Archived: The Mellowes Care Home

The Mellowes Care Home in Gillingham, Dorset, is registered to provide accommodation and nursing or personal care to up to 45 people. At the time of our inspection visit there were 30 people living at the service.

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

People were supported to meet their needs and stay safe by sufficient numbers of suitably trained staff. The manager had played an integral role in recruiting and retaining staff. This, and a drive to reduce the use of agency workers, had increased staffing numbers and the consistency of care people received.

People told us they felt safe and enjoyed living at The Mellowes Care Home. Their relatives were confident that their family members were receiving good care. Detailed and regularly reviewed risk assessments supported this. A relative said, “ I am sure [person] is safe with them, they are on to everything so quick.”

People were supported by staff who demonstrated a good understanding of how to keep them safe from harm or abuse and understood their responsibility to raise concerns if they were to witness poor or abusive practice.

People received their medicines on time from staff with the required training and competency assessments. If errors occurred, these were thoroughly investigated in a timely way and learning shared to reduce the chance of it happening again.

Although the home had experienced a period of management change in 2021, all stakeholders spoke positively about the improvements the new manager had brought to the home. A staff member told us, “[Manager] has made a massive difference to the home, is very supportive to both staff and residents.”

The home had an open, professional and supportive culture. Staff told us they were proud to work at the home and felt supported by their colleagues. Management held formal structured conversations with staff to discuss their career goals and aspirations.

People and relatives told us the home communicated with them well and sought their opinion on how things could be improved at the home. This was via a number of means including surveys, newsletters, telephone calls and the provider’s website. One relative told us, “We get asked what we think could be improved. We did suggest some new activities and they followed up on that.”

The home had developed good working relationships with other agencies. This included supporting GP surgeries, student nurse placements, and work experience for local school pupils.

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 good (published 6 January 2018).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found following examples of good practice:

¿ The service was clean, there was a thorough cleaning regime in the service, this included cleaning of any regular touchpoint surfaces.

¿ Safe arrangements were in place for both external professionals and people’s relatives visiting the service. This included a confirmed negative lateral flow device test’s result, a proof of vaccination against COVID-19, hand sanitisation and use of personal protective equipment (PPE).

¿ Policies and procedures relating to COVID-19 were up to date and enabled staff to keep people safe.

¿ The service conducted regular infection prevention and control audit and ensured any actions identified had been promptly completed.

¿ All staff received training and followed correct infection control and using PPE processes. The provider ensured staff were compliant with the good practice by carrying out regular spot checks.

The Mellowes 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.

The care home accommodates 40 people across two floors, each of which has separate adapted facilities.

Our last inspection on 10 and 11 May 2017 found that systems and processes were not in place to ensure robust assessing and monitoring of quality, safety and risks. We found that some people did not receive safe care and treatment. Staff did not receive regular supervision and appraisal. Risks were not assessed or mitigated effectively. People did not always receive personalised care and consent was not always sought. During this inspection we found that improvements had been made.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions safe, effective, caring, responsive and well led to at least good. We found that during this inspection the action plan had been followed and improvements had been made.

The service had 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.

Risk assessments in relation to people’s care and treatment were completed, regularly reviewed and up to date. However, risk assessments associated to activities inside and away from the service were not in place.

Specific care plans were not completed to reduce the risk of infections and guidelines to include the use of some personal protective equipment was not always in place. The registered manager told us that this would be completed as a priority.

People, relatives, a health professionals and staff told us that the service was safe. Safeguarding alerts were being managed and lessons learnt by the home. Professionals confirmed that improvements had been made. Staff were able to tell us how they would report and recognise signs of abuse and had received training in safeguarding.

Care plans were in place which detailed the care and support people needed to remain safe whilst having control and making choices about their lives. Each person had a care plan and associated files which included guidelines to make sure staff supported people in a way they preferred.

Medicines were managed safely, securely stored, correctly recorded and only administered by on duty nurses and team leaders that were trained and assessed as competent to give medicines.

Staff had a good knowledge of people’s support needs and received regular local mandatory training as well as training in response to people’s changing needs for example some people were receiving end of life care and staff had been trained in this area.

Staff told us they received regular supervisions which were carried out by the management team. Staff told us that they found these useful. We reviewed records which confirmed this.

Staff were aware of the Mental Capacity Act and training records showed that they had received training in this. Capacity assessments were completed and best interest decisions recorded as and when appropriate.

People and relatives told us that the food was good. We reviewed the menu which showed that people were offered a variety of healthy meals. We saw that food was regularly discussed and recorded on food preference sheets. The chef told us that the majority of meals are home cooked.

People were supported to access healthcare appointments as and when required and staff followed professional’s advice when supporting people with ongoing care needs. Records we reviewed showed that people had recently seen the GP, physiotherapist, mental health team and a chiropodist.

People told us that staff were caring. We observed positive interactions between staff, managers and people. This showed us that people felt comfortable with the staff supporting them.

Staff treated people in a dignified manner. Staff had a good understanding of people’s likes, dislikes and interests. This meant that people were supported by staff who knew them well.

People had their care and support needs assessed before being admitted to the service and care packages reflected needs identified in these. We saw that these were regularly reviewed by the service with people, families and health professionals when available.

