Archived: Melrose Residential Home

Melrose residential care home is a care home supporting up to 26 older people over the age of 65. Some people living at the home have physical disabilities and some are living with dementia. At the time of the inspection there were 5 people living in the home who were supported with their personal care needs. The building has two floors, with sub floors. Stairs, a lift and two stair lifts give access to each floor. At the time of the inspection the lift was out of operation and people all lived in rooms on the ground floor. There is a kitchen, lounge and dining room to the ground floor and laundry in the basement.

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

Accidents were not always safely managed, and people did not always receive their medicines as prescribed. Fire safety remained a concern with inconsistent testing of equipment and an evacuation plan that could not be implemented with the available staff on site. We had ongoing concerns with the environment and equipment including an inoperable lift and no working extraction fan in the kitchen. Infection prevention and control measures had improved, and the home was clean.

The developing governance system did not address concerns identified by the inspection team. Policies recently purchased were yet to be rolled out across the service.

This was a targeted inspection to review specific areas identified in the ongoing monitoring of provisions at the service. Based on our inspection we found some areas of concern had been addressed but further work was required to address previous issues identified.

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 inadequate (22 March 2022). The provider sent a report to CQC about the action they had taken to meet regulations and assure the commission, suggested enforcement action was not required. At this inspection we found improvements had not been consistently made and the provider remained in breach of some regulations.

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.

We undertook this targeted inspection to check action had been taken to address concerns in relation to regulations 12, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We use targeted inspections to follow up on concerns and assure ourselves action has been taken to keep people safe. They do not look at an entire key question, only the part of the key question we are specifically concerned about. 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 not changed from inadequate based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led key sections of this full report.

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

Enforcement and Recommendations

We found the provider had not taken the action we were assured they would, to address breaches in the regulations. We have identified continued breaches in relation to medicines management, risk, and governance at this inspection. The numbers of people living in the home had reduced significantly, following the cancellation of the Local Authority's commissioning contract, as such staffing in place was considered adequate and no longer in breach. Following the last inspection we issued a Notice of Decision to vary a condition to the providers registration to remove the location at Melrose residential care home, Leyland. The provider had submitted an appeal to this decision. This inspection was completed to determine if we required to attend tribunal to remove the condition from the provider's registration. We still had concerns and made the decision to continue with the previously agreed enforcement action. Prior to attendance at tribunal the provider revoked their appeal and agreed to the Notice of Decision. The provider's registration will be varied and the location at Melrose residential care home, Leyland will be removed. Once completed the provider will no longer be able to provide the regulated activity at the location until a new registration is applied for and agreed with the Care Quality Commission.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions of their registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it, and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Melrose residential care home is a care home supporting up to 26 older people over the age of 65. Some people living at the home have physical disabilities and some are living with dementia. At the time of the inspection there were 17 people living in the home who were supported with their personal care needs. The building has two floors, with sub floors. Stairs, a lift and two stair lifts give access to each floor. There is a kitchen, lounge and dining room to the ground floor and laundry in the basement.

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

People did not always receive their medicines safely or as prescribed and action to protect people from health associated risks was not always effectively taken. The provider did not ensure there was an effective system of audit and oversight to ensure issues and concerns were either identified or addressed.

This was a targeted inspection to review specific areas identified at the previous inspection. Based on our inspection we found some areas of concern had been addressed but further work was required to address previous issues identified.

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 inadequate (22 March 2022). The provider sent a report to CQC about the action they had taken to meet regulations and assure the commission, suggested enforcement action was not required. At this inspection we found improvements had not been consistently made and the provider remained in breach of some regulations.

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.

We use targeted inspections to follow up on concerns and assure ourselves action has been taken to keep people safe. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

We undertook this targeted inspection to check action had been taken to address concerns in relation to regulation 9, 12, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The overall rating for the service has not changed following this targeted inspection and remains inadequate. Not all aspects of the breach to regulation 9 were reviewed as part of this inspection as the focus was targeted to visiting arrangements.

We have found evidence that the provider needs to make improvements. Please see the safe and well led key sections of this full report.

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

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified continued breaches in relation to medicines management, risk, infection control, staffing and governance at this inspection. Following the last inspection we issued a Notice of Proposal to vary a condition to the providers registration to remove the location at Melrose residential care home, Leyland. This inspection was completed to ensure improvements had been made. We still had concerns and made the decision to continue with the previously agreed enforcement action.

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 continue to monitor information we receive about the service, which will help inform when we next inspect.

Special Measures:

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures

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

There was not enough competent staff deployed effectively to meet people’s needs and staff had not always been safely recruited. The home was not cleaned to a suitable standard to minimise the risk and spread of infection and staff were not routinely following safe practice guidelines to reduce this risk. This included poor use of personal protective equipment and ineffective monitoring and auditing of the environment. Where risk was identified, it was not managed in a timely or effective way, this included where people had an accident or required additional support to keep them safe. Medicines were not managed effectively. There was not the information needed to show when people may need particular medicines and records were not kept in line with best practice.

Guidance supplied to ensure people’s human right to family life was protected, was not followed or implemented by the provider, despite clear prompts from the regulator of the requirement to provide better visiting arrangements for families and loved ones. Audits were not completed effectively to identify concerns and ensure people’s needs were met. Whilst we saw some examples of involvement in how people received their care, recent feedback did not confirm this had continued during the pandemic. Previous enforcement action taken by the CQC to ensure action was taken to improve services had not been addressed and concerns continued to impact on the quality of care received by people living in the home.

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 inadequate (published 06/05/2021). This focused inspection reviewed the key questions of safe and well led only. 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 remained inadequate based on the findings of this inspection

Why we inspected

We undertook a targeted inspection to follow up on specific concerns which we had received about the service. The inspection was prompted in part due to concerns received about the deployment of staff and the management of risk, including infection control. A decision was made for us to inspect and examine those risks.

