Melrose Court Rest Home is registered for 21 older people with a range of needs. It is situated close to the centre of Southport which can be accessed via nearby public transport. Accommodation is provided over three floors. The home has three double rooms and eight of the 18 rooms have en-suite facilities. A passenger lift provides access throughout the home. Bathrooms and toilets are provided with equipment to assist with bathing.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

At this inspection we found the service remained Good.

Everyone who lived in the home said they felt safe. There were robust measures in place to ensure people were safe. Risk assessments were in place for areas such as pressure care, safe environment, falls and mobility, and nutrition and hydration.

There were sufficient staff on duty to meet people's needs. Staff rotas showed a consistent number of staff were on duty each day. People told us call bells were answered within a reasonable time.

Staff had been appropriately recruited to ensure they were suitable to work with vulnerable adults. We found that staff had the skills, knowledge and experience to support people effectively and safely. Staff were supported by the home manager through regular supervisions, annual appraisal and regular training. Staff had attended training in subjects such as first aid, fire safety, food safety, moving and handling, infection control, safeguarding and medication. New staff were required to complete an induction. Staff meetings were held regularly.

Medicines were managed safely and people received their medicines as prescribed. Staff had been trained to administer medicines to ensure errors were kept to a minimum.

The home was very clean and there were no odours. The home was well maintained and in good decorative order. People's bedrooms were personalised and were decorated and furnished to a high standard.

Regular checks and tests, such as gas, electricity, water safety, fire drills, fire alarm tests and external checks of firefighting equipment, were completed to maintain safety in the home.

People's needs were assessed and reviewed regularly to reflect their current health and support needs. People were supported to maintain healthy lives; records showed that people were supported to attend medical appointments.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. We saw clear evidence of staff working effectively to deliver positive outcomes for people.

People were supported to eat and drink enough to maintain a balanced diet and meet their dietary requirements. Drinks were offered throughout the day to ensure people's hydration needs were met. Staff understood people's individual nutrition and hydration needs and we saw that meals were provided accordingly.

Everyone living in the home was very complementary about the attitude of the staff and the way they were treated. Staff showed kindness towards the people in the home. It was clear from the banter and laughter that people were comfortable with staff and enjoyed their support.

Staff supported people to make decisions about their care, support and treatment. Staff showed a good understanding of people's likes and dislikes and preferred routines. This information was recorded in people's care records.

People and their family members were involved in the planning of their care and family members kept up to date with matters relating to their relative's health and welfare.

There was a complaints policy in

This unannounced inspection was conducted on 13 July 2016.

Melrose Court is a residential care home for up to 21 people. It is situated lose to the centre of Southport which can be accessed via nearby public transport. Accommodation is provided over three floors. At the time of the inspection 18 people were living at the home.

A registered manager was 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.

The people that we spoke with and their relatives told us that care was delivered safely. People understood what action to take if they were unhappy with the quality of care. Staff knew how to recognise abuse and neglect and understood what action to take if they had concerns.

Accidents and incidents were accurately recorded and were subject to assessment to identify patterns and triggers.

Risks were clearly identified within care records and appropriate measures were in place to reduce risk without imposing undue restrictions. Information about individual risks to people’s safety was displayed in a staff room.

The provider regularly completed a number of safety checks and made use of external contractors where required. Checks included; gas safety, electrical safety, water temperatures and general health and safety. Each of the checks had been completed in accordance with the relevant schedule. We saw evidence that prompt action had been taken were issues had been identified.

Staff were recruited safely following a robust procedure. Staffing numbers were sufficient to safely meet the needs of people living at the home.

People’s medication was stored and administered in accordance with good practice. We spot-checked Medicine Administration Record (MAR) sheets and stock levels. Each of the MAR sheets had been completed correctly. Stock levels tallied with the figures recorded on the MAR sheets.

Staff were suitably trained and skilled to meet the needs of people living at the home. The staff we spoke with confirmed that they felt equipped for their role. People living at the home and their relatives told us that they had no concerns about staff knowledge or skills.

The records that we saw showed that the home was operating in accordance with the principles of the MCA. Applications to deprive people of their liberty had been submitted appropriately.

Meals were freshly prepared and served in a well presented dining room. People gave us positive views on the quality of the food. We saw people being offered hot and cold drinks throughout the course of the inspection.

People were supported to maintain good health and to access healthcare services by staff. Most of the people that we spoke with had a good understanding of their healthcare needs and were able to contribute to care planning in this area.

Each of the people that we spoke with were extremely positive about the attitude and approach of the care staff and the registered manager. We saw that relatives were encouraged to stay for as long as they liked and were offered food and drinks during their visits.

Throughout the inspection we saw staff engaging with people in a positive and caring manner. Staff spoke to people in a respectful way and used language, pace and tone that was appropriate for the individual.

Each person who came to live at the home had been given a welcome pack which included; a statement of purpose (important information about the home and its services), a copy of the complaints procedure, information about the staff team and guidance on safety in the home.

All of the people living at the home that we spoke with told us they received care that was personalised to meet their needs. We saw evidence in care records that people’s preferences were recorded. Pe

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five 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 using services were cared for in an environment that was safe, clean and hygienic. We observed evidence that all equipment at the rest home, for example, hoists and lifts had been serviced and maintained regularly.

There was an adequate number of staff members on duty at all times, which included a senior member of staff. The owner told us they were also on call in case of any emergencies. This meant all people using services were kept safe at all times.

