Melrose House

We found the following examples of good practice.

The home had comprehensive policies and procedures to manage any risks associated with the COVID-19 pandemic. This included the management of people with a COVID-19 positive diagnosis. The policies and procedures were updated regularly following any changes in national guidance.

People living in the home and their relatives were supported to maintain contact.

A programme of regular COVID-19 testing for both people in the home, staff, essential carers and visitors to the home was implemented. All visitors, including professionals were subject to a range of screening procedures, including showing evidence of vaccination and a negative lateral flow test before entry into the home was allowed.

There was an ample supply of PPE for staff and any visitors to use. Hand sanitiser was readily available throughout the service. Staff had received updated training on the use of PPE and we observed staff wearing it correctly during out inspection. Clear signage and information was in place throughout the home to remind staff of their responsibilities.

Daily cleaning schedules were implemented by housekeepers and all staff were involved in undertaking touch point cleaning.

Melrose House is a care home providing accommodation and personal care for up to 10 people living with a mental health condition, learning disabilities and/or autism in one building. At the time of inspection, the home was fully occupied. In addition to this care home, the service also provides a domiciliary care service to older people living in their own homes. At the time of inspection, the service was supporting 45 people in their own home.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

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

People told us they liked living at the home and the care people received in their own home was of a good standard. Feedback from relatives was very positive regarding the level of care and support people received.

People told us they received safe care. Appropriate environmental and personal risk assessments were in place to keep people safe, whilst supporting people to maintain as much independence as possible. Medicines were handled safely both in the home and out in the community, and staff had received appropriate training in this area. The provider continued to have a robust staff recruitment in place.

People’s needs were fully assessed prior to living in the home or receiving care in their own home. Staff received training to support them in their role. However, some training was out of date for some staff employed within the care home. We have made a recommendation about this.

Staff told us they felt supported by the registered manager. They described them as open and approachable. Staff felt the registered manager welcomed their feedback.

People were supported to maintain a varied, healthy and balanced diet. They had a choice in what food was prepared for them. People receiving care in their own homes told us staff prepared meals the way they wanted. Where necessary, staff quickly referred people to healthcare professionals to support their health and well-being as well as supporting people (if needed), to attend any healthcare appointments.

Without exception, people and relatives told us staff supported them in a very caring way. They also told us they felt comfortable talking to staff and staff listened to them if they had any concerns.

People were encouraged and supported to form and maintain friendships as well as engaging in various activities within the home. Where people received care in their own home, staff supported people with social time activities. Staff also supported people to achieve their own personal goals. For example, one person was now confident to be able to access the community on their own and meeting friends for coffee.

The registered manager welcomed feedback through various sources. They sent out questionnaires to gather people’s opinions. This feedback was used to further improve the level of care and support provided. The registered manager carried out a range of monthly quality checks across all aspects of care and service provided.

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. Some care plans did not include details regarding people’s end of life wishes.

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 good (published 13 March 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

We carried out an unannounced comprehensive inspection of the service on 18 January 2017. At a previous comprehensive inspection carried out in January 2016, we identified five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, namely, person centred care, safe care and treatment, premises, staffing and good governance. However, following a focussed inspection conducted in July 2016, we found the provider had implemented improvements in order to meet these legal requirements. We did not change the rating of the service at that time because we wanted to be sure the provider achieved sustained compliance with relevant regulations.

There was a registered manager in post who had been employed at the service since February 2016 and registered with the Care Quality Commission (CQC) to manage the carrying on of the regulated activity since June 2016. A registered manager is a person who has registered with CQC 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 we spoke with had lived at Melrose House for many years. They told us they felt the safest they had ever been. Established safeguarding procedures were in place and the registered manager ensured all of the staff were aware of their responsibilities with regards to recognising and reporting any suspicion of people being exposed to harm or abuse.

Individual risk assessments were in place to assist staff to support people in the safest possible way. Actions which staff could take to mitigate risks were clearly documented. Accidents and incidents continued to be recorded, monitored and reported to the local authority and CQC as necessary.

The registered manager ensured the premises were safe. Essential safety tests of the electricity, gas and water utilities had all been undertaken and were monitored for renewal dates. A handyman completed daily, weekly and monthly checks on the premises to ensure it was safe and well maintained. Equipment used to help people mobilise around the property was serviced as required.

Personal emergency evacuation plans were in place and regularly updated to ensure the service held a current record of the support people would need to evacuate the building in an emergency.

Staff recruitment was robust and the registered manager ensured pre-employment vetting checks were in place before employees commenced in their roles. Staff were monitored for their competence and suitability throughout a probationary period and were closely supervised until the registered manager was satisfied with their performance. There were enough staff employed at the service to meet people’s needs. Staff confirmed they had enough time to complete their duties and people told us the staff were available whenever they needed them day or night.

Medicines were managed safely. We observed staff safely administered medicines to several people during our visit. Procedures were in place to ensure medicines were ordered, stored, administered and recorded in line with best practice guidance.

The registered manager had placed a high priority on infection control and we saw that initial improvements to reduce the risk of cross infection had continued. The premises were exceptionally clean and tidy. Staff followed best practice guidelines in relation to the control of infection.

Staff were inducted into the service and trained in topics which were relevant to their job. The registered manager had sourced external training to enhance staff’s skills and knowledge. The registered manager and a senior support worker completed competency checks on staff to ensure they continued to be fit for their role.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) including the Deprivation of Liberty Safeguards (DoLS), and to report on what we find. The registered manager told us that nobody living at Melrose House had any restrictions placed on their liberty in line with the Mental Capacity Act 2005.

