Mellish House provides accommodation, nursing and personal care for up to 48 older people. There were 45 people living in the home on the day of our inspection. This inspection took place on 18 and 20 October 2017 and was unannounced.

There was a registered manager in post at the time of our inspection. 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 our last inspection on 10 February 2016 we rated the service ‘Good’. At this inspection we found significant improvements people continued to receive a very good level of care and that further developments had been made under responsive and well-led. We have rated the service ‘Outstanding’ in responsive and well-led and therefore overall.

At this inspection we found that the service provided an outstanding level of responsive care and support that placed people at the centre of the care and enabled them to be instrumental in their support. The registered manager had a strong leadership presence All the people we spoke with had nothing but praise for the service and the excellent quality of life people living in the service experienced. There was an especially strong ethos within the home of respecting people as individuals. Information was given to people about how to raise any concerns they may have and where concerns were raised these were dealt with speedily and in detail. Relatives said they felt welcomed at the service and felt their family member was very well cared for.

The home was exceptionally well led. There were very effective quality monitoring processes in place which covered all areas of the home and care delivered to people. The registered manager was actively monitoring quality in the service in detail. People were routinely consulted and listened to. The registered manager undertook comprehensive audits to ensure areas for improvement were identified and addressed. We received feedback about the home and the standards of care and support people received from a number of healthcare professionals we spoke with. The home was described overall in outstanding terms.

There were robust systems and processes in place to protect people from the risk of harm. Staff were able to describe in detail different types of abuse and what their responsibilities were in protecting people and further reporting this. This ensured the welfare of people was protected through whistle blowing and safeguarding procedures.

Medicines were managed in accordance with best practice and the provider’s policies. Medicines were stored, administered and recorded safely. All staff administering medicines had received training in the correct procedures to follow.

The provider had followed a recruitment process that ensured people were supported by staff whose suitability had been checked. People received effective care because staff were appropriately trained and supported to do their jobs.

People's right to make decisions about their care was respected and those people, who lacked capacity to make their own decisions, had been appropriately supported under the principles of the Mental Capacity Act 2005.

People’s care needs were assessed before they made the decision to move to the home. This helped to ensure the home was able to meet their needs and preferences. Care plans were person centred and contained appropriate risk assessments. Care plans also contained important information about a person's social history which helped staff to get to know people. Staff demonstrated that this was effective through their knowledge of people as individuals.

Mellish House provides accommodation, nursing and personal care for up to 48 older people. There were 45 people living in the home on the day of our inspection. This inspection took place on 18 and 20 October 2017 and was unannounced.

There was a registered manager in post at the time of our inspection. 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 our last inspection on 10 February 2016 we rated the service ‘Good’. At this inspection we found significant improvements people continued to receive a very good level of care and that further developments had been made under responsive and well-led. We have rated the service ‘Outstanding’ in responsive and well-led and therefore overall.

At this inspection we found that the service provided an outstanding level of responsive care and support that placed people at the centre of the care and enabled them to be instrumental in their support. The registered manager had a strong leadership presence All the people we spoke with had nothing but praise for the service and the excellent quality of life people living in the service experienced. There was an especially strong ethos within the home of respecting people as individuals. Information was given to people about how to raise any concerns they may have and where concerns were raised these were dealt with speedily and in detail. Relatives said they felt welcomed at the service and felt their family member was very well cared for.

The home was exceptionally well led. There were very effective quality monitoring processes in place which covered all areas of the home and care delivered to people. The registered manager was actively monitoring quality in the service in detail. People were routinely consulted and listened to. The registered manager undertook comprehensive audits to ensure areas for improvement were identified and addressed. We received feedback about the home and the standards of care and support people received from a number of healthcare professionals we spoke with. The home was described overall in outstanding terms.

There were robust systems and processes in place to protect people from the risk of harm. Staff were able to describe in detail different types of abuse and what their responsibilities were in protecting people and further reporting this. This ensured the welfare of people was protected through whistle blowing and safeguarding procedures.

Medicines were managed in accordance with best practice and the provider’s policies. Medicines were stored, administered and recorded safely. All staff administering medicines had received training in the correct procedures to follow.

The provider had followed a recruitment process that ensured people were supported by staff whose suitability had been checked. People received effective care because staff were appropriately trained and supported to do their jobs.

People's right to make decisions about their care was respected and those people, who lacked capacity to make their own decisions, had been appropriately supported under the principles of the Mental Capacity Act 2005.

People’s care needs were assessed before they made the decision to move to the home. This helped to ensure the home was able to meet their needs and preferences. Care plans were person centred and contained appropriate risk assessments. Care plans also contained important information about a person's social history which helped staff to get to know people. Staff demonstrated that this was effective through their knowledge of people as individuals.

We spoke with three people who used the service, two relatives, four members of staff and a visiting professional as part of this inspection. A relative told us how they struggled to provide care for their relative before admission to the service and stated, “I am delighted with the support both my relative and I receive.”

We learnt that the choice of lunch was decided on the day. The chef and staff were knowledgeable about people’s needs regarding their diet. One person said “I always eat everything it is lovely.”

We saw that staff had received training in the provision of dementia care and observed people being supported and not rushed to meet their needs. The service employs activity co-ordinators and we saw pictures of people enjoying a recent Spanish themed night. This was an opportunity to enjoy the food and look at the culture of another country which had been well supported by relatives and friends.

During our visit to the service we saw that care workers interacted with people in a

caring, respectful and professional manner and people who used the service were

given appropriate information and support regarding their care or treatment.

People told us that staff assisted them in all areas of their care where they needed it. One person stated that "People are very kind here and will always help me if I need it."

Three people told us that the staff treated them well and listened and acted on what they said.

Whilst the majority of people using this service were unable to communicate their views verbally, we did speak with four people who used the service and all said they were happy and were positive about the care and support they received.

One person spoken with said that they "Liked the staff and that they were kind." Another person was able to confirm that if they had a problem they would "Go to the staff and report it."

Two people were able to confirm that they had recently been consulted about the meals provided with a view to ensuring people are involved in the preparation of the menu's. One person we spoke with told us that "Staff do listen to me and understand what I need."

People using the service told us that staff were kind to them, and that they liked some of the activities offered to them.