We inspected and found there was a concern with a lack of general improvement from the last inspection and ongoing breaches to the regulations were found in relation to risk management, staffing and person-centred care, including concerns about visiting restrictions. We widened the scope of the inspection to become a focused inspection which included the key questions of safe and well led. This inspection also followed up on action we told the provider to take at the last inspection.

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.

We have found evidence that the provider needs to make improvements. Please see the safe and well led section of this full report.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to the safe management of medicines, assessment and management of risk including, infection control, fire safety and people’s welfare. We have also identified breaches in how staff are recruited and deployed to meet people’s needs and concerns on how the service provided to people is monitored and overseen. We have issued a recommendation to ensure restrictive practice is assessed and implemented lawfully.

Due to concerns found at this inspection, we issued a Notice of Proposal to vary a condition to the providers registration to remove the location at Melrose residential care home, Leyland.

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.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Melrose Residential Home (Melrose) is a care home and is located in a residential area of Leyland. It is registered to accommodate up to 26 adults who need support with personal care, including those who are living with dementia. At the time of our inspection there were 16 people living at the home.

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

People were at risk of avoidable harm because they were not always supported by staff with the skills, knowledge or experience to keep them safe. Plans of care were not always reflective of people’s needs, one person did not have a care plan or risk assessments in place and professional support had not been sought for another person. Staff had not received appropriate training and were not fully aware of people’s needs. This exposed people to potential risks of incorrect or inappropriate care and support being delivered.

We recommend the provider ensures healthcare advice is sought as necessary and staff work with other agencies to provide the care and support people need.

We requested a range of information from the provider and senior staff on several occasions, but this was not received. Several incidents within the home which had resulted in harm had not been adequately managed or escalated in line with safeguarding and duty of candour processes. We shared this with the local authority safeguarding team. The provider had failed to submit notifications of these incidents to CQC, which they are required to do.

We found the premises to be poorly maintained. However, the provider informed us of imminent plans to make structural changes to the premises in order to enhance the environment for those who live at the home.

We made a recommendation in relation to the provider continuing with plans to improve the environment for those who live at the home.

Risks were identified in relation to fire safety. We requested a visit by Lancashire Fire and Rescue Service, who served an enforcement notice because people who lived at the home were at risk of harm.

The standard of cleanliness throughout the environment was poor and processes were not in place to protect people from Covid-19 or other infectious diseases. This placed people at the risk of harm. The laundry department was dirty and not fit for purpose.

Systems were either not in place or were not effective enough to support the safe management of medicines. Staff were not always suitably qualified and competent to administer medicines safely. This placed service users at risk of harm from unsafe practices in relation to the management of medicines.

Recruitment practices adopted by the home were not robust. New staff had not been thoroughly checked prior to employment commencing. This meant staff were not deemed fit to support the vulnerable people who lived at Melrose.

There was no evidence available of meaningful activities taking place and people's needs and choices were not always assessed to ensure effective care, treatment and support was delivered in line with current legislation, standards and evidence-based guidance.

We have made a recommendation about improving stimulation for those who live at Melrose, particularly during the pandemic when visitors and external entertainers are not able to access the home and when isolation and boredom could be experienced.

Staff helped people in the least restrictive way possible. However, they were not always supported to have maximum choice and control of their lives.

We have made a recommendation about improving how the Mental Capacity Act is complied with. The provider needs to ensure progress continues to be made to identify areas in which people lack capacity to make particular decisions, so that people’s needs are accurately reflected and decisions are made in their best interests.

People had always been involved in planning their own care and support to enable them to make decisions about how they wished to be supported. Relatives told us they had not been involved in making decisions about their loved ones care.

We recommend the provider ensures people are able to express their views and make decisions about their own care and support.

The complaints process was being managed by the new manager However, there was no clear audit trail to show past complaints had been appropriately managed.

We made a recommendation for the provider to review best practice in the management of complaints and to include the use of technology to enhance the process for people in the home and their relatives.

People were not offered choice at mealtimes and were not adequately supported.

We have made a recommendation about the mealtime service.

The home was not being well-led. Systems were not in place to assess and monitor the quality of service provided. Relatives told us they were concerned about the recent high turnover of staff and the regular change of managers. They also said communication from the home was poor, particularly during lockdown and they were not kept up to date about the health and welfare of their loved ones.

We did observe people being treated with kindness and compassion. We saw some good interactions by staff and people were assisted in a gentle and respectful manner. Some relatives spoke positively about the care provided. One family member told us, "The staff are lovely and very caring, but the home could do with some refurbishment, although I understand this is in the pipeline.”

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

This service was registered with us on 14/05/2019 and this is the first inspection.

The last rating for the service under the previous provider was inadequate, published on 20 December 2018.

Why we inspected

The inspection was prompted in part due to concerns received about care planning, the premises, staffing levels, medicines management, falls and management of the service. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. However, we identified other concerns during our inspection and therefore a decision was made for us to inspect all five key questions.

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 coronavirus and other infection outbreaks effectively.

We have found evidence that the provider needs to make improvements. Please see the Safe, Effective, Caring, Responsive and Well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

Since our inspection the provider has appointed a consultant, who is managing the home on a day to day basis. Care plans and risk assessments were being updated to ensure people’s needs were being met. Systems and processes were being introduced to assess and monitor the quality and safety of the service provided. The provider had produced an action plan and was showing willingness to work with other health and social care professionals in order to raise standards within the home. This action had mitigated the more serious risks to people’s health, safety and welfare.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to fire safety, infection control, care planning, recruitment, reporting of incidents, management of medicines, safeguarding people, assessing and monitoring of the service at this inspection.

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 for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.