The inspection was completed on 29 January 2018 and was unannounced. At the time of this inspection there were 16 people living at Melrose House.

Melrose House 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 up to 34 older people and people living with dementia.

Melrose House is a large detached building situated in a quiet residential area in Southend on Sea and close to all facilities and amenities. The premises is set out on three floors with each person using the service having their own individual bedroom and adequate communal facilities are available for people to make use of within the ground floor.

At the last inspection on the 19 and 20 September 2017, the service was rated ‘Requires Improvement ’. A breach of regulatory requirements was evident for Regulation 13 [Safeguarding service users from abuse and improper treatment], Regulation 17 [Good governance] and Regulation 18 [Staffing]. 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 of ‘Safe’, ‘Effective’, ‘Caring’, ‘Responsive’ and ‘Well-Led’ to at least good. The home improvement plan was received on 24 November 2017. At this inspection, we found the service had made significant improvements and was now rated ‘Good’. However, ‘Well-Led’ was rated ‘Requires Improvement’. This is because the location has a condition of registration that it must have a registered manager, but it does not have one. We held an internal management review meeting on 1 February 2018 and agreed that the service no longer needed to remain in ‘Special Measures’ and the condition imposed on the registered provider’s registration in 2016 removed.

Our key findings across all the areas we inspected were as follows:

Suitable arrangements were now in place to assess and monitor the quality of the service provided. There was a positive culture within the service that was person-centred, open and inclusive. The registered provider and manager were able to demonstrate a better understanding and awareness of the importance of having suitable quality assurance processes in place. This was a significant improvement and this had resulted in better outcomes for people using the service. Feedback from people, those acting on their behalf and staff were positive. This referred specifically to there now being confidence that the registered provider and management team were doing their utmost to make the required improvements.

Suitable arrangements were now in place to take action when abuse had been alleged or suspected. People were protected from abuse and avoidable harm and people living at the service confirmed they were kept safe and had no concerns about their safety and wellbeing. Policies and procedures were being followed by staff to safeguard people and staff now understood the importance of these measures. We observed that staff followed safe procedures when giving people their medicines. Medicines were stored safely and records showed that minor improvements were required to ensure people received their medicines as prescribed.

Risks to people were clearly identified and managed to prevent people from receiving unsafe care and support. People were protected by the provider’s arrangements for the prevention and control of infection. Arrangements were in place for learning and making improvements when things go wrong.

People were treated with care, kindness, dignity and respect. People received a good level of care and support that met their needs and preferences. Support plans were in place to reflect how people would like to receive their care and support, and covered all aspects of a person's individual circumstances. Staff had a good knowledge and understanding o

At a previous unannounced comprehensive inspection of this service carried out on 7, 13 and 14 March 2017 we found breaches with regulatory requirements relating to Regulation 9 [Person centred care], Regulation 10 [Dignity and respect], Regulation 12 [Safe care and treatment], Regulation 13 [Safeguarding service users from abuse and improper treatment], Regulation 15 [Premises and equipment], Regulation 17 [Good governance] and Regulation 18 [Staffing]. As a result of our concerns the Care Quality Commission took action in response to our findings by rating the service as ‘Inadequate’ and placing the service back into ‘Special Measures.’ Following the inspection action was taken to cancel the registered manager’s registration.

We asked the registered provider to send us an action plan which outlined the actions they would take to make the necessary improvements. In response, the registered provider shared with us their action plan at regular intervals between August and September 2017detailing their progress to meet regulatory requirements and to achieve compliance with the fundamental standards. At this inspection some considerable progress had been made to meet regulatory requirements, however further improvements were still required, in particular relating to the registered provider’s quality assurance and governance arrangements.

The overall rating for this service is 'Requires Improvement.' However, we are placing the service in 'Special Measures.' We do this when services have been rated as 'inadequate' in any key question over two consecutive comprehensive inspections. The 'Inadequate' rating does not need to be in the same question at each of these inspections for us to place services in special measures.

Melrose House provides accommodation, personal care and nursing care for up to 34 older people and older people living with dementia.

This inspection was completed on 19 and 20 September 2017. There were 18 people living at the service when we inspected.

A registered manager was not in post at the time of this inspection. The service was being managed by a team leader as the manager who had been appointed in May 2017 had left the service prior to 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.

Whilst improvements were noted since our last inspection in relation to some aspects of care provision, for example, care planning arrangements, medicines management, ensuring that bedrails for people using the service were now safe and fit for purpose, pressure relieving equipment was set correctly and infection control practices were now effective; quality assurance arrangements at provider and service level were not robust or as effective as they should be.

