The inspection took place on 12 April 2017 and was unannounced.

The Mellows is a residential service which provides care to older people, some of whom were living with dementia. The Mellows is registered to provide care for up to 50 people. At the time of our inspection there were 42 people living there.

This service was last inspected on 29 June and 01 July 2016, three regulations were not met and improvement was required. This inspection was carried out to check sufficient improvements had been made to the service.

The home is required to have 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 and associated Regulations about how the service is run. At the time of this inspection the home had a registered manager.

The service did not have a clear process in place to ensure people were always offered a choice of food and drink. People's nutritional needs had been assessed.

Where people who used the service lacked capacity to consent to care and treatment the appropriate steps were taken to protect their rights. Mental capacity assessments were completed and correct procedures were followed under Deprivation of Liberty Safeguards.

Staff were trained in the safe administration of medicines and had their competency assessed on a regular basis. Audits of medicines were carried out regularly and these were effective in identifying issues.

There were systems in place to ensure risks were assessed and steps taken to mitigate the identified risks. Staff were aware of how to recognise and report any allegations of abuse and had attended safeguarding training.

There were sufficient staff who had been recruited safely and who had the correct skills and knowledge to provide care and support in ways that people preferred.

Staff received annual appraisals, regular supervision and attended meetings to ensure they reflected on practice and were kept up to date with any changes.

The service had employed an activity co-ordinator who actively engaged with people individually or in groups. Care plans contained information about people's care needs, including their personal histories.

Quality assurance systems had been improved so that the service could be monitored and developed. There were arrangements for people who lived in the home and their relatives to be consulted about their opinions of the service.

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This was an unannounced inspection that took place on 29 June and 1 July 2016

The Mellows is a residential care home that provides accommodation and personal support for up to fifty older people who have a range of nursing, and other care needs associated with old age. On the day of inspection 45 people were using the service.

The home had 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 and associated Regulations about how the service is run.

At this inspection the home did not meet all the regulations. You can see what action we have asked the provider to take at the back of the full version of this report.

The registered provider had failed in their duties to ensure they met their legal obligations in reporting to the Care Quality Commission all safeguarding incidents which had occurred at the home.

People lived in a service where the premises and equipment had been improved to keep them safe, and further improvements had been planned.

People and their relatives told us the home provided a relatively good service. They found that staff were caring, attentive and provided the care and support they needed in a friendly and kind way.

Staff were provided with appropriate training courses to ensure they had the required knowledge and skills to meet people's care needs.

The service had not always carried out regular supervision and appraisal to ensure that staff had the support required.

People's mental capacity assessments were inadequately completed. There was a risk that people's capacity was not assessed in a way that met their needs

People and their relatives were encouraged to discuss health needs with staff and had access to community based health professionals, and GPs as required.

People were protected from risks associated with nutrition and hydration and had balanced diets that also met their likes and dislikes.

There was some improvements to social activities on offer for people who lived at the home.

The service was run by a competent manager with input from the provider, who demonstrated a commitment to make improvements where necessary. Areas for improvement should continue to be identified to drive quality in the service.

We carried out an unannounced comprehensive inspection on 03 March 2015 at which two breaches of the legal requirements were found. These related to the safety and decoration of the premises and the monitoring of the quality of the service.

After the comprehensive inspection, the provider wrote to us to say what they would do to meet the legal requirements in relation to the two breaches. We undertook a focused inspection on the 29 July 2015 to check that they had followed their plan and to confirm that they now met legal requirements. We also followed up on information of concern we had received.

This report only covers our findings in relation to these breaches and concerns. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘The Mellows’ on our website at www.cqc.org.uk.

The Mellows provides accommodation and personal care for up to 51 older people including those living with dementia. At the time of our inspection there were 46 people living in the service.

There was no registered manager at the service on the day of our focused inspection. An application to CQC had been made by the current manager to be the registered manager for the service. A registered manager is a person who has registered with the Care Quality Commission (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.

At our focused inspection on 29 July 2015, we found that the provider had followed their plan which they had told us would be completed by 30 June 2015 for assessing and monitoring the quality of the service, and 31 December 2015 for safety in the environment.

The provider had carried out a range of improvements to make the first floor facilities safer for people to live in.

There were sufficient staff on duty to support people and keep them safe.

Plans were in place to provide people with more opportunities to participate and be engaged in activities of their choice.

The manager had improved the quality of the service by the involvement of people who used the service and their relatives and to feedback the action taken. They had put in place systems to monitor improvements in relation to the whole service as well as the first floor accommodation.

The Mellows provides accommodation and personal care for up to 51 older people including those living with dementia. Accommodation is located over three floors. At the time of our inspection there were 41 people living in the home.

This unannounced inspection was undertaken on 3 March 2015. During the previous inspection on 19 June 2014 we found the provider was not meeting all the regulations that we assessed. We found that there were breaches of two of the regulations and these were in relation to medicines and the quality assurance processes. The provider wrote and told us of the actions that they would take to ensure that the regulations were met. During this inspection we found that improvements had been made in relation to the quality assurance process and the administration of people’s medicines.

