The inspection took place on 10 November and was unannounced. The inspection continued 13 November and was again unannounced.

The Mellowes 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 40 people across two floors, each of which has separate adapted facilities.

Our last inspection on 10 and 11 May 2017 found that systems and processes were not in place to ensure robust assessing and monitoring of quality, safety and risks. We found that some people did not receive safe care and treatment. Staff did not receive regular supervision and appraisal. Risks were not assessed or mitigated effectively. People did not always receive personalised care and consent was not always sought. During this inspection we found that improvements had been made.

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 safe, effective, caring, responsive and well led to at least good. We found that during this inspection the action plan had been followed and improvements had been made.

The service had a registered manager in place. 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.

Risk assessments in relation to people’s care and treatment were completed, regularly reviewed and up to date. However, risk assessments associated to activities inside and away from the service were not in place.

Specific care plans were not completed to reduce the risk of infections and guidelines to include the use of some personal protective equipment was not always in place. The registered manager told us that this would be completed as a priority.

People, relatives, a health professionals and staff told us that the service was safe. Safeguarding alerts were being managed and lessons learnt by the home. Professionals confirmed that improvements had been made. Staff were able to tell us how they would report and recognise signs of abuse and had received training in safeguarding.

Care plans were in place which detailed the care and support people needed to remain safe whilst having control and making choices about their lives. Each person had a care plan and associated files which included guidelines to make sure staff supported people in a way they preferred.

Medicines were managed safely, securely stored, correctly recorded and only administered by on duty nurses and team leaders that were trained and assessed as competent to give medicines.

Staff had a good knowledge of people’s support needs and received regular local mandatory training as well as training in response to people’s changing needs for example some people were receiving end of life care and staff had been trained in this area.

Staff told us they received regular supervisions which were carried out by the management team. Staff told us that they found these useful. We reviewed records which confirmed this.

Staff were aware of the Mental Capacity Act and training records showed that they had received training in this. Capacity assessments were completed and best interest decisions recorded as and when appropriate.

People and relatives told us that the food was good. We reviewed the menu which showed that people were offered a variety of healthy meals. We saw that food was regularly discussed and recorded on food preference sheets. The chef told us that the majority of meals are home cooked.

People were supported to access healthcare appointments as and when required and staff followed professi

The Mellowes is a nursing home that is situated on the outskirts of Gillingham. Accommodation is provided over two floors. A passenger lift enables access to the upper floor. All rooms have en-suite toilet and washbasin facilities. The Mellowes has three communal lounges and a dining area. The home has landscaped gardens and a patio. The Mellowes is registered to support 45 older people, at the time of the inspection there were 36 people living at the home.

We inspected The Mellowes in November 2015. At that Inspection the service was rated Good. At this inspection we found the provider to be in breach of five regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. These correspond to regulations, 9, person centred care, 11, consent, 12, Safe Care and Treatment, 18, staffing, and 17 good governance of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

There was 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.’ At the time of the inspection the registered manager had just taken back full responsibility of the home. They had previously been supporting the management of two of the provider’s homes.

We found a number of areas where care was not completely safe and where staff needed better information and guidance on how to support people’s emotional and social needs. Procedures to assess and monitor risks to people’s health and safety were not always followed. Where people were at risk of dehydration, fluid intake levels had not been recorded.

Risks to people were identified but measures were not always implemented to reduce the risk. Some risks had not been fully assessed, and measures to reduce the risk to people were not fully effective or agreed with other health professionals.

Where people required specialist equipment such as specialist chairs, pressure mattresses, mobility aids or hoisting equipment, these were provided. Although staff told us they had been trained in moving and assisting, people told us they were not always supported to transfer safely.

Improvements were needed to make sure everyone received person centred care and had opportunities for social stimulation. This was a particular concern regarding the care of some people who remained in their rooms. There was an activity programme in place, however records and observation showed some people were left for long periods of the day alone.

People had mental capacity assessments in their care plans. However. although we found evidence of decision specific mental capacity assessments, few had been completed to include evidence of subsequent best interest decision making involving all relevant parties.

A recruitment procedure was in place and staff received pre-employment checks before starting work with the service. New members of staff received an induction which included shadowing experienced staff before working independently. There was no evidence of supervision or support over a period of six month for new staff or for existing staff. This meant there was a risk new staffs were not being appropriately supported within their roles.

Registered nurses were always on duty and held the responsibility for leading the shifts, which meant people’s healthcare needs were monitored. People told us they did not always receive support in a timely manner. Staff were seen to be task focused. One visiting health professional told us, “I am concerned at times that things don’t always get done as quickly as requested”.

Systems were in place to ensure people received their medicines safely. All staff received medicine administration training and had to be assessed as competent before

People told us that their agreement was sought prior to staff supporting them with their care needs. A person told us, "They explain what they are going to do and ask if it’s O.K.” Another person told us, “They ask my permission.”

People's needs were assessed and care was planned and delivered to meet people's needs. A visiting relative told us, "His care has been good – If there are any changes they do keep me informed."

We saw that medicines were stored securely and given at the correct time. We found that the home had procedures in place for the management and disposal of controlled drugs. A person told us, “They manage my medicine. They’ve never made any mistakes. They are very diligent.”

People’s needs were met by staff who were appropriately supported, trained, supervised and appraised. Staff were enabled to acquire further skills and qualifications that were relevant to the work that they did. A care assistant told us, "I really love my job -- I get on the job supervision. My supervisor does spot checks and will pull you up on anything that looks out of line."

