Melrose Care Home

We found the following examples of good practice.

Melrose had an active and extensive activities timetable. Staff had been creative, along with the people, in thinking of ways to improve well-being and minimise isolation despite a lack of external activities and reduced visitors. This included activities linked to special occasions, for example, people learnt how to write their names in Chinese characters for Chinese New Year. The Well-being Assistant had implemented a monthly newsletter to keep people and their loved ones informed of the events in the home.

The home had installed a sealed ‘pod’ in a conservatory to enable visits to continue safely. This was accessed externally by visitors, without coming into the home and was sealed from floor to ceiling, with microphones to support communication.

Staff were wearing appropriate personal protective equipment (PPE) in line with government guidelines and there was plentiful supply seen around the home. Staff had also undertaken additional infection prevention and control training.

The home was clean and tidy. The housekeeping team were assigned to specific areas of the home to ensure all cleaning tasks were completed thoroughly.

Testing in the home was completed in line with government guidance. This was done by the same staff member each time, to allow people to build rapport with them and feel more at ease while the test was being completed.

The registered manager and relatives of people spoke positively about the team and how they had managed during the pandemic. One relative reported, “Staff have been absolutely fantastic throughout a difficult year”. Another said, “I have nothing but praise for the amazing team. I am confident my parents are in the safest place possible during this pandemic.”

Melrose Care Home is a 26 bedded home that provides nursing care and support to elderly frail people, specialising in end of life care and people with long term health conditions. At the time of inspection there were 25 people living at the home. It is also registered to provide personal care to older people in their own homes and at the time of inspection five people were being supported.

People’s experience of using this service:

The management of the service had instilled an outstanding culture of care and support. Without exception people and their relatives said that the service provided by Melrose was of an exceptionally high standard. People were extremely confident in the management of the service and spoke very highly of the dedication and enthusiasm of the provider, registered manager and team of very caring staff. They maintained their professional knowledge and commitment to people and had received awards which recognised the level of commitment and dedication by management and staff. Relatives said they would “highly recommend” Melrose to others.

A provider of another home who worked closely with Melrose told us, “The registered manager is amazing and is the pillar of Melrose, she is hands on and knows exactly what is going on in the service. She is supportive to staff and has never had a Christmas off in 20 years. Nothing is too much bother.”

People received exceptionally high-quality care that met and exceeded their needs. The management and staff team went above and beyond to ensure that people’s care and preferences met their expectations, with people’s wellbeing, independence and happiness at the heart of the service. People and their relatives said how the service was responsive to their individual needs and circumstances which gave them reassurance and peace of mind that their loved ones were well cared for. One person said, “Your individuality is respected by all staff and care is delivered with dignity.”

Activities for people were innovative and highly regarded by people and relatives. The service went the extra mile to ensure that people were involved and empowered in the planning of activities to reduce social isolation and improve well-being. One relative told us, “Carers are always looking for ways to stimulate residents through activities. My mother loved the faces of the alpacas that came in, it was a real highlight.”

End of life care was delivered with the utmost thought and compassion by staff who showed a deep sense of empathy. The service went above and beyond to ensure people had a dignified and pain free death.

People were overwhelmingly positive about the quality of the food and enjoyed socialising with each other in the dining room. Extensive thought had been given to the environment of the service to give a home from home feel. The furnishings and décor were of an especially high standard.

Staff were exceptionally competent in their roles, demonstrating deep compassion, understanding and empathy. People felt they genuinely mattered and felt important. Positive relationships were developed between staff and people and they knew each other well, with people saying they always felt respected by staff and that their privacy, confidentiality and dignity were maintained.

The service was safe, with systems and processes which ensured that any concerns were reported to appropriate authorities without delay. One visiting professional told us, “This is a safe place because it has a workforce who really want to be here. Compared to some other Care Homes it is a ’home’ as in a ‘real home’. They have fun here, they don’t want gloom and doom.”

People had access to health and social care services as needed. The staff and management team provided strong support and worked openly and professionally with external professionals which supported people to receive a coordinated and consistent service.

Rating at last inspection: Good [Last inspection report published on 22 July 2016].

