The Mellows

The Mellows is a residential care home providing accommodation and personal care to up to 50 people. The service provides support to older people, some of whom are living with dementia. At the time of our inspection there were 49 people using the service.

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

The inspection identified minor improvements were required in the management of medicines. Accidents and incidents that occurred within the home were recorded and appropriate action was taken to ensure people were safe. However, we identified some accidents and incidents that required a referral to the local safeguarding team. People told us they felt safe living at the Mellows.

Risks to people's health and well-being had been assessed and staff had a good level of knowledge and understanding about people's individual risks and how best to support them. There were enough staff to meet the needs of people living in the service.

People were supported to have maximum choice and control of their lives and staff them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. The meal experience was positive overall, and people were offered a choice of meal options. However, further monitoring was required to ensure people received the option they had chosen. People were supported by competent and knowledgeable staff who were well supported to meet people's needs.

The service was well-led. The staff team told us they felt supported by the registered manager. The registered manager had processes in place to monitor and improve the quality of service people received and had responded proactively to minor concerns identified during this inspection.

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 21 December 2019).

At our last inspection we recommended that the provider ensured recruitment checks were in line with Schedule 3 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At this inspection recruitment files looked at met Schedule 3.

Why we inspected

This inspection was prompted by a review of the information we held about this service. We received concerns in relation to staff not recognising or escalating people’s healthcare needs in a timely way. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe, effective and well led relevant key questions sections of this full report.

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.

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 the same based on the findings of this inspection.

Follow up

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

The Mellows is a residential care home providing personal and nursing care for up to 50 people aged 65 and over. This also includes people living with dementia. At the time of the inspection there were 46 people living at the service.

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

Recruitment practices were not as robust as they should be to make sure the right staff were recruited, however we were assured from our discussions with the registered manager, immediate steps would be taken to make the required improvements. People told us they were safe. Suitable arrangements were in place to protect people from abuse and avoidable harm. Risks to people’s safety and wellbeing were assessed, recorded and followed by staff. Suitable arrangements were in place to ensure people received their medication as they should. Staff understood how to raise concerns and knew what to do to safeguard people. Enough numbers of staff were available to support people living at The Mellows and to meet their needs. People were protected by the prevention and control of infection. Findings from this inspection showed lessons were being learned and improvements made when things went wrong.

Suitable arrangements were in place to ensure staff were appropriately trained and newly appointed staff received an induction. Staff felt valued and supported by the provider and registered manager; and received formal supervision and an annual appraisal. The dining experience for people using the service was good. People received enough food and drink to meet their needs. People were supported to access healthcare services and receive ongoing healthcare support. The service worked with other organisations to enable people to receive effective care and support. 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. Since our last inspection to the service, many areas of the home environment had been refurbished and redecorated.

People and those acting on their behalf told us they were treated with care, kindness, respect and dignity. Staff had a good rapport and relationship with the people they supported, and observations demonstrated what people told us.

People’s care and support needs were documented, and staff had a good understanding and knowledge of these and the care to be delivered. However, improvements were required to ensure information relating to people’s end of life care needs was recorded in a more robust way. Suitable arrangements were in place to enable people to participate in meaningful social activities to meet their needs. Whilst some improvements were noted relating to the service’s complaint management arrangements, the registered manager wrote to us following the inspection. This provided an assurance that suitable measures would be immediately implemented to ensure robust investigations were carried out.

People told us the service was well-led and managed. Quality assurance arrangements enabled the provider and registered manager to monitor the quality of the service provided and staff performance.

We have recommendations relating to end of life care and recruitment practices.

Rating at last inspection

The rating at last inspection was good (published May 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit as outlined in our inspection programme and schedule. If any concerning information is received we may inspect sooner.

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

The Mellows is a residential service which provides care to older people, some of whom were living with dementia. The Mellows is registered to provide care for up to 50 people. At the time of our inspection there were 42 people living there.