Deprivation of Liberty Safeguards (DoLS) become important when a person is judged to lack the capacity to make an informed decision related to their care and treatment. The provider told us no applications for DoLS had been made but knew the procedure to be followed if an application needed to be made. One person who had recently been admitted to the rest home was being continually observed in case a DoLS application was necessary.

Is the service effective?

During our inspection, we spoke to several people using services and also family members/carers. No concerns were expressed by people we spoke to. People told us they were happy with the care and support they received.

From observations we made, it was clear staff members had the skills and knowledge that met the individual needs of all people using services. One person told us, "We are all very happy here - we are well looked after." Staff members had received appropriate training which provided them with the required skills to care and support people who used services.

Is the service caring?

We spent time in communal areas and saw people being supported by staff members in a patient, caring and unhurried manner. Care and support was provided in accordance with the wishes of people as recorded within their individual care plans.

People using services and their relatives had completed an annual satisfaction survey. We noted a high level of satisfaction had been recorded for both surveys and any issues that had been raised had been addressed.

Is the service responsive?

All people using services had undergone a pre-admission assessment and we saw that they and their families had been involved in writing up their care plans. Care was delivered in line with the choices and preferences which had been expressed by the person at the time of the assessment.

People had access to activities at the rest home and around the local community. One person had gone out with her friends for the day. People using services took part in a quiz during the morning and in the afternoon, the Salvation Army attended and sang several songs which people joined in with. People were also supported and encouraged to attend church services of their choice which helped meet their spiritual needs.

Is the service well-led?

We saw evidence of a multi-agency approach to providing care at Melrose Court Rest Home. All professional visits had been recorded within people`s care plans. The provider told us they had a good relationship with other professional agencies and were told, "When we need to call them out they usually attend very quickly."

The provider showed us evidence of regular internal and external audits which were aimed at improving the quality of service being provided to people using services. We saw that if any issues had been identified during the auditing process, an action plan was implemented and all issues had been addressed. Staff members were aware of their roles and responsibilities which meant people using services received good quality care at all times.

We inspected the home because when we previously inspected in April 2013 we found there were improvements that needed to be made in two areas of care. These were; how people who may lack the mental capacity to make decisions for themselves are assessed and managed and management of medicine administration.

The provider had sent us an action plan outlining how they would become compliant and meet regulations. We carried out this inspection to check improvements had been made.

We found that where people did not have the mental capacity to consent to their care the provider was able to demonstrate they had put assessments and systems in place so that people’s rights were maintained and the provider was acting within legal requirements and good practice.

We looked at medicine administration and safety and found the provider now had systems in place to ensure safe standards.

We looked at some specific care and treatment issues for people who lived at Melrose Court to assess whether they had been involved in decisions and whether their consent had been gained. We found there was a lack of clear systems in place to assess and record people’s mental capacity and agreement to treatment and care.

People told us they were happy with the care and support they received. Their comments included, ‘’ It’s lovely here – I am well looked after.’’ ‘’The staff are very good and are on hand to help me with my care when I need it.’’ ‘’ I feel this is my home. I go out regularly and come and go as I please.’’

We found staff ensured good referral and access to health care professionals so people’s right to ongoing health care was maintained. We found that people were not fully protected against the risks associated with medicines and there were some improvements needed to ensure standards are maintained.

We looked at staffing and saw there were enough staff to carry out care for people. People we spoke with said that staff were supportive and competent.

People we spoke with said could make their views known if they were not happy with the service provided. There were systems in place to help ensure the quality of care was monitored and safety standards were maintained.

People told us what it was like to live at this home and described how they were

treated by staff and their involvement in making choices about their care. They

also told us about the quality and choice of food and drink available. This was

because this inspection was part of a themed inspection programme to assess

whether older people living in care homes are treated with dignity and respect

and whether their nutritional needs are met.

The inspection team was led by a Care Quality Commission (CQC) inspector

joined by an Expert by Experience who has personal experience of using or

caring for someone who uses this type of service. At the time of our visit sixteen people lived in the home. We spoke with seven of these people and two family members visiting people. We also spoke to the home manager and five care assistants.

During our observations we saw staff were respectful and treated people as individuals when they provided care to them. For example, when supporting people to eat their meals, staff were careful to feed at a gentle pace, asking the person if they were ready for another spoonful of food and using their name when talking to them. We heard staff talk to people in calm, supportive tones and not rushing people such as when supporting them to move around the home

The support provided also respected individual needs and pace. For example, at lunchtime one person was supported to walk in using a walking frame and another with support of the member of staff.

We also observed that everyone was looked clean and well cared for.

We observed lunchtime in the dining room. There was one person who required help with finishing their meal. This support was delivered in a person centred and unobtrusive way. Staff took time to allow people to eat their food and offered them a sip of their drink throughout the meal. They regularly spoke to them using their name and made conversation throughout the meal time. Meals were eaten in a pleasant room, with condiments, flowers and napkins on the tables. The meal time was not rushed. We saw that food was served hot and presented well on the plate. One person who lived at the home told us the meal they had just eaten was very nice.

During our observations we saw there was enough staff to meet people’s observable care, support and nutritional needs. The interaction between people who lived at the home and the staff was relaxed and informal and the atmosphere was friendly and homely.

One person told us; “I can go out with the carers; they’re very good”