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Melrose Requires improvement

Reports


Inspection carried out on 21 November 2019

During a routine inspection

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 25 people living there.

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

Inspection carried out on 3 June 2019

During a routine inspection

About the service:

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

Inspection carried out on 11 April 2018

During a routine inspection

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 carried out on 24 April 2017

During a routine inspection

This inspection was carried out on 24 and 27 April 2017 and was unannounced. Melrose is an ex local authority home built over two floors. It is in an area of Hoylake that is close to transport links and shops. The home is registered to accommodate up to 29 people and at the time of our inspection there were 27 people were living at the home.

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.

Inspection carried out on 07 and 10 September 2015

During an inspection to make sure that the improvements required had been made

We carried out an unannounced, comprehensive inspection of this service on 13 January 2015. Breaches of legal requirements were found. After the inspection the provider wrote to us to say what they would do to meet legal requirements in relation to consent to care and treatment, meeting nutritional needs and submitting statutory notifications.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. 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

This report covers our findings in relation to those requirements. In addition, during the inspection on 07 and 10 September 2015, we found that there were concerns relating to medication and staffing which we have included in this report.

The home required a registered manager. A registered manager is a person who is 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. Melrose had a registered manager who had been in post for several years.

At the last inspection on 13 January 2015, we asked the provider to take action to make improvements relating to consent, nutrition and hydration, and statutory notification submissions. The provider had provided us with an action plan which stated that they would achieve these requirements by 31 May 2015. We found that they had met the requirement regarding nutrition and hydration but had not met the requirements relating to consent and statutory notification submissions to the Care Quality Commission (CQC). The provider had not improved the training and understanding of the Mental Capacity Act and had not completed the necessary capacity assessments. The provider had not submitted the required statutory notifications to CQC as required as we knew there had been concerns raised by other organisations to CQC.

During the course of this inspection we found that there had been a serious medication error which had gone unnoticed. We had also been notified by whistle-blowers that there were not enough staff throughout the course of each day and night. The provider had sent us a copy of the staff rota which showed that there should be at least five staff members on duty throughout the day. However we found that this was not people's experience. We also found on the days of our inspection that there were insufficient staff on duty.

We have made a recommendation in relation to the staffing levels.

We found breaches of the Health and Social Care Act 2008, relating to consent, statutory notifications and medication administration. You can see what action we have told the provider to take at the back of the full version of this report.

Inspection carried out on 13 January 2015

During a routine inspection

This unannounced inspection took place on 13 January 2015. At our last inspection, on 16 January 2014 we had found there was a breach of Regulation 22 Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, regarding staffing numbers and training. The provider sent us an action plan to tell us that this would be addressed by 01 June 2014. We found on this inspection that the breach had been dealt with.

The home 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.

The service was registered to accommodation for 29 people and at the time of our inspection, there were 24 people resident, one of whom was there for short term respite. The people supported by the service all had mental health needs and some had additional physical needs.

The home was an ex local authority home, it was light, airy and was well laid out. There were peoples’ bedrooms throughout the home and most communal areas were on the ground floor. The home had a separate part of the top floor designed to enable people to live semi independently and for some to work towards being able to live independently in the community. This part had six bedrooms, with its own kitchen and lounge. People were able to take part in everyday tasks such as making drinks and snacks.

We found that most people felt safe and happy with the care and the staff. However, people were not given a choice about many of the aspects of their daily life such as when to have a snack. Staff were supported and trained but they were not conversant with the Mental Capacity Act (2005) or the associated Deprivation of Liberties Safeguards. The management style was not appropriate to the people being supported and the way the home was run did not allow people to live their lives freely or independently.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, which correspond to regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and we also found a breach of the Care Quality Commission (Registration) Regulations 2009. You can see what action we told the provider to take at the back of the full version the report.

Inspection carried out on 9 January 2014

During a routine inspection

We spoke to different people about this service to gain a balanced overview of what people experienced, what they thought and how they were cared for and supported. We spoke to two people resident at the service and three staff members. We spent time observing people using the service, to see how they were cared for and how staff interacted with them.

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.