This service was last inspected on 29 June and 01 July 2016, three regulations were not met and improvement was required. This inspection was carried out to check sufficient improvements had been made to the service.

The home is required to have a registered manager. 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 and associated Regulations about how the service is run. At the time of this inspection the home had a registered manager.

The service did not have a clear process in place to ensure people were always offered a choice of food and drink. People's nutritional needs had been assessed.

Where people who used the service lacked capacity to consent to care and treatment the appropriate steps were taken to protect their rights. Mental capacity assessments were completed and correct procedures were followed under Deprivation of Liberty Safeguards.

Staff were trained in the safe administration of medicines and had their competency assessed on a regular basis. Audits of medicines were carried out regularly and these were effective in identifying issues.

There were systems in place to ensure risks were assessed and steps taken to mitigate the identified risks. Staff were aware of how to recognise and report any allegations of abuse and had attended safeguarding training.

There were sufficient staff who had been recruited safely and who had the correct skills and knowledge to provide care and support in ways that people preferred.

Staff received annual appraisals, regular supervision and attended meetings to ensure they reflected on practice and were kept up to date with any changes.

The service had employed an activity co-ordinator who actively engaged with people individually or in groups. Care plans contained information about people's care needs, including their personal histories.

Quality assurance systems had been improved so that the service could be monitored and developed. There were arrangements for people who lived in the home and their relatives to be consulted about their opinions of the service.

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The Mellows is a residential care home that provides accommodation and personal support for up to fifty older people who have a range of nursing, and other care needs associated with old age. On the day of inspection 45 people were using the service.

The home had a registered manager. 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 and associated Regulations about how the service is run.

At this inspection the home did not meet all the regulations. You can see what action we have asked the provider to take at the back of the full version of this report.

The registered provider had failed in their duties to ensure they met their legal obligations in reporting to the Care Quality Commission all safeguarding incidents which had occurred at the home.

People lived in a service where the premises and equipment had been improved to keep them safe, and further improvements had been planned.

People and their relatives told us the home provided a relatively good service. They found that staff were caring, attentive and provided the care and support they needed in a friendly and kind way.

Staff were provided with appropriate training courses to ensure they had the required knowledge and skills to meet people's care needs.

The service had not always carried out regular supervision and appraisal to ensure that staff had the support required.

People's mental capacity assessments were inadequately completed. There was a risk that people's capacity was not assessed in a way that met their needs

People and their relatives were encouraged to discuss health needs with staff and had access to community based health professionals, and GPs as required.

People were protected from risks associated with nutrition and hydration and had balanced diets that also met their likes and dislikes.

There was some improvements to social activities on offer for people who lived at the home.

The service was run by a competent manager with input from the provider, who demonstrated a commitment to make improvements where necessary. Areas for improvement should continue to be identified to drive quality in the service.

We looked at staff training records, health and safety checks, staff and resident meeting minutes and records of the checks the provider's representative completed to monitor the quality of the service.

We considered our inspection findings to answer questions we always ask; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well-led?

This is a summary of what we found;

Is the service safe?

People told us they felt safe living in the service. They also told us that they would feel able to speak up if they had concerns or worries and felt that they would be listened to. A visiting relative said, 'I do feel [person] is safe. There are always staff available and monitoring them, there is always a staff member in the lounge'.

Staff were provided with training in safeguarding vulnerable adults from abuse, Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). This meant that staff were provided with the information that they needed to ensure that people were safeguarded.

People were not protected against the risks associated with medicines because the provider did not have appropriate arrangements in place to manage medicines safely. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to the safe management of medicines.

We saw records which showed that the health and safety in the service was regularly checked. People were protected from the risk of infection because appropriate guidance had been followed.

Is the service effective?

People's care records showed that care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. The records were regularly reviewed and updated. This meant that staff were provided with up to date information about how people's needs were to be met safely and effectively.

We saw that the service had effective systems in place to ensure that people's nutritional well-being was monitored and supported.

