Melrose Court Rest Home Limited - 74 Cambridge Road

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

At this inspection we found the service remained Good.

Everyone who lived in the home said they felt safe. There were robust measures in place to ensure people were safe. Risk assessments were in place for areas such as pressure care, safe environment, falls and mobility, and nutrition and hydration.

There were sufficient staff on duty to meet people's needs. Staff rotas showed a consistent number of staff were on duty each day. People told us call bells were answered within a reasonable time.

Staff had been appropriately recruited to ensure they were suitable to work with vulnerable adults. We found that staff had the skills, knowledge and experience to support people effectively and safely. Staff were supported by the home manager through regular supervisions, annual appraisal and regular training. Staff had attended training in subjects such as first aid, fire safety, food safety, moving and handling, infection control, safeguarding and medication. New staff were required to complete an induction. Staff meetings were held regularly.

Medicines were managed safely and people received their medicines as prescribed. Staff had been trained to administer medicines to ensure errors were kept to a minimum.

The home was very clean and there were no odours. The home was well maintained and in good decorative order. People's bedrooms were personalised and were decorated and furnished to a high standard.

Regular checks and tests, such as gas, electricity, water safety, fire drills, fire alarm tests and external checks of firefighting equipment, were completed to maintain safety in the home.

People's needs were assessed and reviewed regularly to reflect their current health and support needs. People were supported to maintain healthy lives; records showed that people were supported to attend medical appointments.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. We saw clear evidence of staff working effectively to deliver positive outcomes for people.

People were supported to eat and drink enough to maintain a balanced diet and meet their dietary requirements. Drinks were offered throughout the day to ensure people's hydration needs were met. Staff understood people's individual nutrition and hydration needs and we saw that meals were provided accordingly.

Everyone living in the home was very complementary about the attitude of the staff and the way they were treated. Staff showed kindness towards the people in the home. It was clear from the banter and laughter that people were comfortable with staff and enjoyed their support.

Staff supported people to make decisions about their care, support and treatment. Staff showed a good understanding of people's likes and dislikes and preferred routines. This information was recorded in people's care records.

People and their family members were involved in the planning of their care and family members kept up to date with matters relating to their relative's health and welfare.

There was a complaints policy in place, which was displayed in the home. No complaints had been made since the last inspection.

Activities were planned each day and took place each morning and afternoon.

Quality assurance audits were completed by the registered manager and senior care staff which included, medication and health and safety.

People living in the home met each month with their key workers to provide any feedback about the home and any issues they had. There was a process completed annually where their relatives had the opportunity to voice their opinions about the service.

There was a caring, person-centred, and open culture in the home. The registered manager and registered provider met their legal requirements with the Care Quality Commission (CQC). They had submitted notifications and the ratings from the last inspection were clearly displayed in the home and on their website.

Further information is in the detailed findings below.

Melrose Court is a residential care home for up to 21 people. It is situated lose to the centre of Southport which can be accessed via nearby public transport. Accommodation is provided over three floors. At the time of the inspection 18 people were living at the home.

A registered manager was 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 people that we spoke with and their relatives told us that care was delivered safely. People understood what action to take if they were unhappy with the quality of care. Staff knew how to recognise abuse and neglect and understood what action to take if they had concerns.

Accidents and incidents were accurately recorded and were subject to assessment to identify patterns and triggers.

Risks were clearly identified within care records and appropriate measures were in place to reduce risk without imposing undue restrictions. Information about individual risks to people’s safety was displayed in a staff room.

The provider regularly completed a number of safety checks and made use of external contractors where required. Checks included; gas safety, electrical safety, water temperatures and general health and safety. Each of the checks had been completed in accordance with the relevant schedule. We saw evidence that prompt action had been taken were issues had been identified.

Staff were recruited safely following a robust procedure. Staffing numbers were sufficient to safely meet the needs of people living at the home.

People’s medication was stored and administered in accordance with good practice. We spot-checked Medicine Administration Record (MAR) sheets and stock levels. Each of the MAR sheets had been completed correctly. Stock levels tallied with the figures recorded on the MAR sheets.

Staff were suitably trained and skilled to meet the needs of people living at the home. The staff we spoke with confirmed that they felt equipped for their role. People living at the home and their relatives told us that they had no concerns about staff knowledge or skills.

The records that we saw showed that the home was operating in accordance with the principles of the MCA. Applications to deprive people of their liberty had been submitted appropriately.

Meals were freshly prepared and served in a well presented dining room. People gave us positive views on the quality of the food. We saw people being offered hot and cold drinks throughout the course of the inspection.

People were supported to maintain good health and to access healthcare services by staff. Most of the people that we spoke with had a good understanding of their healthcare needs and were able to contribute to care planning in this area.

Each of the people that we spoke with were extremely positive about the attitude and approach of the care staff and the registered manager. We saw that relatives were encouraged to stay for as long as they liked and were offered food and drinks during their visits.

Throughout the inspection we saw staff engaging with people in a positive and caring manner. Staff spoke to people in a respectful way and used language, pace and tone that was appropriate for the individual.

