Melbreck 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. Melbreck accommodates up to 26 people with learning disabilities and complex needs in one adapted building. At the time of our inspection there were 24 people living at the service.

This service was set up and registered prior to Building the Right Support and Registering the Right Support and it is not the type or size of service we would be registering if the application to register was made to CQC today. This is because it does not conform to the guidance as it is very difficult for large services for people with learning disabilities to meet the standards.

This inspection took place on 30 October 2018 and was unannounced.

There was a registered manager in post who supported us during the inspection. 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.

At our inspection on 19 and 25 July 2017 we rated the service 'Requires Improvement' and identified four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to staffing, consent, person-centred care and good governance. At our inspection on 27 March 2018 we found that despite some improvements having been made, the provider had not met the legal requirements in relation to risk management, person-centred care and staffing. We made a recommendation with regards to the governance of the service.

Following both inspections, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions of Safe, Effective, Caring, Responsive and Well-Led to at least good. At this inspection we found that although further improvements had been made in some areas, there were continued breaches of regulations. These related to the management of risk, healthcare monitoring, family involvement, responding to complaints, record-keeping and good governance.

There were continued risks to people’s safe care and well-being as healthcare needs were not consistently monitored. The supervision and competence monitoring of clinical staff was not consistent and effective. The service had not always fully involved families in their loved one’s care and complaints were not always recorded. People’s care records were not always accurately maintained and quality audits did not always identify shortfalls in the service. There was a lack of support for the registered manager from the provider. The policy review process had negatively impacted on the trust some relatives had in the service.

Sufficient staff were deployed to meet people’s needs. Robust recruitment processes were in place to ensure only suitable staff were employed. Staff demonstrated a good understanding of their responsibilities in safeguarding people from potential abuse. Safe medicines processes were in place and staff competence in supporting people in this area was assessed. Accidents and incidents were reviewed and action taken to prevent them happening again. People lived in a safe environment and regular health and safety checks were completed. Staff followed safe infection control procedures. The provider had developed a contingency plan to ensure that people's care would continue to be provided in the event of an emergency.

People were supported by staff who received an induction into the service and regular training. People lived in an environment which was suited to their needs. In some areas of their care people had access to healthcare professionals to support them in maintaining good health.

The inspection took place on 27 March 2018 and was unannounced. At our last inspection on 19 and 25 July 2017 we rated the service ‘Requires Improvement’ and identified four breaches of Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to staffing, consent, person centred care and governance.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions of Safe, Effective, Caring, Responsive and Well-Led to at least good. At this inspection, we found that despite some improvements having been made the provider had not met the legal requirements in relation to risk management, person centred care and staffing. We have also made a recommendation with regards to the governance of the service.

Melbreck is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. Melbreck accommodates up to 26 people with learning disabilities and complex needs in one adapted building. At the time of our inspection there were 26 people living at the service.

There was a registered manager in post who supported us during the inspection. 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.

Risks management plans were not always followed to ensure people’s safety and well-being were maintained. People’s weight was not always monitored to highlight concerns and people did not have regular access to a range of health care professionals. Clinical staff did not receive effective supervision and skills were not monitored. Access to activities within the community was limited and daily activities at home were repetitive. Quality assurance systems had not highlighted the above concerns to ensure that people received the care they required.

Staffing levels had increased and the way in which staff were deployed had changed. This meant that people’s day to day care was now provided in a more organised and timely manner. Care staff had access to the training they required and regular supervision was provided to support staff in their roles. Prior to starting work staff underwent robust recruitment checks to help ensure they were suitable to be employed at the service. Staff told us they felt supported in the roles and that the new registered manager had had a positive effect on staff morale and the culture within the service.

People received their medicines as prescribed and medicines were safely stored and managed. Staff knew people’s needs well and we observed positive interactions with people throughout the inspection. Assessments took place prior to people moving into the service to enable staff to better understand their needs. Detailed care plans were in place to support staff in providing people’s care and people’s independence was maintained. The registered manager had introduced person centred reviews to increase people’s involvement in their care.

People had a choice of nutritious foods and their dietary needs and preferences were known to staff. People’s cultural needs were respected and staff understood the importance of this. Systems were in place to ensure that the principles of the Mental Capacity Act 2005 were followed and people’s rights were respected. Staff understood their responsibilities in keeping people safe from potential abuse. Accidents and incidents were monitored to minimise the risk of them happening again.

People lived in a safe, clean and comfortable environment. Regular health and safety and maintenance chec

Melbreck provides support and accommodation for a maximum of 26 people who have profound physical and learning disabilities. People have varied communication needs and abilities due to their complex needs. At the time of our inspection there were 23 people living at Melbreck.

There was no 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 had left the service in December 2016. At the time of our inspection the service was being managed by an interim manager and clinical operations manager who supported us during the inspection. We have been informed since the inspection that a new manager has been appointed.