The home had systems in place to manage comments and complaints. The home also had procedures to ensure that comments and complaints were responded to appropriately.

We saw that the home has had recently undergone a refurbishment. The registered manager told us, “People were involved in choosing the colours they preferred in their rooms.”

Our inspection of 10 April 2012 found that people were not always involved in the planning of their care and they had not received personal care when it was needed. During this inspection we found that improvements had been made. One person told us “We were involved in the development of our care plans”. Another person told us “We get assistance whenever we want it”.

Our previous inspection found that appropriate standards of cleanliness of shared equipment had not been maintained. During this inspection we found that improvements had been made. One person told us “The equipment is clean. I’ve never noticed it to be dirty”.

Our previous inspection found that the provider did not always develop action plans to address problems identified by audits they had undertaken. This had resulted in the same issues being identified several times and a risk that people received inappropriate care. We found that improvements had been made and action plans were developed and reviewed.

People told us that they were treated with dignity and respect and were supported to manage their care needs. One person told us “the nursing staff will check that I’ve had my treatment as sometimes I forget”. People were involved in planning their care but were not always involved in the review. People told us that their care and treatment was appropriate and delivered by skilled staff. One person told us “the staff know what they are doing.

People were able to access other care services as they required. One person told us “I can see a doctor when I want, I don’t usually have to wait long, I feel enough information is passed from the home to whoever visits”.

People told us they felt safe at The Mellowes and able to raise concerns and complaints. The staff we spoke to were able to tell us how they would identify and respond to any allegation or suspicion of abuse. Call bells were answered promptly. One person told us “my call bell is answered quickly, it’s quite amazing really”. People’s views and opinions were sought. One person told us “the new manager has introduced fortnightly resident’s meetings. I think it’s good, she listens to us”.

We found that people’s care plans reflected the assessment of their needs and staff demonstrated knowledge of people’s needs and care plans. We spoke to visiting professional’s who told us the provider worked well with them for the benefit of people living at the home. We saw that people had access to call bells throughout the home and that these were responded to. The duty rota showed that there was a consistent number of staff throughout the week and at weekends.

A structured quality assurance process was in place which included completion of audits of practice. Action plans were not consistently generated as a result of all quality monitoring activity which resulted in the same deficits being identified but not being addressed.

There were policies and procedures in respect of infection prevention and control, and practice was audited. The appropriate standard of cleanliness of shared equipment was not always maintained. This may have put people at risk of cross infection.

People who lived in the home told us that they were able to make choices about what they did and were respected by staff. We saw that people’s privacy and dignity was not consistently respected.

People were able to receive visitors and participate in meaningful activities.

People we spoke with told us they would know how to raise any concerns they may have.

A person’s relative considered that people did not have to wait long to be seen by staff and there were adequate staff members available to give support.

People we spoke with were aware of how to raise concerns and considered that the care they received was satisfactory. They considered that they were safe.

Although peoples experiences are good, they were not always involved in decision making and their care plans were not routinely updated to make sure that it reflected their current needs.

This inspection took place on 17 and 19 November 2015.

The Mellowes Nursing Home provides nursing and residential care for up to 45 older people. There were 40 people living in the home at the time of our visit. Accommodation was over two floors with outside space accessible from downstairs.

There was 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 2008 and associated Regulations about how the service is run.

There were sufficient trained and competent staff to meet people’s needs. The registered manager had been proactive in recruiting staff and was introducing an on call system for care workers at weekends. This would mean on call staff could work unfilled shifts if staff were ill at weekends. This would provide people with some continuity. People told us they felt safe living in the home and had confidence in the staff.

People told us they enjoyed the food and were offered a choice at mealtimes; they had access to snacks throughout the day. People who had specific dietary needs were catered for; their nutritional needs were monitored by staff. We saw staff encourage some people to eat and drink when they needed some help or support. People who had specific dietary needs were reviewed weekly.

People told us they were happy with the care they received, they were positive about staff. We saw staff being kind and respectful to people. People and their families told us they felt involved in decisions about their care. People had their privacy and dignity respected.

People had personalised care plans which were informative and indicated peoples likes, dislikes and preferences. Staff were able to talk with us about people and demonstrated to us they knew people as individuals.

There was a clear management structure. The registered manager was supported by a deputy manager and staff told us they felt supported and that management were approachable. There were robust systems in place for monitoring the quality of the service. Senior management did unannounced monitoring visits each month and the registered manager was responsible for ensuring that any actions were completed within an agreed timeframe.

Staff told us they loved working in the home and staff talked about the home being part of the community. One member of staff bought their dog into work each day which some people enjoyed and benefitted from. There was a range of activities available and people were asked what they would prefer. People who were nursed in bed or chose to stay in their rooms had visits from an activity co-ordinator. The registered manager was recruiting a second member of staff to support the activity coordinator so that more activities could be offered over the full week.

Staff told us that in addition to their usual annual training they had access to further training opportunities. One member of staff attended training on the Gold Standard Framework for end of life care. This is a nationally recognised training to support staff in delivering good end of life care support. People, who chose to were being supported to have an advanced care plan to ensure they received the care they wanted for themselves at the end of life.

There were systems and processes in place to ensure effective communication with people, their families and staff. For example, there were meetings for people, questionnaires and various staff meetings where information could be shared and suggestions made.

Information was on display either in reception or on notice boards in communal areas, for example about the home. On entering the building there was a friendly welcome from staff.