There was a lack of oversight by the registered provider to check and monitor the quality of the service provided or to check that the manager was making progress to the action plan so as to achieve compliance with regulatory requirements. It was evident from our findings at this inspection and following discussions with the registered provider that they had relied heavily on the manager to provide them with reassurance about their progress. Although the registered provider was told not to worry and everything was in hand, the registered provider had failed to monitor and evaluate this progress properly so as to assure themselves that sufficient improvements had been undertaken to their audit and governance arrangements and these were effective.

Robust procedures and processes that make sure people are protected from abuse and improper treatment had not been considered and followed by the manager. There had been a lack of preventative actions undertaken by t

Following comprehensive inspections to the service in March 2016 and September 2016, the service attained an overall quality rating of ‘Inadequate’. As a result of our concerns the Care Quality Commission took action in response to our findings by placing the service into ‘Special Measures’ and amending the provider’s conditions of registration. This included the provider not being able to admit anyone new to the service. However, following a further inspection to the service in December 2016, the quality rating of the service was judged to be ‘Requires Improvement’ as a result of significant improvements made at that time. The Care Quality Commission agreed with the provider and registered manager that admissions to the service could be reinstated but only with the ‘Commission’s permission. However, at this inspection we found that those improvements had not been sustained or maintained.

Melrose House provides accommodation, personal care and nursing care for up to 34 older people and older people living with dementia.

This inspection was completed on 7, 13 and 14 March 2017. There were 23 people living at the service when we inspected.

The overall rating for this provider is ‘Inadequate’. This means that it has been placed back into ‘Special measures’ by the Care Quality Commission. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve.

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

• Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will be kept under review and if needed could be escalated to urgent enforcement action.

A registered manager was in post at the time of this inspection and had been registered with us since 6 February 2017. 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.

There was a lack of provider and managerial oversight of the service. Quality assurance audits carried out by the deputy manager were not robust, as they did not identify the issues we identified during our inspection and had not identified where people were placed at risk of harm or where their health and wellbeing was compromised. The provider and registered manager had not monitored progress in relation to the above so as to improve the quality and safety of services, and take appropriate action where progress was not achieved. In particular, the provider and registered manager had not ensured that information was accurate and properly analysed or that the person delegated to undertake this role was skilled and competent.

Suitable control measures were not put in place to mitigate risks or potential risk of harm for people using the service as steps to ensure people and others health and safety were not always considered and risk assessments had not been developed for all areas of identified risk. The management of medicines was not consistently safe as people did not always receive their medication as prescribed and medicines were not

Melrose House provides accommodation, personal care and nursing care for up to 34 older people and older people living with dementia.

Following our inspection to the service on 1, 2 and 5 September 2016, and as a result of repeated failings, an internal management review meeting was held on 5 September 2016, when it was agreed that a Notice of Proposal to cancel the provider’s registration would be issued. The overall rating for this provider was ‘Inadequate’. This means that it remained in ‘Special measures’ by the Care Quality Commission.

The provider shared with us their action plan on 6 November 2016. This provided sufficient detail outlining their progress to meet regulatory requirements. Following this inspection of 12 December 2016 a further internal management review meeting was held on 14 December 2016, whereby it was agreed that sufficient improvements had been made to not pursue our action to cancel the provider’s registration.

This inspection was completed on 12 December 2016. There were 22 people living at the service when we inspected.

The service had a manager in post. They were not yet formally registered with the Care Quality Commission but had submitted their application to be registered with us and were awaiting their ‘Fit Person Interview’. 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.’

We found the provider and manager had made some progress to address previous identified shortfalls, however there were still areas that had not been satisfactorily addressed and these had not been picked up as part of the provider’s quality assurance arrangements.

Suitable control measures were not always in place to mitigate risks or potential risk of harm for people using the service as steps to ensure people and others health and safety were not always considered. The management of medicines was not safe as people did not always receive their medicines as prescribed.

Improvements were required to ensure that staff received a robust induction for their role and responsibilities. Furthermore, improvements were required to make sure where topics were discussed as part of formal supervision arrangements, actions were not recorded and addressed. Aims and objectives were not set as part of annual appraisal procedures.

People told us the service was a safe place to live and that there were sufficient staff available to meet their needs. Staff understood the risks and signs of potential abuse and the relevant safeguarding processes to follow.

