Archived: Melrose Residential Home

Updated 4 July 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

This was a targeted inspection to check whether the provider had taken action to address concerns in relation to: regulation 12. Risks were associated with the safe management of medicines, infection risks and risks to people and the environment. We also reviewed regulation 17 in relation to governance, audit and oversight and regulation 18 associated with staffing.

As part of this inspection, we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was completed by two inspectors.

Service and service type

Melrose residential home is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Melrose residential home is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations. At the time of our inspection there was not a registered manager in post. A new manager had been in post for approximately 6 months and had submitted an application to register. We are currently assessing this application.

Notice of inspection

This inspection was unannounced. Inspection activity started on 28 February 2023 and ended on 24 March 2023 when formal feedback was provided. We visited the location’s service on 28 February 2023.

What we did before the inspection

We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. Prior to this inspection we reviewed assurance given to us following the previous inspections and planned to review the action had been taken. We also reviewed information we held about the service provided. We used all this information to plan our inspection.

During the inspection

We looked around the environment including communal areas and people’s bedrooms. We observed care and support being provided and asked 3 people living in the home their views on the support they received. We spoke with staff on duty, 2 who had finished the night shift and 3 staff working the day of the inspection. We spoke with the manager and the domestic who was completing a short contract to bring the home up to standard. We reviewed care plans, medication records and paperwork used to keep people safe. We also looked at management information including policies and audits.

Whilst collecting additional information and during feedback we discussed concerns with the nominated individual for the provider’s services. The nominated individual is responsible for supervising the management of the service on behalf of the provider.

Updated 4 July 2023

Melrose Residential Home is a residential care home which can support up to 26 people in one adapted building. On the first day of inspection support was being provided to 13 people aged 65 and over. Two new people had been admitted by the second day of inspection increasing support being provided to 15 people.

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

There was not enough competent staff deployed effectively to meet people’s needs and staff had not always been safely recruited. The home was not cleaned to a suitable standard to minimise the risk and spread of infection and staff were not routinely following safe practice guidelines to reduce this risk. This included poor use of personal protective equipment and ineffective monitoring and auditing of the environment. Where risk was identified, it was not managed in a timely or effective way, this included where people had an accident or required additional support to keep them safe. Medicines were not managed effectively. There was not the information needed to show when people may need particular medicines and records were not kept in line with best practice.

Guidance supplied to ensure people’s human right to family life was protected, was not followed or implemented by the provider, despite clear prompts from the regulator of the requirement to provide better visiting arrangements for families and loved ones. Audits were not completed effectively to identify concerns and ensure people’s needs were met. Whilst we saw some examples of involvement in how people received their care, recent feedback did not confirm this had continued during the pandemic. Previous enforcement action taken by the CQC to ensure action was taken to improve services had not been addressed and concerns continued to impact on the quality of care received by people living in the home.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was inadequate (published 06/05/2021). This focused inspection reviewed the key questions of safe and well led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has remained inadequate based on the findings of this inspection

Why we inspected

We undertook a targeted inspection to follow up on specific concerns which we had received about the service. The inspection was prompted in part due to concerns received about the deployment of staff and the management of risk, including infection control. A decision was made for us to inspect and examine those risks.

We inspected and found there was a concern with a lack of general improvement from the last inspection and ongoing breaches to the regulations were found in relation to risk management, staffing and person-centred care, including concerns about visiting restrictions. We widened the scope of the inspection to become a focused inspection which included the key questions of safe and well led. This inspection also followed up on action we told the provider to take at the last inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We have found evidence that the provider needs to make improvements. Please see the safe and well led section of this full report.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to the safe management of medicines, assessment and management of risk including, infection control, fire safety and people’s welfare. We have also identified breaches in how staff are recruited and deployed to meet people’s needs and concerns on how the service provided to people is monitored and overseen. We have issued a recommendation to ensure restrictive practice is assessed and implemented lawfully.

Due to concerns found at this inspection, we issued a Notice of Proposal to vary a condition to the providers registration to remove the location at Melrose residential care home, Leyland.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.