was carried out by 2 inspectors, 1 specialist pharmacy advisor (SPA) and an expert by experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

Mellieha is a ‘care home.’ People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Mellieha is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there were 2 registered managers in post and recruitment for a third registered manager was underway.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke with 9 people that use the service. We also spoke with 11 members of staff including the registered managers, Dialectic Behavioural Therapy (DBT) manager, deputy manager and support staff.

We observed staff providing support to people in the communal areas of the service. We reviewed a range of records. This included 4 people's care records and 3 people's medicines administration records. Quality monitoring systems and a variety of records relating to the management of the service, including policies and procedures were reviewed.

Updated 13 May 2023

About the service

Mellieha is a residential care home which has 3 adapted buildings each providing personal care to adults with learning disabilities or mental health conditions. At the time of the inspection 15 people were using the service. The service can support up to 15 people.

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

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

Right Support: Overall, people were supported to have choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service did not consistently support this practice. Records relating to consent and capacity needed improving and we have made a recommendation about this.

People living at the home each had unique and complex needs and staff knew people and understood most risks to people. However, we found risk management needed to improve in some areas. Staff provided kind, caring, person-centred care and support. Staff communicated with people in ways that met their needs.

Right Care: People's needs were assessed and developed into a support plan. Further work was needed to ensure support plans contained detailed information to enable people to receive appropriate care and support that was responsive to their needs, we have made a recommendation about this. The registered manager and staff understood their responsibilities in relation to the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. There were sufficient staff deployed to meet people's needs and wishes, however, there were significant shortfalls in the levels of training required. People received person-centred care that promoted their dignity, privacy, and human rights. Staff recognised and responded to changes to individual's needs. Staff treated people with kindness and patience. People had access to meaningful activities, however, we found that people had missed opportunities for activities.

Right Culture: Governance arrangements were not as effective or reliable as they should be. Further improvement was needed in strengthen the quality assurance processes to identify shortfalls, to drive further improvement and to embed them into practice. Support plans and risk assessments relating to people were completed but needed more person-centred detail. People and staff gave positive feedback about the culture at the service. We found the provider to be responsive, open, and transparent to the inspection and acted responsively to making improvements.

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

Rating at last inspection

This service was registered with us on 16 December 2022, and this is the first inspection.

The last rating for the service under the previous provider was good, published on 17 November 2018.

Why we inspected

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

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

You can see what action we have asked the provider to take at the end of this full report. Following this inspection, the provider acted responsively to address all of the concerns we identified and were open and transparent throughout the inspection.

Enforcement and Recommendations

We have identified breaches in relation to safety, safeguarding, staff training, medicines, and management at this inspection.

Please see the action we have told the provider to take at the end of this report.

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 request an action plan from the provider to understand what they will do to improve the standards of quality and safety. 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.