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 mana

Melrose House provides accommodation and personal care for adults with mental health needs or a learning disability. The home can accommodate up to ten people. At the time of our inspection nine people were in receipt of care and support from the service.

We carried out an unannounced comprehensive inspection of this service on 3 and 4 October 2015. Breaches of legal requirements were found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to person centred care, safe care and treatment, premises, staffing and good governance.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Melrose House on our website at www.cqc.org.uk

The new manager of the service was registered with the Care Quality Commission. 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.

People told us they felt safe living at Melrose House with the support of the staff. Safeguarding procedures were now in place and the manager ensured staff were aware of their responsibilities. Accidents and incidents were recorded, monitored and reported as necessary to the local authority and CQC.

A previous ‘house rule’ which restricted people’s freedom had been immediately removed following the last inspection and people were able to choose what time they went to bed at night.

Improvements had been made in infection control. Deep cleaning had taken place, staff training had been provided by the local NHS infection control and prevention team and one support worker had been given the responsibility of cleaning and maintaining communal areas.

The manager and provider had ensured the premises were safe. Essential safety checks of the electrical hardwiring, portable appliances and emergency lighting had all been undertaken. Equipment used to help people mobilise around the property had been recently serviced.

Risk assessments which were previously missing were in place but needed further development and the manager intended to address this issue immediately.

Existing staff recruitment records needed to be re-audited as they were still missing some documentation which verifies a person’s identity and suitability to work with vulnerable adults. The manager addressed this issue during the inspection and had implemented a checklist to use when recruiting new staff.

Care records had been given some attention. The manager had created new medicine files which contained a detailed, person-centred medicine care plan and records of daily well-being checks. However other care records did not contain thorough assessments of people’s needs, person-centred care plans and detailed risk assessments. The manager told us she would address this urgently and link up with a local care home manager for additional support and guidance on this aspect of the service. We made a recommendation about this.

People continued to access the community as they wished and made their own arrangements with regards to activities. The service had communal activities available for people to access if they wished within the home and they organised monthly parties, theme nights and celebrations to encourage socialisation.

The service had received no complaints since the last inspection. During the inspection nobody raised any concerns with us and the feedback we received from external professionals and services was positive.

Everyone we spoke with spoke highly of the manager. We saw she had made a lot of improvements thr

We spoke with five people about their experience of the care and support they received. We also spoke with the manager and two staff.

People and staff told us that consent was gained before care was delivered and we found that the provider acted in accordance with people’s wishes.

We found people’s needs were assessed and care and treatment was planned and delivered in line with their individual care plans. We observed that relationships between staff and people appeared to be good and people appeared relaxed and well cared for.

Records were available to show that the manager monitored the administration of medication. This meant that people’s medicines were checked regularly by the manager to see that staff were administering, ordering and disposing of medication properly.

There were enough qualified, skilled and experienced staff to meet people’s needs. One person said, “The staff are lovely, there are always there to help.”

The provider had effective systems to regularly assess and monitor the quality of service that people received.

We talked with people who had lived at the home for some time and people who had more recently moved in. Some people were not able to tell us about their experiences due to their abilities or health at the time of the visit.

People we spoke with were happy with the arrangements for their care. Two people thought they would do more for themselves once the premises were altered so that they could use the laundry and looked forward to doing so. People felt they were supported and had their independence promoted and said, "I like it here, the staff are good and they are helping me to be independent and live in the community" and " The staff help me, I like my keyworker."

We spoke with a married couple one of whom said,"We are proud of our room, it is away from everyone else on the top floor. We have our own furniture and new wardrobes."

Melrose House provides personal care and accommodation for adults with mental health needs or a learning disability. The home can accommodate up to ten people. At the time of our inspection nine people were in receipt of care and support from the service.

The inspection took place over two days, 3 and 4 November 2015 and was unannounced. The manager and one care worker were on duty throughout the duration of the inspection. The manager had been in post since July 2014 and was in the process of applying to the Care Quality Commission to become the registered manager of the home. The service has not had a registered manager since July 2014.

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.

People spoke highly of the manager and the care workers who supported them to live independently at the service. People told us they felt safe and secure. They informed us that they felt well-cared for, happy and relaxed.

Policies and procedures were in place to safeguard people from harm or abuse, however there was no effective system in place to record any incidents or monitor trends. This could mean that reoccurring incidents were not investigated properly or managed effectively. The manager informed us that they were aware that all the service’s policies and procedures were in need of updating.

People told us about a variety of activities and clubs they attended in the community. Most people actively accessed the local community themselves and we observed people going out shopping for items for the evening meal. The home had recently celebrated Halloween and people told us how they had been involved in decorating the home and had worn fancy dress costumes, which they enjoyed.

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 manager told us that nobody living at the home had any restrictions placed on their liberty in line with the Mental Capacity Act 2005.

People told us they received their medication in a safe and timely manner. We observed staff following the medication procedure correctly and people receiving their medication as prescribed. Medication was stored safely and securely and records were concise and up to date.

People were supported by the service to maintain a balanced diet. Menu’s contained a variety of options and people could choose for themselves. We observed people enjoying an evening meal in which one person had been involved in preparing with staff.

Overall, people’s care needs were assessed and the service had considered risks associated with these needs. The staff had a good knowledge of the care people required. However, care records were adequately detailed and the manager had not considered the risks associated with people accessing the community. One person had not had risks associated with their mental health condition assessed and measures were not in place to mitigate these risks as much as possible.

There were sufficient staff employed to manage the service and all had been employed for longer than nine months. Staff had received a variety of training and had either completed or were working towards qualifications in health and social care. The manager carried out regular staff supervision and appraisal meetings which confirmed they all took an active part in these meetings.

Staff vetting procedures were not robust with unexplained gaps in employment histories and references not always obtained from potential new staff’s previous employers. Evidence suggested that Disclosure and Barring Service (DBS) checks had not been carried out and checked appropriately.

The building was in a relatively good state of repair and decoration. Individual bedrooms and communal bathrooms were not clean and were in need of some attention. The kitchen extension to the rear of the ground floor was well equipped and well used by people living at the service.

We found that several mandatory premises checks were not up to date. We brought this to the attention of the manager during the inspection and she acted upon our concerns straight away.

We found a significant number of events where the police had been involved had not been notified to us.

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