Malvern House

At our last inspection we rated the service good overall and requires improvement in the Well-Led domain because staff supervisions were not recorded in line with the provider and best practice guidance. At this inspection we found the evidence continued to support the rating of good and staff supervisions were well organised and completed. There was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

People were safe at Malvern House. Staff understood the need to safeguard people from abuse and harm and would report any incidents. The risks people experienced were assessed and understood and guidance was put in place for staff. People’s medicines were well managed and the documentation was clear. The home was a safe and clean environment to live in and staff protected people from the risk and spread of infection. There were enough staff to meet people’s needs and give individual support.

People’s needs were assessed and recorded in individual plans. The staff had been trained in mandatory and relevant knowledge and skills to give effective care. People’s health needs were understood and they were helped to stay healthy and attend appointments. People were involved in making their own meals and supported to eat a balanced diet. The physical environment was suitable and there was enough space for people to live together happily. The legal requirements for consent to care were met. People had choice and control in their lives and were supported in the least restrictive way possible.

The staff ensured there was a calm atmosphere in the home and understood people well. Staff interaction with people was always patient and caring. People were supported to have as much independence as was possible and staff encouraged people to do things for themselves. People were respected and spoken to in an appropriate way.

Each person’s personality and preferences were known and staff responded to people in an individual way. There was a plan for each person to undertake activities that suited them during the day. Complaints were responded to in a timely way. People’s wishes at end of life were being explored in a sensitive way.

There was a culture of delivering person centred care in the organisation. The registered manager was respected and had developed an open and honest approach with staff. Governance, reporting and accountability arrangements were clear. Peoples’ and relatives’ views were sought and listened to. There was an internal quality audit process and a willingness to try new things that would improve people’s lives. Staff were engaged and felt able to offer their ideas. The service was part of the local community and people benefitted from accessing the town and its facilities.

Further information is in the detailed findings below.

This inspection took place on 6 July 2016 and was unannounced.

The home was run by 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.

People and their relatives gave positive feedback about the service they or their family member received. People were very happy.

People said that they felt safe and they appeared happy and at ease in the presence of staff. One person said; “The staff are kind, I feel safe.” We saw staff had written information about risks to people and how to manage these in order to keep people safe.

People benefited from a safe service where staff understood their safeguarding responsibilities. Staff had received training in safeguarding adults and were able to tell us about the different types of abuse and signs a person may show if they were being harmed. Staff knew the procedures to follow to raise an alert should they have any concerns or suspect abuse may have occurred.

People who may harm themselves or displayed behaviour that challenged others had shown a reduction of incidents since being at the home. However incidents and accident were not always fully recorded by the staff and registered manager. We have made a recommendation about this.

People received their medicines as they were prescribed and when they needed them. Processes were in place in relation to the correct storage, disposal and auditing of people’s medicines.

Care was provided to people by a sufficient number of staff who were appropriately trained and deployed. People did not have to wait to be assisted.

Staff recruitment processes were robust and helped ensure the provider only employed suitable staff to care for people.

Staff were aware of the home’s contingency plan, if events occurred that stopped the service running. They explained actions that they would take in any event to keep people safe. The premises provided were safe to use for their intended purpose.

People and their families had been included in planning and agreeing to the care provided. We saw that people had an individual plan, detailing the support they needed and how they wanted this to be provided. Staff ensured people had access to healthcare professionals when needed.

People said that they consented to the care they received. The home was meeting the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). People said that they were involved in making decisions about their care as much as they wanted to be.

Staff had the specialist training they needed in order to keep up to date with care for people. Staff demonstrated best practice in their approach to the care, treatment and support people received.

People were provided with a choice of meals each day and where they wanted to eat, for example go out for lunch or have lunch at home. Facilities were available for staff to make or offer people snacks at any time during the day or night. Specialist diets to meet medical or religious or cultural needs were provided where necessary.

People were treated with kindness, compassion and respect. Staff took time to speak with the people who they supported. We observed some positive interactions and it was evident people enjoyed talking to staff. People were able to see their friends and families as they wanted and there were no restrictions on when relatives and friends could visit.

People took part in community activities on a daily basis; for example trips to the shops. The choice of activities was specific to each person and had been identified through the assessment process and the regular house meetings held.

People’s views were obtained by holding residents’ meetings and sending out an annual satisfaction survey. People knew how to make a complaint. Complaint procedures were up to date and people and relatives told us they would know how to make a complaint if they needed to. The policy was in an easy to read format to help people and relatives know how to make a complaint if they wished. Staff knew how to respond to a complaint should one be received.

People were at the heart of the service. The provider's philosophy, vision and values were understood and shared across the staff team.

The provider had quality assurance systems in place, including regular audits on health and safety, medicines and support plans. The registered manager met CQC registration requirements by sending in notifications when appropriate. However some incidents had not been reported. We have made a recommendation about this. We found both care and staff records were stored securely and confidentially.

This was a follow-up inspection because at our last inspection on 25 July 2013 we found the registered person was not fully meeting all of the regulations set out in the health and social care act 2008. The registered person sent us an action plan telling us what actions they would take and when they would become fully compliant with the regulations.

At this inspection we found that the provider had taken appropriate steps to ensure that the people who used the service could be confident that their human rights would be respected and taken into account.

At this inspection we found that the provider had implemented their action plan and that the premises were generally well maintained and safe.

People spoke about activities they were involved in, including going to college, shopping and trips out. People also told us they had enjoyed their meal, liked the food, got enough to eat and could have a snack or a drink at any time.

One person told us they were going to choose what breakfast they wanted as they had got up late, and another told us they were making their lunch and showed us what they were making.

We found that people who used the service could not always be confident that their human rights will always be upheld because some decisions and restrictions were being made for people without their consent and without a formal assessment of the need for decisions to be made for them, under the Mental Capacity Act.

We found that the home was not always protecting people as windows were left without secure restrictors fitted where it had been risk assessed that restrictors were needed, and chemical hazards that were required to be kept locked safely were left accessible to people.

We found that files containing information about people who use the service were kept securely and confidentially.

A person who uses the service showed us their room and how they had individualised it and decorated it in their favourite colours.

People spoke about community activities they were involved in, such as going to college, parties, horse riding and shopping.

People also told us they liked the staff, their rooms, and felt safe living at their home and would go to their key-worker if anyone upset them.