The home had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (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 and associated Regulations about how the service is run.

The CQC monitors the operation of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) which applies to care services. We saw that there were policies and procedures in relation to the MCA and DoLS to ensure that people who could not make decisions for themselves were protected. We saw that the registered manager had followed guidance and had submitted an application for one person who liberty was being deprived. Staff we spoke with were clear about the process to follow if people were being deprived of their liberty or where they had not got the capacity to make decisions.

The environment had not been maintained effectively and the upper floor was in need of decoration.

Care records reflected people’s current care and support needs. People were provided with sufficient quantities to eat and drink.

Medicines were stored correctly and records showed that people had received their medication as prescribed. Staff had received appropriate training for their role in medicine management.

Staff ensured that people’s dignity was protected when they were providing personal care. People were cared for by staff who were kind to them.

The provider had an effective complaints process in place which was accessible to people, relatives and others who used or visited the service.

The provider had a recruitment process in place. A sufficient number of staff were employed only after all essential safety checks had been satisfactorily completed.

The provider had a service improvement plan in place but this did not provide clear action to be taken in relation to improving the quality of the service for people.

We found that there were breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 which correspond to breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the provider to take at the back of the full version of the report.

As part of our inspection on 3 July 2014, we looked at the care records of five of the 37 people living at The Mellows. We spoke with six people who used the service and also spoke with two visitors who were their friends or relatives. We also spoke with six members of staff.

We looked at staff training records, health and safety checks, staff and resident meeting minutes and records of the checks the provider’s representative completed to monitor the quality of the service.

We considered our inspection findings to answer 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 told us they felt safe living in the service. They also told us that they would feel able to speak up if they had concerns or worries and felt that they would be listened to. A visiting relative said, “I do feel [person] is safe. There are always staff available and monitoring them, there is always a staff member in the lounge”.

Staff were provided with training in safeguarding vulnerable adults from abuse, Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). This meant that staff were provided with the information that they needed to ensure that people were safeguarded.

People were not protected against the risks associated with medicines because the provider did not have appropriate arrangements in place to manage medicines safely. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to the safe management of medicines.

We saw records which showed that the health and safety in the service was regularly checked. People were protected from the risk of infection because appropriate guidance had been followed.

Is the service effective?

People's care records showed that care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. The records were regularly reviewed and updated. This meant that staff were provided with up to date information about how people's needs were to be met safely and effectively.

We saw that the service had effective systems in place to ensure that people's nutritional well-being was monitored and supported.

Is the service caring?

People told us that they received the care they needed. One person said, “It is good here. The staff are very nice. The staff are very caring. They come in and talk to me when I am in my room.”

We noted that staff were kind and caring towards people who used the service. Staff spoke with people by name and interacted with them in a friendly and respectful way. People who used the service also knew the staff by name.

Is the service responsive?

We saw that the service had acted promptly to protect a person who did not have the capacity to make decisions to keep them safe. The risk to their safety was considered in the least restrictive way to support and respect their human rights.

Visitors confirmed that they were able to see people in private and that visiting times were flexible.

People using the service were provided with the opportunity to participate in meetings and to express their views. The chef met with people who used the service to hear their comments and ensure that they enjoyed the meals.

People's choices were taken in to account. A person who used the service told us that the care was good and they were well looked after. They said, “I go down for the singsongs sometimes and have a chat, otherwise you would get melancholy, but I like to watch television here in my room and do things for myself.”

Is the service well-led?

We saw that the improvements identified as required at our last inspection in relation to management of infection, safeguarding people from abuse and keeping records that were accurate and fit for purpose had been put into place.

The manager had been absent from the service for some weeks and the care team leader was acting as manager of the service as well as completing their own role. We found that many aspects of the service were well managed. Systems such as the acting manager completing daily checks while they walked around the service had been implemented. Whilst the provider did have some systems in place to monitor the quality of the service provided, it was apparent from our inspection that the absence of robust quality monitoring maybe a contributory factor to the failure of the provider to identify non-compliance or any risk of non-compliance sooner.

At previous inspections carried out in April and August 2013, we found that certain minimum standards of quality and safety had not been met. We identified shortfalls in relation to safeguarding practices, infection control, the levels of support provided to staff and record keeping.

We told the provider to make improvements and subsequently received action plans which stated that the home would be compliant with the regulations by 31 October 2013. During our inspection carried out on 07 January 2014 we found that, although some improvements had been made, there were still areas of non-compliance with the regulations.

We saw that suitable arrangements had been put in place to ensure that staff were appropriately trained and supported to perform their roles. One member of staff told us, “Training has really improved in recent months. We are well supported now and have regular staff meetings.”

We found that some improvements had been made in relation to safeguarding practices, infection control and record keeping. However, the regulations had still not been met so we have told the provider to make further improvements.

