Melrose House provides accommodation, personal care and support for up to ten adults with mental health needs and/or a learning disability. At the time of our inspection eight people were living at the service and one person was in receipt of respite care.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.