People were encouraged to feedback. We reviewed the resident’s satisfaction survey results for 2016 which contained mainly positive feedback. Improvements had been made in activities in response to people’s feedback.

There was an active system in place for recording complaints which captured the detail and evidenced steps taken to address them. The registered manager told us that lessons were learnt and shared with staff in meetings. This demonstrated that the service was open to people’s comments and acted promptly when concerns were raised.

Staff had a good understanding of their roles and responsibilities. Information was shared with staff so that they had a good understanding of what was expected from them. Staff felt recognised and that team moral was good.

People and staff felt that the service was well led. The registered and service manager both encouraged an open working environment.

The service understood its reporting responsibilities to CQC and other regulatory bodies they provided information in a timely way.

Quality monitoring audits were completed by the registered manager and customer relationship manager. The management team analysed the detail and identified trends, actions and learning which was then shared as appropriate.

The Mellowes is a nursing home that is situated on the outskirts of Gillingham. Accommodation is provided over two floors. A passenger lift enables access to the upper floor. All rooms have en-suite toilet and washbasin facilities. The Mellowes has three communal lounges and a dining area. The home has landscaped gardens and a patio. The Mellowes is registered to support 45 older people, at the time of the inspection there were 36 people living at the home.

We inspected The Mellowes in November 2015. At that Inspection the service was rated Good. At this inspection we found the provider to be in breach of five regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. These correspond to regulations, 9, person centred care, 11, consent, 12, Safe Care and Treatment, 18, staffing, and 17 good governance of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

There was a 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 in the Health and Social Care Act 2008 and associated Regulations about how the service is run.’ At the time of the inspection the registered manager had just taken back full responsibility of the home. They had previously been supporting the management of two of the provider’s homes.

We found a number of areas where care was not completely safe and where staff needed better information and guidance on how to support people’s emotional and social needs. Procedures to assess and monitor risks to people’s health and safety were not always followed. Where people were at risk of dehydration, fluid intake levels had not been recorded.

Risks to people were identified but measures were not always implemented to reduce the risk. Some risks had not been fully assessed, and measures to reduce the risk to people were not fully effective or agreed with other health professionals.

Where people required specialist equipment such as specialist chairs, pressure mattresses, mobility aids or hoisting equipment, these were provided. Although staff told us they had been trained in moving and assisting, people told us they were not always supported to transfer safely.

Improvements were needed to make sure everyone received person centred care and had opportunities for social stimulation. This was a particular concern regarding the care of some people who remained in their rooms. There was an activity programme in place, however records and observation showed some people were left for long periods of the day alone.

People had mental capacity assessments in their care plans. However. although we found evidence of decision specific mental capacity assessments, few had been completed to include evidence of subsequent best interest decision making involving all relevant parties.

A recruitment procedure was in place and staff received pre-employment checks before starting work with the service. New members of staff received an induction which included shadowing experienced staff before working independently. There was no evidence of supervision or support over a period of six month for new staff or for existing staff. This meant there was a risk new staffs were not being appropriately supported within their roles.

Registered nurses were always on duty and held the responsibility for leading the shifts, which meant people’s healthcare needs were monitored. People told us they did not always receive support in a timely manner. Staff were seen to be task focused. One visiting health professional told us, “I am concerned at times that things don’t always get done as quickly as requested”.

Systems were in place to ensure people received their medicines safely. All staff received medicine administration training and had to be assessed as competent before they were allowed to administer people’s medicines.

People’s relatives told us they were made to feel very welcome when they visited The Mellowes, they could visit at times convenient to them, there were no set visiting times or unreasonable restrictions.

Relatives were confident they could raise concerns or complaints with the registered manager and they would be listened to. The provider had systems in place to collate and review feedback from people and their relatives to gauge their satisfaction and make improvements to the service.

The provider and registered manager had a number of audits and checks in place to review how the service was running. These had not identified the concerns on this inspection.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can read at the back of the full report what action we have told the provider to take.

People's needs were assessed and care was planned and delivered to meet people's needs. A visiting relative told us, "His care has been good ' If there are any changes they do keep me informed."

We saw that medicines were stored securely and given at the correct time. We found that the home had procedures in place for the management and disposal of controlled drugs. A person told us, 'They manage my medicine. They've never made any mistakes. They are very diligent.'

People's needs were met by staff who were appropriately supported, trained, supervised and appraised. Staff were enabled to acquire further skills and qualifications that were relevant to the work that they did. A care assistant told us, "I really love my job -- I get on the job supervision. My supervisor does spot checks and will pull you up on anything that looks out of line."

The home had systems in place to manage comments and complaints. The home also had procedures to ensure that comments and complaints were responded to appropriately.

We saw that the home has had recently undergone a refurbishment. The registered manager told us, 'People were involved in choosing the colours they preferred in their rooms.'

Our previous inspection found that appropriate standards of cleanliness of shared equipment had not been maintained. During this inspection we found that improvements had been made. One person told us 'The equipment is clean. I've never noticed it to be dirty'.

Our previous inspection found that the provider did not always develop action plans to address problems identified by audits they had undertaken. This had resulted in the same issues being identified several times and a risk that people received inappropriate care. We found that improvements had been made and action plans were developed and reviewed.