Appropriate arrangements were in place to recruit staff safely so as to ensure they were the right people. Staff were able to demonstrate a good understanding and knowledge of people’s specific support needs.

Staff demonstrated a good understanding and awareness of how to treat people with respect and dignity. The dining experience for people was positive and people were complimentary about the quality of meals provided. People received appropriate support to have their social care needs met. People told us that their healthcare needs were well managed. Care plans accurately reflected people’s care and support needs.

Where people lacked capacity to make day-to-day decisions about their care and support, we saw that decisions had been made in their best interests. The manager was up-to-date with recent changes to the law regarding the Deprivation of Liberty Safeguards (DoLS) and at the time of the inspection they were working with the local authority to make sure people’s legal rights were being protected.

Staff were friendly, kind and caring towards the people they supported and care provided met people’s individual care and support needs.

People and their relatives told us that if they

Melrose House provides accommodation, personal care and nursing care for up to 34 older people and older people living with dementia.

Following our inspection to the service in March 2016, an Urgent Notice of Decision was issued to the registered provider advising that no further admissions could be made to the service without the prior agreement of the Care Quality Commission (CQC). The overall rating for this provider was ‘Inadequate’. This means that it was placed into ‘Special measures’ by CQC. In addition, the Care Quality Commission met with the registered provider on 11 April 2016 to discuss our on-going concerns. During the meeting the registered provider and registered manager gave an assurance that things would improve.

This inspection was completed on 1, 2 and 5 September 2016. There were 23 people living at the service when we inspected.

The overall rating for this provider is still ‘Inadequate’. This means that the service remains in ‘Special measures’ by CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve.

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

• Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

Because the service was in special measures already we inspected within the six months timeframe. Insufficient improvements had been made; we are now taking action in line with our enforcement procedures.

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.

There was a lack of provider and managerial oversight of the service. Quality assurance checks and audits carried out by the registered manager were not robust, did not identify the issues we identified during our inspection and had not identified where people were put at risk of harm or where their health and wellbeing was compromised. There was a reactive rather than proactive approach by the management team which meant that people did not receive a consistent safe and appropriate service. Lessons had not been learned and several areas of improvement had not been sustained in the longer term.

Staff were able to demonstrate an understanding and awareness of the different types of abuse and how to respond appropriately where abuse was suspected, however the registered manager had failed to implement robust procedures and processes to make sure that people using the service were safeguarded and protected from abuse.

Suitable control measures were not put in place to mitigate risks or potential risk of harm for people using the service as steps to ensure people and others health and safety were not always considered. Risk assessments had not been developed for all areas of identified risk and had not always been completed to determine that these were suitable for the individual person so that any risks identified were balanced against the anticipated benefits. The management of medicines was not safe as people did not always receive their medicines as prescribed.

People did not think that there were sufficient numbers of staff available to meet their needs. Our observations showed that staffing levels and the deployment of staff were not always suitable. Staff did not always have time to spend with the people they supported to meet their needs and the majority of interactions by staff were routine and task orientated. People’s comments about the care and support they received were variable. Wh

Melrose House provides accommodation, personal care and nursing care for up to 34 older people and older people living with dementia.

The inspection was completed on 29 March 2016 and 31 March 2016. There were 32 people living at the service when we inspected.

The overall rating for this provider is ‘Inadequate’. This means that it has been placed into ‘Special measures’ by the Care Quality Commission. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve.

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

• Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will be kept under review and if needed could be escalated to urgent enforcement action.

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.

There was a lack of provider and managerial oversight of the service as a whole. Quality assurance checks and audits carried out by the registered manager were not robust, did not identify the issues we identified during our inspection and had not identified where people were put at risk of harm or where their health and wellbeing was compromised.

Suitable control measures were not put in place to mitigate risks or potential risk of harm for people using the service as steps to ensure people and others health and safety were not always considered. Controls to manage the risk from hot water were not in place and therefore increased a scalding risk to people using the service. Safety checks relating to the service’s gas and electrical installations had not been completed at suitable intervals to ensure that these were safe. Individual Personal Emergency Evacuation Plans (PEEP) were not in place to respond effectively to health and safety incidents and other emergencies that may occur. Equipment within the kitchen and adjoining utility area were not properly maintained and people did not always have access to an appropriate supply of hot water.

People did not think that there were sufficient numbers of staff available to meet their needs or their relative’s needs. The deployment of staff was not appropriate to meet the needs of people who used the service and required reviewing so as to ensure people’s care and support needs were met. Staff did not have time to spend with the people they supported to meet their needs and the majority of interactions by staff were routine and task orientated. Suitable arrangements were not in place to ensure that the right staff were employed at the service.

