The inspection was unannounced and took place on 14, 18 and 19 April 2016.

Melrose Care Home is a 26 bedded nursing home that provides nursing care and support to older people. At the time of inspection there were 22 people living at the home. It is also registered to provide personal care to older people in their own homes. This regulated activity is included in the registration of the care home and operates from the same location. At the time of our inspection Melrose Care Home was providing a personal care service to five people.

The service has 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 we spoke with told us they felt safe. They knew what to do if they felt they had been badly treated or if they wished to complain. Staff confirmed they had been trained in how to identify and report any incidents of abuse they may witness.

Any potential risks to individual people had been identified and appropriately managed. For example, people at risk of pressure wounds had received appropriate nursing care to reduce the risk of their occurrence or recurrence.

People’s medicines had been administered and managed safely.

There were sufficient numbers of staff on duty with the necessary skills and experience to meet people’s needs. Where people received personal care at home, the service had systems in place to allocate calls and to ensure consistency of staffing so that the staff visiting people understood their needs and knew how they liked to be supported.

Staff supported people to prepare meals and to eat and drink if required. They ensured people at risk of malnutrition received adequate nutrition and hydration.

The registered manager and staff understood their role in relation to the Mental Capacity Act 2005 (MCA) and how the Deprivation of Liberty Safeguards (DoLS) should be put into practice. These safeguards protect the rights of people by ensuring, if there are any restrictions to their freedom and liberty, these have been authorised by the local authority as being required to protect the person from harm. We were informed that, currently, two people lacked capacity to make decisions for themselves. Appropriate steps had been taken to ensure decisions made on their behalf were in their best interests. No one required a DoLS to be put in place to protect their rights.

People were provided with support to access health care services in order to meet their needs.

Positive, caring relationships had been developed with staff to ensure people received the support they needed. They were encouraged to express their views and to be actively involved in making decisions about the support they received to maintain the lifestyle they have chosen.

Melrose Care Home had achieved a nationally recognised accreditation in end of life care through the Gold Standards Framework and has also been awarding the GSF Beacon Status in 2012 and 2015 which recognised their sustained good practice in this area of care. In 2015 they achieved the GSF Care Home of the Year award which was given in recognition of their commitment to providing high quality of end of life care.

The culture of the service was open, transparent and supportive. People and their relatives were encouraged to express their views and make suggestions so they may be used by the provider to make improvements.

We spoke with nine people who lived there, three relatives and ten staff members. We looked at four care plans, other records and three staff files. We observed interactions between staff and people who lived there.

People who lived there told us they were “very happy here” and one said “it is a home from home.” They told us how much they enjoyed the food describing the meals as “wonderful” and telling us they had plenty of choices available.

People told us they were included in decisions regarding how they were supported and assisted. They were also given the opportunity to be involved in changes in the home, such as décor in the lounge.

We saw people had their healthcare needs assessed and met by the staff in the home and, when appropriate, other health professionals. Risks to peoples’ health, safety and welfare were assessed and measures were taken to reduce identified risks.

Staff understood their responsibilities with regard to safeguarding people from abuse and were aware of the actions to take should they have any concerns.

We found that staff were only employed to work at the home following the necessary checks to ensure they were fit to do so. People told us the staff were “wonderful” and “very helpful”. One relative said “I can’t speak highly enough of the staff, nothing is too much trouble.”

We spoke with two residents, the registered provider, registered manager, two care workers and other ancillary staff. We toured the building and observed interactions with staff.

One resident we spoke to told us that “I have all I want, I have been looked after so well and I am extremely happy.” Another resident told us “the atmosphere is friendly, small and cosy."

We found that there were regular activities at the home, that residents enjoyed, were involved in resident’s committee meetings with changes made on feedback from the residents.

We found that the home was well maintained, decorated brightly with pictures and ornaments with a well maintained garden. It was clean and tidy, free from odours and dust and residents were protected from the risk of infection because appropriate guidance had been followed.

We found that residents were cared for by staff that were appropriately qualified, trained, mentored and supervised, had regular team meetings and encouraged to undertake extra qualifications and training.

We found that residents were protected against the risks associated with medicines because there were appropriate arrangements for obtaining, recording, handling, using, safe keeping, dispensing, safe administration and disposal of medicines at Melrose Care Home.

We found there were robust systems in place to obtain feedback on the service, to monitor the quality of service and to respond where improvements were needed.

The people who live in Melrose told us that they were very happy living in the home. They told us that the staff “go out of their way to make sure we are happy”. We spoke with people both individually and in groups and they told us that “the staff could not be kinder” and they were full of admiration at their patience and understanding.

We spoke to relatives of people staying in the home. They told us that their relative’s needs and wishes were identified, addressed and taken into account. One person whose relative was in the home for respite care was full of praise for the home and staff. They told us that the short stay was like a holiday for their relative.