Is the service caring?

People told us that they received the care they needed. One person said, 'It is good here. The staff are very nice. The staff are very caring. They come in and talk to me when I am in my room.'

We noted that staff were kind and caring towards people who used the service. Staff spoke with people by name and interacted with them in a friendly and respectful way. People who used the service also knew the staff by name.

Is the service responsive?

We saw that the service had acted promptly to protect a person who did not have the capacity to make decisions to keep them safe. The risk to their safety was considered in the least restrictive way to support and respect their human rights.

Visitors confirmed that they were able to see people in private and that visiting times were flexible.

People using the service were provided with the opportunity to participate in meetings and to express their views. The chef met with people who used the service to hear their comments and ensure that they enjoyed the meals.

People's choices were taken in to account. A person who used the service told us that the care was good and they were well looked after. They said, 'I go down for the singsongs sometimes and have a chat, otherwise you would get melancholy, but I like to watch television here in my room and do things for myself.'

Is the service well-led?

We saw that the improvements identified as required at our last inspection in relation to management of infection, safeguarding people from abuse and keeping records that were accurate and fit for purpose had been put into place.

The manager had been absent from the service for some weeks and the care team leader was acting as manager of the service as well as completing their own role. We found that many aspects of the service were well managed. Systems such as the acting manager completing daily checks while they walked around the service had been implemented. Whilst the provider did have some systems in place to monitor the quality of the service provided, it was apparent from our inspection that the absence of robust quality monitoring maybe a contributory factor to the failure of the provider to identify non-compliance or any risk of non-compliance sooner.

We told the provider to make improvements and subsequently received action plans which stated that the home would be compliant with the regulations by 31 October 2013. During our inspection carried out on 07 January 2014 we found that, although some improvements had been made, there were still areas of non-compliance with the regulations.

We saw that suitable arrangements had been put in place to ensure that staff were appropriately trained and supported to perform their roles. One member of staff told us, 'Training has really improved in recent months. We are well supported now and have regular staff meetings.'

We found that some improvements had been made in relation to safeguarding practices, infection control and record keeping. However, the regulations had still not been met so we have told the provider to make further improvements.

We saw that suitable arrangements were in place surrounding the administration and reconciliation of medicines, although there was some concern surrounding their storage.

We also saw that staff were not allowed to start work until all relevant checks had been satisfactorily completed. However, it was not always clear from some of the records we looked at whether or not full employment histories had been obtained.

The home was visibly very dirty and dusty in some areas. Although there were some processes in place to ensure that cleaning could be done thoroughly, these were not being followed or checked.

We found that people's needs were individually assessed. We found examples where care had been delivered in an individual and personalised way. One person told us, "If you want to do something [they] let you do it and give you the time, that's very important.' We saw that care in some instances had not been delivered in a planned manner.

People who used the service told us that, "It's so nice and friendly here I feel safer here than I did at home.' However, we found that some staff were unable to demonstrate sufficient knowledge of safeguarding.

People we spoke with and our observations showed us there were enough staff to meet people's needs. One staff member told us, "On the whole there are enough staff. I think we provide the care that people need."

We found that staff were not supported appropriately or trained to provide care and support to people. Staff were unclear about the purpose of supervision and appraisals had not been completed for some staff.

We found that people were not always protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were not maintained.

We found the improvement plan submitted by the provider had been actioned. For example, we found that improvements had been made with regard to meeting people's nutritional needs, with cleanliness and infection control and with the audits of medicines.

We saw that people were being asked their consent for their care plan and other matters. However this was still in an early stage. The provider set the end of February 2013 as the target date to reach compliance with this standard.

We noted a number of poor staff interactions and comments from people using the service that they were not always treated with dignity and respect. This was discussed with the care manager at the inspection.

We looked at care planning due to concerns raised by a safeguarding referral being received and found that the care plans contained clear information about people's needs and how these should be met.