Each person who came to live at the home had been given a welcome pack which included; a statement of purpose (important information about the home and its services), a copy of the complaints procedure, information about the staff team and guidance on safety in the home.

All of the people living at the home that we spoke with told us they received care that was personalised to meet their needs. We saw evidence in care records that people’s preferences were recorded. Person-centred language was used throughout care records and people’s life histories were recorded to give staff a better understanding of each individual. The use of person-centred language indicated that the home understood and focused on the care needs of each individual. Some relatives had been involved in the development of these records.

The home had a programme of activities including games, exercises and entertainers. We saw that the home maintained a good stock of books, games and craft materials to support activities.

People’s views about the quality of the home and the care provided were sought during reviews of care, through the regular distribution of surveys and informally through conversation. The recent surveys that we saw recorded high levels of satisfaction from each of the respondents.

Information regarding compliments and complaints was displayed in the reception area. The home had not received a formal complaint in the previous 12 months.

We spoke extensively with the registered manager throughout the inspection. It was clear that they knew each person living at the home and their care needs well. The registered manager demonstrated an awareness of the day-to day culture of the home and provided practical care and support as required. People spoke positively about the registered manager, their approachability, leadership of the home and the quality of communication.

Staff understood what was expected of them and were motivated to provide good quality care. We saw that staff were relaxed, positive and encouraging in their approach to people throughout the inspection.

The registered manager had robust systems in place to monitor safety and quality. They completed regular audits which included information that was fed-back to the staff team.

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well led?

This is a summary of what we found -

Is the service safe?

People using services were cared for in an environment that was safe, clean and hygienic. We observed evidence that all equipment at the rest home, for example, hoists and lifts had been serviced and maintained regularly.

There was an adequate number of staff members on duty at all times, which included a senior member of staff. The owner told us they were also on call in case of any emergencies. This meant all people using services were kept safe at all times.

Deprivation of Liberty Safeguards (DoLS) become important when a person is judged to lack the capacity to make an informed decision related to their care and treatment. The provider told us no applications for DoLS had been made but knew the procedure to be followed if an application needed to be made. One person who had recently been admitted to the rest home was being continually observed in case a DoLS application was necessary.

Is the service effective?

During our inspection, we spoke to several people using services and also family members/carers. No concerns were expressed by people we spoke to. People told us they were happy with the care and support they received.

From observations we made, it was clear staff members had the skills and knowledge that met the individual needs of all people using services. One person told us, "We are all very happy here - we are well looked after." Staff members had received appropriate training which provided them with the required skills to care and support people who used services.

Is the service caring?

We spent time in communal areas and saw people being supported by staff members in a patient, caring and unhurried manner. Care and support was provided in accordance with the wishes of people as recorded within their individual care plans.

People using services and their relatives had completed an annual satisfaction survey. We noted a high level of satisfaction had been recorded for both surveys and any issues that had been raised had been addressed.

Is the service responsive?

All people using services had undergone a pre-admission assessment and we saw that they and their families had been involved in writing up their care plans. Care was delivered in line with the choices and preferences which had been expressed by the person at the time of the assessment.

People had access to activities at the rest home and around the local community. One person had gone out with her friends for the day. People using services took part in a quiz during the morning and in the afternoon, the Salvation Army attended and sang several songs which people joined in with. People were also supported and encouraged to attend church services of their choice which helped meet their spiritual needs.

Is the service well-led?

We saw evidence of a multi-agency approach to providing care at Melrose Court Rest Home. All professional visits had been recorded within people`s care plans. The provider told us they had a good relationship with other professional agencies and were told, "When we need to call them out they usually attend very quickly."

The provider showed us evidence of regular internal and external audits which were aimed at improving the quality of service being provided to people using services. We saw that if any issues had been identified during the auditing process, an action plan was implemented and all issues had been addressed. Staff members were aware of their roles and responsibilities which meant people using services received good quality care at all times.

The provider had sent us an action plan outlining how they would become compliant and meet regulations. We carried out this inspection to check improvements had been made.

We found that where people did not have the mental capacity to consent to their care the provider was able to demonstrate they had put assessments and systems in place so that people's rights were maintained and the provider was acting within legal requirements and good practice.

We looked at medicine administration and safety and found the provider now had systems in place to ensure safe standards.

People told us they were happy with the care and support they received. Their comments included, ' It's lovely here ' I am well looked after.' 'The staff are very good and are on hand to help me with my care when I need it.' ' I feel this is my home. I go out regularly and come and go as I please.'

We found staff ensured good referral and access to health care professionals so people's right to ongoing health care was maintained. We found that people were not fully protected against the risks associated with medicines and there were some improvements needed to ensure standards are maintained.

We looked at staffing and saw there were enough staff to carry out care for people. People we spoke with said that staff were supportive and competent.

People we spoke with said could make their views known if they were not happy with the service provided. There were systems in place to help ensure the quality of care was monitored and safety standards were maintained.