Archived: Melrose Residential Home

Updated 20 December 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider had addressed the breaches identified at the previous inspection, if they were meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service and to provide a new rating for the service under the Care Act 2014.

This inspection was undertaken on 15, 16 and 18 October 2018 and was unannounced. It was conducted by two adult social care inspectors from the Care Quality Commission (CQC), a pharmacy inspector and an inspection manager. An expert by experience was also part of the inspection team. An expert by experience is someone who has experience of the type of service being inspected. At the time of our inspection there were 16 people who lived at Melrose. We spoke with five of them and four family members.

We spoke with four members of staff and the provider. We toured the premises and observed the day-to-day activity within the home. We also looked at a wide range of records, including the care files of eleven people who used the service.

We also looked at the personnel records of three staff members, which helped us to establish the robustness of recruitment practices and the level of training provided for the staff team. Other records we saw included a variety of policies and procedures, training records, medication records and quality monitoring systems.

Prior to our inspection we reviewed all the information we held about the service, including statutory notifications, which are a requirement and which tell us about any significant events. We also looked at information we had received from other sources, such as the local authority. We requested a Provider Information Return (PIR), which was submitted within the timeframe. A PIR is a document which provides us with key information and data about the service, including improvements they plan to make. We also checked progress against the provider’s action plan sent to us after the last inspection. We used a planning tool to collate all this evidence and information prior to visiting the home.

Updated 20 December 2018

Melrose Residential Home (Melrose) is a care home. 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. Both were looked at during this inspection.

Melrose is located in a residential area of Leyland, close to the town centre. The home is on three floors, with passenger lift access. Accommodation is provided in single rooms for up to 26 adults, who need assistance with personal care. At the time of this inspection there were 16 people who lived at the home. There is easy access to local amenities, such as shops, supermarkets, pubs and churches. Some parking spaces are available at the front of the home and on road parking is also permitted. There are garden areas to the front and rear of the premises.

The last inspection of this location was conducted on 27 and 28 February 2018. At that time, we found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to person centred care, safe care and treatment and good governance. We served two warning notices against the regulations of safe care and treatment and good governance, because these were continued breaches. Due to these failings a rating of ‘Inadequate’ was awarded to the domain of ‘safe’ and therefore the home remained in ‘special measures’. This means that the service was kept under review, and was inspected again within six months of the inspection report being published. The key questions of ‘effective’, ‘responsive’ and ‘well-led’ were rated as, ‘requires improvement’, with the key question of ‘caring’ being rated as ‘good.’

Following the last inspection, the provider developed an improvement plan to confirm how and when they were going to make improvements, in order to improve the key questions of ‘safe’, ‘effective’, ‘responsive’ and ‘well-led’ to at least ‘good.’

This inspection was unannounced, which meant that people did not know we were going to visit the home. It was undertaken on 15, 16 and 18 October 2018. At the time of the inspection there was no 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 of the Health and Social Care Act and associated regulations about how the service is run.

At this inspection we found two continued breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, in relation to safe care and treatment and good governance. We also found three additional breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, in relation to need for consent, safeguarding people from abuse and improper treatment and staffing. A breach of regulation 18 of the Care Quality Commission (Registration) regulations was also identified, as the provider was failing to send notifications of reportable events to the Care Quality Commission.

People were supported to have some choice and control of their lives and staff supported them in the least restrictive way possible. However, systems in the service did not always support this practice, as assessments had not always been conducted in order to determine if people had the mental capacity to make decisions and to give consent for their care and support.

We found risks to people’s health and safety had not always been identified and mitigated, in order to safeguard people from harm. There were also some safety issues noted during our tour of the premises. We found people’s needs were not always met and people’s safety was being compromised. The staffing levels were not adequate to meet the needs of those who lived at the home. This was evidenced by the excessive number of unwitnessed falls experienced by those who lived at Melrose.

We found infection control practices had improved. The environment was, in general clean throughout. Some refurbishment had been completed since our last inspection, which enhanced the environment for those who lived at Melrose.

We found some improvements had been made to the planning of people’s care. However, assessed needs had not always been incorporated into the care planning process. This meant that people may have not always received the care and support they required. We made a recommendation about this.

Policies in relation to equality and diversity had not been introduced. We made a recommendation about this.

We found people who lived at the home were treated with respect and their privacy and dignity was consistently promoted. People looked happy and comfortable in the presence of staff. We observed some lovely interactions by staff members with those who lived at Melrose.

At this inspection we found that medicines were not managed safely. We assessed the systems for monitoring the quality of service provided. We found there was little oversight and leadership of the service. Quality monitoring, governance and oversight systems were not effective.

We looked at the personnel records of three staff members who were employed at Melrose. We found that recruitment practices adopted by the home could have been better. We made a recommendation about this.

Although induction programmes and a variety of training had been provided for the staff team, records showed that supervision and appraisal sessions were sporadic and not structured. We made a recommendation about this.

We found the home had not always shared appropriate information with the relevant authorities and statutory notifications had not always been submitted to the Care Quality Commission.

Meals looked appetising and were well presented and we observed a pleasant dining experience for those who lived at the home.

We found that equipment had been serviced in accordance with the manufacturer’s recommendations, to ensure they were fit for use.

People we spoke with were aware of how to raise concerns, should they need to do so. A complaints procedure was in place at the home and a system had been implemented for the recording of complaints received.

People we spoke with were complementary about the staff team. They felt that they were treated in a kind, caring and respectful manner. Most we spoke with expressed their satisfaction about the home and the services provided.

We did not see much evidence of the provision of leisure activities and people who lived at the home felt this was an area which could be improved. We made a recommendation about this.

At this inspection, although we found the plans of care to be better, further improvements were still needed. People were not always involved in planning their own care and support. We made a recommendation about this.

This service remains in ‘special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Full information about CQC's regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.