There were insufficient staff deployed throughout the service to ensure people’s needs could be met. We observed people spent periods of time without staff interaction. Due to the high level of agency staff used people were not always supported by staff who knew there needs well. People’s nutritional needs were not always monitored to ensure they received safe care. We have made a recommendation regarding this.

There was a lack of stimulating activities available to people. People had limited access to community activities and activities within the service were repetitive. People’s rights were not always protected as the service was not consistently acting within the Mental Capacity Act 2005. Capacity assessments and best interest decisions completed were not always decision specific and Deprivation of Liberties applications did not always clearly highlight the restrictions in place.

The lack of good leadership after the departure of the registered manager had an impact across

key areas we looked at. It affected the safety of the home, how effective the home was at meeting people’s needs, and how well the home was led. Quality assurance systems were not always effective in identifying concerns and the lack of consistent leadership in the service had led to low staff morale and concerns regarding communication of changes taking place.

Staff had received safeguarding adults training and were aware of their responsibilities in protecting people. Records showed that where concerns were raised these were reported and investigated. Risks to people’s personal safety were assessed and control measures implemented to help keep them safe. Accidents and incidents were monitored and reviewed to minimise the risk of them re-occurring. The provider had developed a business continuity plan to ensure people would continue to receive safe care in the event of an emergency. Personal emergency evacuation plans were in place to guide staff in the support people would require should they need to evacuate the building.

People were supported to receive their medicines safely. Medicines were administered in line with prescription guidelines and were stored securely. Staff competency in the administration of medicines was assessed. People had access to a range of health care professionals and advice provided was followed by staff. People were provided a choice of food and drinks which was prepared in the line with the specific needs.

Staff received appropriate training, which was reflective of people’s needs, to support them in their roles. Regular staff supervisions were held to monitor staff performance. Prior to being employed staff underwent robust recruitment checks to ensure they were suitable to work in the service.

People were supported with kindness and compassion by staff who knew their needs well. However, the high use of agency staff impacted on the care people received. Staff were aware of people’s individual communication styles and supported their cultural needs. Care plans were detailed rega

This was an unannounced inspection which took place on 09 November 2015.

Melbreck provides support and accommodation for a maximum of 26 people who have profound physical and learning disabilities. People have varied communication needs and abilities. Some people are able to express themselves verbally using one or two words; others use body language to communicate their needs. The home offers single room accommodation and benefits from having on site facilities such as physiotherapy and sensory rooms. The home is registered to provide nursing care and provides both permanent and respite services to people. At the time of the inspection there were 24 people living at the home, one of whom was leaving the service on the day of our inspection after a period of respite.

During our inspection the registered manager was present. 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 committed to continuous improvement and feedback from people, whether positive or negative, was used as an opportunity for improvement. The registered manager demonstrated a good understanding of the importance of effective quality assurance systems. There were processes in place to monitor quality and understand the experiences of people who used the service. The registered manager demonstrated strong values and a desire to learn about and implement best practice throughout the service. She took responsibility for maintaining her own knowledge and shared this with staff at the home.

Staff were highly motivated and proud of the service. They said that they were fully supported by the registered manager and a programme of training and supervision that enabled them to provide a high quality service to people.

People appeared very happy and at ease in the presence of staff. Staff were aware of their responsibilities in relation to protecting people from harm and abuse.

People were supported to take control of their lives in a safe way. Risks were identified and managed that supported this. Systems were in place for continually reviewing incidents and accidents that happened within the home in order that actions were taken to reduce, where possible reoccurrence. Checks on the environment and equipment had been completed to ensure it was safe for people.

Medicines were managed safely and staff training in this area included observations of their practice to ensure medicines were given appropriately and with consideration for the person concerned.

Staff were available for people when they needed support in the home and in the community. Staff told us that they had enough time to support people in a safe and timely way. Staff recruitment records contained information that demonstrated that the provider took the necessary steps to ensure they employed people who were suitable to work at the home.

Melbreck was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS). These safeguards protect the rights of people by ensuring if there are any restrictions to their freedom and liberty these have been authorised by the local authority as being required to protect the person from harm.

People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. Records included the use of photographs and symbols which supported people's involvement and understanding in the care planning process. Capacity to make decisions had been assumed by staff unless there was a professional assessment to show otherwise. People were supported to access healthcare services and to maintain good health.

The home had suitable equipment and other adaptations to the premises had been made, which helped to meet people’s needs and promote their independence.

Positive, caring relationships had been developed with people. We observed people smiling and choosing to spend time with staff who always gave people time and attention. Staff knew what people could do for themselves and areas where support was needed. Staff appeared very dedicated and committed.

People received personalised care that was responsive to their needs. During our inspection we observed that staff supported people promptly in response to people’s body language and facial gestures. Activities were offered which included those aimed for people with complex needs. People were also supported to maintain contact with people who were important to them.

Staff understood the importance of supporting people to raise concerns who could not verbalise their concerns. Pictorial information of what to do in the event of needing to make a complaint was displayed in the home.