Archived: Melrose

Melrose is a care home providing accommodation for persons who require nursing or personal care to up to 29 people. The service provides support to people living with mental health needs. At the time of our inspection there were 17 people using the service.

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

There was a lack of effective monitoring of the quality and safety of the service. Oversight and governance of the service was not always clear and robust. The registered manager acted to quickly address the issues raised during the inspection and had a plan in place to make improvements.

We have made a recommendation about the signage used in the home. This was because signage used did not promote person-centred care for people.

People, relatives and staff were complimentary of how the service was managed and were confident that if they had any concerns they would be listened to and action taken.

There were sufficient numbers of staff to support people safely and meet their needs. However, due to recent increased workforce pressure the home had been through a difficult period of challenges in retaining and recruiting staff. People were supported with their medicines safely and to access healthcare.

The registered manager and staff had safely managed all risk associated with COVID-19.

People were supported to have maximum 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 supported this practice.

Regular meetings enabled people to provide their feedback about the service. The registered manager and staff team worked with other health and social care professionals to ensure people's needs were met and made relevant referrals when required.

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

Rating at last inspection

The last rating for this service was requires improvement (published 8 April 2021)

Why we inspected

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.

The inspection was prompted in part due to concerns we received about unsafe care people were receiving at the service. A decision was made for us to inspect to ensure people received safe care and to check monitoring systems were in place. As a result, we undertook a focused inspection to review the key questions of safe and well-led and examine those risks.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has stayed the same based on the finding from this inspection.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe and well-led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Melrose on our website at www.cqc.org.uk.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Melrose is a care home that provides personal care to people living with mental health needs. There are 29 bedrooms over two floors and at the time of the inspection, there were 21 people living there.

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

At the last inspection we identified breaches in regulation regarding the governance of the service and the safety of the environment. At this inspection we found that improvements had been made and the provider was no longer in breach of regulation. However, further improvements were still required.

The monitoring systems in place did not identify the concerns we highlighted during the inspection and not all policies and procedures were up to date. The registered manager acted to quickly address the issues raised during the inspection.

Most people’s care files included assessments of risks each person faced. However, additional risk assessments were required for one person, to ensure all risks could be mitigated effectively. The environment was warm and safely maintained and personal emergency evacuation plans were in place to ensure people could be safely supported to leave the home in the event of an emergency.

Staff had completed infection control training, had access to adequate supplies of personal protective equipment (PPE) and a COVID-19 testing programme was in place. Appropriate bins were not in place to ensure PPE could be disposed of safely, but this was addressed by the second day of the inspection. Increased cleaning schedules had been developed and the home appeared clean.

There were sufficient numbers of safely recruited staff available to support people. People and their relatives told us Melrose was a safe place to live. Staff had completed safeguarding training and understood their responsibilities regarding reporting any concerns. Medicines were administered by staff who had completed training and had their competency assessed.

The registered manager was aware of events and incidents that needed to be notified to CQC and ratings from the previous inspection were displayed within the home and on the providers website as required. Feedback from people and their relatives regarding the service provided was positive. Regular meetings enabled people to provide their feedback. The registered manager and staff team worked with other health professionals to ensure people's needs were met and made relevant referrals when required.

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

Rating at last inspection (and update)

The last rating for this service was requires improvement (published 8 January 2020). At that inspection we identified breaches of regulation regarding safe care and treatment and the governance of the service. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

As part of CQC’s response to the coronavirus pandemic we are looking at the preparedness of care homes in relation to infection prevention and control. This was initially a targeted inspection looking at the infection control and prevention measures the provider had in place. We inspected and found there was a concern with infection control practices, so we widened the scope of the inspection to become a focused inspection which included the key questions of safe and well-led.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service remained requires improvement. This service has been rated requires improvement for five consecutive inspections.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

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

On the first day of inspection we found that the environment was not always safely maintained. The heating was not working in some parts of the home and people told us they were cold. Changes made to the smoking area had left a door to the home unsecure. These issues were raised with the registered manager and on the second day of the inspection, we found that they had been addressed. People were supported by a sufficient number of staff who had been safely recruited and were knowledgeable about safeguarding procedures. People told us they received their medicines when they needed them.