The implementation of staff training was not as effective as it should be so as to ensure that staff knew how to apply their training and provide safe and effective care to the people they supported. Not all staff had received regular supervision or an annual appraisal. Formal support arrangements were not always in place for staff and people did not benefit from a well-supported staff team through appropriate training

We visited Melrose House in April 2013 and found that improvements were needed in a number of areas. This inspection of September 2013 was to check if the required improvements had been made.

We spoke with a number of people living in Melrose House and a visiting relative. People were happy with the care and support provided and thought that the staff were kind and responsive.

We found that the service was being maintained to a better standard of cleanliness. The right guidelines and suitable procedures were in place to ensure that people were protected by better levels of infection control being maintained.

Staffing levels were being monitored more closely. Better levels of staffing were being maintained to ensure that people were cared for safely.

People praised the staff at the service and made comments such as, "They are all good, kind and they look after me well." We found that staff were now better supported through induction, supervision and ongoing training.

We found that the quality and safety monitoring of the service had improved, but that further work was needed to provide a fully robust system. People now had more opportunities to express their views on the service.

During our inspection in April 2013 we spoke with a number of people living in Melrose House and three visiting relatives/friends. People were satisfied with the care and support provided by staff and management. One person told us, "I am quite happy and comfortable here." We saw that the service had received positive feedback and thank you cards from people who had used it.

We found that the service needed to take action in some areas to improve the quality of care and service provided to people. People needed to be more involved in saying how they wished their needs to be met and in ongoing reviews of their care needs. Peoples' care plans needed to be more consistent and in some cases more comprehensive to ensure that people's individual needs were understood and met.

Staffing levels/deployment needed to be improved to ensure that staff are readily available when needed and to provide better opportunities for stimulation and activity.

People praised the staff at the service and made comments such as, "They are a good team here and they look after me well." We saw that staff had a good relationship with people and treated people using the service with kindness and respect. We did find however that improvements were needed to ensure that staff were properly trained and supported in carrying out their role.

We found that the overall quality and safety monitoring of the service needed to be improved, but that in many instances improvements were in hand.

People using the service told us that they were happy living in Melrose House and that they felt satisfied with the care and support they were offered.

People said that they liked the food provided and told us they were offered choice about what they ate.

People told us that they felt safe and secure and that the staff were friendly and caring.

The inspection took place on 16 April 2015 and 6 May 2015. Melrose House is care home for up to 34 older people who require support and personal care. People living at Melrose House may have care needs associated with living with dementia. At the time of our inspection 28 people were living at the service.

The service had 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.

People had some opportunities to participate in activities. However, more could be done to ensure that activities were based around people’s individual needs and interests, with good levels of equipment and resources being available to help staff to achieve this.

People felt safe. The provider had taken steps to identify the possibility of abuse happening through ensuring staff had a good understanding of the issues and had access to information and training. The service ensured that people were cared for as safely as possible through assessing risk and having plans in place for managing people’s care.

People were treated with kindness and respect by a sufficient number of staff who were available to them when they needed support. People and their families were happy with the care that was provided at the service.

Staff demonstrated knowledge and skills in carrying out their role. People were supported effectively and safely by staff who were kind and caring.

Staff were properly recruited before they started work at the service to ensure their suitability for the role. Staff received initial and ongoing training and support but there were some shortfalls in the levels of training undertaken by staff.

People were supported with their medication in a way that met their needs. There were safe systems in place for receiving, administering and disposing of medicines.

The manager has a good knowledge of the Mental Capacity Act (MCA) 2005 Deprivation of Liberty Safeguards (DoLS.) DoLS are a code of practice to supplement the main Mental Capacity Act 2005. These safeguards protect the rights of adults by ensuring that if there are restrictions on their freedom and liberty these are assessed by appropriately trained professionals.

People were supported to be able to eat and drink sufficient amounts to meet their needs. People told us they liked the food and were provided with a variety of meals. Care tasks were carried out in ways that respected people’s privacy and dignity

People’s care needs were assessed and planned for. Care plans and risk assessments were in place so that staff would have information and understand how to care for people safely and in ways that they preferred. However, more could be done to ensure that care plans were better individualised and person centred.

People’s healthcare needs were monitored, and assistance was sought from other professionals so that they were supported to maintain their health and wellbeing.

Systems were in place to assess and monitor the quality of the service. People’s views were sought and some audits were carried out to identify any improvements needed.