People were supported by staff to eat well and they were encouraged to consume a balanced diet. Staff prepared a choice of meals from a menu and alternatives were available. Some people helped themselves to food and drinks as they wished.

The property had been adapted to suit the abilities of the people who lived there. Improvements which had been made in this aspect of the service continued to be appropriate for people’s needs.

People told us the registered manager was extremely caring and had been heavily involved with their care. People were very impressed with the registered manager and the support staff. We observed all staff were kind and considerate of people’s capabilities. We saw staff treated people with respect and ensured their privacy and dignity were maintained. All staff were friendly and professional throughout our visit.

Records showed and people confirmed that they had been involved in devising their care plans and they had shared information about themselves in order to help the staff get to know them better. Their likes, dislikes, preference and routines were documented within their care records.

Staff had acted as an advocate for people if it was identified that they needed support and they agreed. Some people also had relatives and/or an independent advocate to support them in decision making with certain matters.

The provider had recently invested in a software system to develop electronic care records. Paper care records were still in use while the registered manager fully integrated all of the information held in the paper files into the electronic system. Since our last inspection the registered manager had made links with other similar local services to seek guidance on best practice care planning. The care records were now detailed and person-centred. They contained thorough assessments of people’s needs, personalised care plans and individual risk assessments.

People accessed the community as they wished and mostly made their own arrangements regarding activities. There were communal activities available for people to access within the home and staff had organised parties, theme nights and celebrations to reduce social isolation.

There had been no complaints since our last inspection and during our visit nobody raised any concerns with us. The feedback we received from external professionals was positive.

Detailed audits to monitor cleanliness, infection control, maintenance, medicines and finances continued to be completed and these were regularly monitored. Staff meetings and ‘house’ meetings were held to ensure everyone was happy with the improvements and changes made throughout the service.

Everyone spoke highly of the registered manager. The improvements she had made throughout the service continued to be recognised by people who used the service, their relatives and visitors. It was apparent that the registered manager and the provider had invested a lot of time and effort into addressing the previous issues and were committed to ensuring Melrose House was a safe place for people to live.

We were reassured that the improvements identified to address the safety and quality of the service had been sustained.

We carried out an unannounced comprehensive inspection of this service on 3 and 4 October 2015. Breaches of legal requirements were found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to person centred care, safe care and treatment, premises, staffing and good governance.

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 House on our website at www.cqc.org.uk

The new manager of the service was registered with the Care Quality Commission. A registered manager is a person who has registered with CQC 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 told us they felt safe living at Melrose House with the support of the staff. Safeguarding procedures were now in place and the manager ensured staff were aware of their responsibilities. Accidents and incidents were recorded, monitored and reported as necessary to the local authority and CQC.

A previous ‘house rule’ which restricted people’s freedom had been immediately removed following the last inspection and people were able to choose what time they went to bed at night.

Improvements had been made in infection control. Deep cleaning had taken place, staff training had been provided by the local NHS infection control and prevention team and one support worker had been given the responsibility of cleaning and maintaining communal areas.

The manager and provider had ensured the premises were safe. Essential safety checks of the electrical hardwiring, portable appliances and emergency lighting had all been undertaken. Equipment used to help people mobilise around the property had been recently serviced.

Risk assessments which were previously missing were in place but needed further development and the manager intended to address this issue immediately.

Existing staff recruitment records needed to be re-audited as they were still missing some documentation which verifies a person’s identity and suitability to work with vulnerable adults. The manager addressed this issue during the inspection and had implemented a checklist to use when recruiting new staff.

Care records had been given some attention. The manager had created new medicine files which contained a detailed, person-centred medicine care plan and records of daily well-being checks. However other care records did not contain thorough assessments of people’s needs, person-centred care plans and detailed risk assessments. The manager told us she would address this urgently and link up with a local care home manager for additional support and guidance on this aspect of the service. We made a recommendation about this.

People continued to access the community as they wished and made their own arrangements with regards to activities. The service had communal activities available for people to access if they wished within the home and they organised monthly parties, theme nights and celebrations to encourage socialisation.

The service had received no complaints since the last inspection. During the inspection nobody raised any concerns with us and the feedback we received from external professionals and services was positive.

Everyone we spoke with spoke highly of the manager. We saw she had made a lot of improvements throughout the service, especially in relation to the cleanliness and maintenance of the premises. New and more detailed audits had been introduced to monitor cleanliness, infection control, maintenance, medicines and finances. Staff meetings and ‘house’ meetings had been held to ensure everyone was aware of and was involved in the improvements and changes being made within the service.

The manager had action plans in place which she used to ensure the identified safety and quality issues throughout the service were addressed and improvements were carried out.

We have not changed the rating of the home at this inspection. This was because we wanted to be reassured that improvements made would be sustained over a longer period of time.

People and staff told us that consent was gained before care was delivered and we found that the provider acted in accordance with people's wishes.

We found people's needs were assessed and care and treatment was planned and delivered in line with their individual care plans. We observed that relationships between staff and people appeared to be good and people appeared relaxed and well cared for.

Records were available to show that the manager monitored the administration of medication. This meant that people's medicines were checked regularly by the manager to see that staff were administering, ordering and disposing of medication properly.

There were enough qualified, skilled and experienced staff to meet people's needs. One person said, 'The staff are lovely, there are always there to help.'

The provider had effective systems to regularly assess and monitor the quality of service that people received.