Staff had been assigned training to help ensure they had the knowledge to support people effectively, although this had not all been completed. People told us it could be a long time from tea until breakfast the following morning. We discussed this with the registered manager and on the second day of the inspection, people told us toast was now regularly available at suppertime. People were supported to have maximum 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 supported this practice.

New checks had been implemented to monitor the quality and safety of the service, however they were not always effective in identifying areas of the service that required improvement. The registered manager had worked hard to address areas of concern raised at the last inspection and was responsive to feedback provided during this inspection. People knew the registered manager and told us they could raise any issue they had with them.

People told us they were treated well by staff. People were involved in decisions regarding their care and were aware of their care plans. Staff knew people and their needs well. Systems were in place to gather feedback from people and people felt able to share their views.

Care plans were in the process of being reviewed and rewritten to ensure they were detailed, accurate and person centred. New care plans reflected people’s preferences in relation to their care. People were supported to access activities in the community if required, to help prevent social isolation. No formal complaints had been received since the last inspection, but records showed they had previously been investigated and responded to.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 4 July 2019). We identified breaches of Regulations 12 (Safe care and treatment) and 17 (Good governance) at the last inspection. The provider completed an action plan to show what they would do and by when to improve. At this inspection, we found that improvements had been made, but additional concerns were identified, and the provider was still in breach of regulations.

The service remains rated requires improvement. This service has been rated requires improvement for the last six consecutive inspections. We met with the provider following the last inspection and found that although still rated as requires improvement, measures had been taken to drive forward the quality of the service in areas raised at the last inspection.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to the safety of the environment and the systems in place to monitor the quality and safety of the service at this inspection.

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

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Melrose 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. Melrose is registered to provide accommodation for up to 29 people with mental health needs. At the time of our inspection, there were 27 people living in the home.

People’s experience of using this service:

The systems in place to assess and oversee the quality and safety of the service were not effective. The checks did not cover all areas of the service, or identify all issues we highlighted during the inspection. Records were stored electronically, but the system was not organised and it was difficult to locate some required information. We had raised these concerns at the last inspection. The action plan provided after the last inspection had not all been completed and not all notifications had been submitted to the Commission about events within the home.

Risk to people and the environment, was not always assessed or managed. This meant people were at an increased risk of harm. The provider was unable to locate a certificate to evidence that the home’s electrics were safe and water temperatures were not monitored. The water temperatures were monitored during the inspection and the general manager told us following the inspection, that they had made plans for the electrical system to be re-inspected.

Medicines were administered safely, but the recording of medicines required further improvement to ensure they were accurate. We recommended that the provider updates its practices to ensure medicines were administered and recorded accurately.

Staff told us they were well supported and had completed training. However, records showed that not all staff had received necessary training to ensure they could meet people’s needs safely. We recommended that the provider reviews staff training to ensure all staff have the necessary knowledge to enable them to meet people's needs safely.

Care plans were detailed regarding people’s needs and how their mental health needs impacted on and presented in their every day lives. Further improvements were required to ensure clear guidance was available on how staff should meet people’s needs and aspirations.

People were supported by sufficient numbers of staff who had been recruited safely. People told us they felt safe in the home with the support they received. Staff were described as, “Nice people.”

People’s nutritional needs were assessed and met. The dining room had been refurbished and most people told us they enjoyed the meals available.

People were supported to have maximum 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 supported this practice. People’s consent to their care and treatment was sought and recorded in line with the law. Applications to deprive people of their liberty had been made appropriately and staff were knowledgeable about who this related to. Independence was promoted and people’s dignity was protected.

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

Rating at last inspection and update:

The last rating for this service was requires improvement (published 7 June 2018) and there were multiple breaches of regulation. The service remains rated requires improvement. This service has been rated requires improvement for the last five consecutive inspections. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection, we found that enough improvements had not been made and the provider was still in breach of some regulations.

Why we inspected:

This was a planned comprehensive inspection based on the previous rating.

Enforcement:

Please see the ‘action we have told the provider to take’ section towards the end of the report.

Follow up:

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

We undertook this inspection to look at all aspects of the service provision, check that the provider had followed their action plan, and confirm that the service now met legal requirements. We found during this inspection that improvements had been made and the breach relating to safe management of medications had been met. However, we identified further breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The overall rating for Melrose remains as requires improvement. We will review the overall rating of requires improvement at the next comprehensive inspection, where we will look at all aspects of the service and to ensure the improvements have been made and sustained.