We inspected The Mellows on 02 August 2013 because we had received a number of concerns regarding poor quality of care, specifically that people were being woken and got of bed very early in the morning. There were further concerns related to inadequate management of medicines and ineffective recruitment procedures. When we inspected the home we arrived at 5.30am and found no evidence that people were being woken and obliged to get up early.

We saw that suitable arrangements were in place surrounding the administration and reconciliation of medicines, although there was some concern surrounding their storage.

We also saw that staff were not allowed to start work until all relevant checks had been satisfactorily completed. However, it was not always clear from some of the records we looked at whether or not full employment histories had been obtained.

The home was visibly very dirty and dusty in some areas. Although there were some processes in place to ensure that cleaning could be done thoroughly, these were not being followed or checked.

We spoke with two people at the home. They spoke positively about the care they received. One said, "Staff are always helpful". Another said they liked the conservatory area to sit around in and join in activities. They also said, "It's peaceful here".

We found the improvement plan submitted by the provider had been actioned. For example, we found that improvements had been made with regard to meeting people’s nutritional needs, with cleanliness and infection control and with the audits of medicines.

We saw that people were being asked their consent for their care plan and other matters. However this was still in an early stage. The provider set the end of February 2013 as the target date to reach compliance with this standard.

We noted a number of poor staff interactions and comments from people using the service that they were not always treated with dignity and respect. This was discussed with the care manager at the inspection.

We looked at care planning due to concerns raised by a safeguarding referral being received and found that the care plans contained clear information about people’s needs and how these should be met.

Due to the cognitive impairment of people living at the home discussion with the majority of people was limited. We spoke with six people living at the home and four relatives. All said they were pleased with the care at the Mellows. They told us that they were very happy with the care and support provided and said that they were happy with the staff.

Meals provided were basic and there was a limited choice available. We spoke with a person recently admitted to the home. They told us, “The food is not that great. I like chicken but I’ve only had it once in a week. There are no fresh vegetables.” We saw that most people enjoyed the lunch that was served. We also saw that action was taken to ensure people received access to healthcare services and that those who were at risk of weight loss were referred to a dietition for advice.

People told us they enjoyed the social activities and entertainment provided at the home. We saw that some people in a group session and others were engaged in conversation with the activities person and each other. We also saw another smaller group in part of the home who were enjoying the music and were playing a game of quoits with staff who were supervising them.

People in the new accommodation told us they liked their rooms. One person who was planning to move in told us how they were able to come to the home to help familiarise themselves with the home. They had visited on a daily basis for a week to furnish their room with their personal belongings.

Due to the presence of cognitive impairment and disorientation to time and place for a number of people living in the home, discussion with the majority of people using the service was limited. However, the people we spoke with said that they were happy, comfortable and content. One person told us that they get up and go to bed when the staff tell them to but said that they do not mind this, as it is ‘just the routine'.

A relative of a person living in the home told us that he was very happy with the choice of home and with his family member’s room. The person living in the home had been able to choose the room and decorate it as they wished.

People spoke positively about the activities officer and enjoyed the activities. During our visit, we saw that people were very keen on the individual activities and enjoyed chatting about events of the week and looking after lifelike dolls.

One person said that their relative is happy at the home, is always well dressed and was no longer distressed. They said that their relative enjoyed outings to a church event and to a local supermarket.

District nurses who visit the home told us that they felt the standard of care given at the home was good.

The people we spoke with said that they liked the food and felt ‘well fed’. One relative said that his loved one is happy with the food and has alternatives if there is anything she doesn’t like. In-house surveys showed that the people who responded felt that the meals at the home were 'average'. Minutes of meetings with people living in the home recorded that they were happy with the food provided.

People said that the care workers were ‘very nice’ and they spoke positively about key members of staff whom they thought were especially good. One relative described the care workers as ‘wonderful’ and said that they are always polite, smiling, considerate and helpful. An in-house audit showed that the people who commented said that they had time to discuss any concerns with the manager.

During our previous inspection on 7 January 2013 we found that people were not always treated with dignity and respect. During our inspection on 5 April and 16 April 2013 we saw that overall staff were friendly, respectful and caring in their interactions with people who used the service.

We found that people's needs were individually assessed. We found examples where care had been delivered in an individual and personalised way. One person told us, "If you want to do something [they] let you do it and give you the time, that's very important.” We saw that care in some instances had not been delivered in a planned manner.

People who used the service told us that, "It’s so nice and friendly here I feel safer here than I did at home.” However, we found that some staff were unable to demonstrate sufficient knowledge of safeguarding.

People we spoke with and our observations showed us there were enough staff to meet people's needs. One staff member told us, "On the whole there are enough staff. I think we provide the care that people need."

We found that staff were not supported appropriately or trained to provide care and support to people. Staff were unclear about the purpose of supervision and appraisals had not been completed for some staff.

We found that people were not always protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were not maintained.