Why we inspected: We completed a planned inspection based on the previous rating of Good.

Follow up: We will review the service in line with our methodology for 'Good' services.

Melrose Care Home is a 26 bedded nursing home that provides nursing care and support to older people. At the time of inspection there were 22 people living at the home. It is also registered to provide personal care to older people in their own homes. This regulated activity is included in the registration of the care home and operates from the same location. At the time of our inspection Melrose Care Home was providing a personal care service to five people.

The service has a 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.

People we spoke with told us they felt safe. They knew what to do if they felt they had been badly treated or if they wished to complain. Staff confirmed they had been trained in how to identify and report any incidents of abuse they may witness.

Any potential risks to individual people had been identified and appropriately managed. For example, people at risk of pressure wounds had received appropriate nursing care to reduce the risk of their occurrence or recurrence.

People’s medicines had been administered and managed safely.

There were sufficient numbers of staff on duty with the necessary skills and experience to meet people’s needs. Where people received personal care at home, the service had systems in place to allocate calls and to ensure consistency of staffing so that the staff visiting people understood their needs and knew how they liked to be supported.

Staff supported people to prepare meals and to eat and drink if required. They ensured people at risk of malnutrition received adequate nutrition and hydration.

The registered manager and staff understood their role in relation to the Mental Capacity Act 2005 (MCA) and how the Deprivation of Liberty Safeguards (DoLS) should be put into practice. 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. We were informed that, currently, two people lacked capacity to make decisions for themselves. Appropriate steps had been taken to ensure decisions made on their behalf were in their best interests. No one required a DoLS to be put in place to protect their rights.

People were provided with support to access health care services in order to meet their needs.

Positive, caring relationships had been developed with staff to ensure people received the support they needed. They were encouraged to express their views and to be actively involved in making decisions about the support they received to maintain the lifestyle they have chosen.

Melrose Care Home had achieved a nationally recognised accreditation in end of life care through the Gold Standards Framework and has also been awarding the GSF Beacon Status in 2012 and 2015 which recognised their sustained good practice in this area of care. In 2015 they achieved the GSF Care Home of the Year award which was given in recognition of their commitment to providing high quality of end of life care.

The culture of the service was open, transparent and supportive. People and their relatives were encouraged to express their views and make suggestions so they may be used by the provider to make improvements.

People who lived there told us they were 'very happy here' and one said 'it is a home from home.' They told us how much they enjoyed the food describing the meals as 'wonderful' and telling us they had plenty of choices available.

People told us they were included in decisions regarding how they were supported and assisted. They were also given the opportunity to be involved in changes in the home, such as d'cor in the lounge.

We saw people had their healthcare needs assessed and met by the staff in the home and, when appropriate, other health professionals. Risks to peoples' health, safety and welfare were assessed and measures were taken to reduce identified risks.

Staff understood their responsibilities with regard to safeguarding people from abuse and were aware of the actions to take should they have any concerns.

We found that staff were only employed to work at the home following the necessary checks to ensure they were fit to do so. People told us the staff were 'wonderful' and 'very helpful'. One relative said 'I can't speak highly enough of the staff, nothing is too much trouble.'

One resident we spoke to told us that 'I have all I want, I have been looked after so well and I am extremely happy.' Another resident told us 'the atmosphere is friendly, small and cosy."

We found that there were regular activities at the home, that residents enjoyed, were involved in resident's committee meetings with changes made on feedback from the residents.

We found that the home was well maintained, decorated brightly with pictures and ornaments with a well maintained garden. It was clean and tidy, free from odours and dust and residents were protected from the risk of infection because appropriate guidance had been followed.

We found that residents were cared for by staff that were appropriately qualified, trained, mentored and supervised, had regular team meetings and encouraged to undertake extra qualifications and training.

We found that residents were protected against the risks associated with medicines because there were appropriate arrangements for obtaining, recording, handling, using, safe keeping, dispensing, safe administration and disposal of medicines at Melrose Care Home.

We found there were robust systems in place to obtain feedback on the service, to monitor the quality of service and to respond where improvements were needed.