Melrose is a ‘care home’ which is registered to provide accommodation for up to 29 adults who require support with personal care and specialises in providing support for younger adults with enduring mental health conditions. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. At the time of this inspection there were 28 people living at the service on a permanent basis and one person who was leaving the service that day after a short ‘respite’ stay.

There was a registered manager in place. 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.

During this inspection, we identified breaches of regulations. This was because the systems and processes to monitor the quality and safety of the service were not sufficiently robust to identify shortfalls in records and areas that needed improvement. Staff recruitment and appraisals records were disorganised and contained gaps and people’s daily records had not been checked . Some staff practices were task led and not person centred. At lunch time staff did not instigate any conversation with people and some interactions that did take place were not dignified or respectful.

Some of the communal areas of the service were not homely. We have made recommendations for the provider to seek advice from a reputable source with regards to current best practice for creating a homely environment.

People were involved in the assessment of their needs and plans were in place for how they wanted and needed their support to be delivered. People were free to come and go throughout the day and spend their time as they wished.

People told us they felt safe and well cared for living at Melrose. They told us staff were always available to support them if needed and that they felt able to raise concerns with them. Staff new people well and most of the time were caring and respectful in their interactions with individuals.

Robust systems were in place to ensure the safe handling of medicines. People were supported to take responsibility for their own medicines whenever possible. The service was clean and the premises and equipment were routinely checked and serviced.

Where necessary, people were supported to access advocacy services to help them express their views and opinions about their care arrangements.

Systems were in place to ensure staff were safely recruited and staff told us they received the induction, training and supervision they needed to be able to carry out their roles effectively. They told us they felt supported by management who they found approachable.

People who used the service were encouraged to participate in activities which met their interests and helped to promote their health and well-being. People were also supported to keep in contact with friends and family.

Records we reviewed showed that, where necessary, people were provided with support from staff to attend health appointments. People were also supported by staff, as far as possible, to maintain a healthy diet.

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

The service required 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 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 time of inspection the service had a manager in post who had been registered with Care Quality Commission since March 2011. The service also had a care manager and administrative staff in post.

During our inspection, we found a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This breach related to the management of medicines.

Medication was not safely managed due to lack of accuracy and completeness of recording. There were gaps on the medication administration record (MAR) sheet and liquid medications had not been dated when they had been opened, this meant that there was a possible risk of people being given out of date medication. We identified that some staff who were responsible for the administration of medications needed additional training, this was immediately rectified by the management in the home.

We identified that staff did not always follow a person’s risk assessment surrounding access to drinks. This was brought to the attention of the management and they immediately acted on the information.

Some training was still required for some staff in mental health topics as the home offered a specific mental health residential service and staff safeguarding knowledge needed updating. We discussed this with the management of the home who immediately organised additional training for staff.

Staff were recruited safely and we saw evidence that staff had been supervised regularly.

Each person living in the home had a plan of care and risk assessments in place. These were specific to them and were regularly reviewed.

The Mental Capacity Act 2005 and the associated deprivation of liberties safeguards legislation had been adhered to in the home. The provider told us that some people at the home lacked capacity and that a number of Deprivation of Liberty Safeguard (DoLS) applications had been submitted to the Local Authority in relation to people’s care. We found that in applying for these safeguards, peoples’ legal right to consent to and be involved in any decision making had been respected.

We saw that infection control standards in the home were monitored and managed appropriately. The home was clean, safe and well maintained. We saw that the provider had an infection control policy in place to minimise the spread of infection

We saw that the people living in the home knew who the registered manager was. We noted that the care manager was a visible presence in and about the home.

The home had quality assurance processes in place including audits staff meetings, quality questionnaires and residents meetings. The home also had up to date policies in place that were updated regularly and staff were informed of the updates through staff meetings and emails.

People said that they had no concerns about the home or the care that service users received, and that the staff were, 'pleasant' and that the manager was approachable. A service user said that they would recommend the service to other people.

We saw that medicines were managed safely.

People told us that there was a high turnover of staff. We saw that there were adequate numbers of staff to support people using the service but that few staff had received appropriate training to care for people with mental health needs.

We saw that provider monitored some aspects of the quality of service provision and assessed safety risks regularly.