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We are carrying out a review of quality at Melrose. We will publish a report when our review is complete. Find out more about our inspection reports.

Inspection Summary


Overall summary & rating

Requires improvement

Updated 9 June 2018

We inspected Melrose on 11 April 2018 and the inspection was unannounced. We previously carried out a comprehensive inspection of the service on 24 April 2017. We found the provider was in breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because we identified concerns in relation to the management of medicines which the provider had not identified and the service received an overall rating of ‘requires improvement’. After that inspection, the provider wrote to us to describe what action they would take to meet the legal requirements.

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

Inspection areas

Safe

Requires improvement

Updated 9 June 2018

The service was not consistently safe.

Staff had been recruited safely but staff personnel files were disorganised and did not all contain the required information.

Incidents of potential abuse had been acted on and reported appropriately.

There were sufficient numbers of staff on duty to meet people's needs.

The premises and equipment were safe, clean and hygienic.

Effective

Requires improvement

Updated 9 June 2018

The service was not consistently effective.

Staff received the training they needed to undertake their roles but had not always received documented supervision or an annual appraisal of their performance.

Parts of the service were not homely. We have made a recommendation in relation to providing a homely environment.

People enjoyed the home cooked meals provided and their dietary needs were catered for.

Staff gained people's consent before delivering care and worked within the principles of the Mental Capacity Act (MCA).

Caring

Requires improvement

Updated 9 June 2018

The service was not consistently caring.

Some practices were outdated and institutional. Staff interactions with people were not always dignified and respectful and people's choice was not always promoted. We have made a recommendation in relation to these issues.

Staff knew people well and people felt cared for.

Information about people was stored securely.

Responsive

Good

Updated 9 June 2018

The service was responsive.

People's needs had been appropriately assessed and planned for.

Staff monitored people's well-being and responded to any changes in their condition,

People felt able to raise concerns and complaints were managed well.

Well-led

Requires improvement

Updated 9 June 2018

The service was not consistently well-led.

Quality assurance systems in the service had not been sufficiently robust to identify the shortfalls found during the inspection.

Staff enjoyed working in the service and felt well supported by their colleagues and management.

The management and staff worked well with other stakeholders involved in people's care.