Background to this inspection
Updated
26 October 2015
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
We visited the home unannounced on 22 September 2015. The inspection team consisted of two inspectors and an expert by experience. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of service.
Before our inspection we reviewed the information we held about the home. We reviewed notifications of incidents that the provider had sent us since the last inspection and previous inspection reports. A notification is information about important events, which the service is required to send us by law. The provider had completed and submitted a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We also contacted a speech and language therapist, a continuing health care nurse, 2 GP surgeries and the local authority service improvement team.
During our inspection, we spoke with 14 people living at the home, three relatives/visitors, one nurse, three members of care staff, the chef, the deputy manager, the registered manager and the registered provider. We observed the environment, how people were supported at lunch, and watched how staff interacted with people during this time.
We observed care and support in communal areas, spoke with people in private and looked at four care plans and associated care documentation. We also looked at records that related to medicines as well as documentation relating to the management of the service. These included policies and procedures, staffing rotas, four staff recruitment files, training records and quality assurance and monitoring paperwork. We also reviewed maintenance and equipment servicing contracts and assessed the safety of the environment.
Updated
26 October 2015
The inspection took place on 22 September 2015 and was unannounced.
Malvern House provides nursing care and accommodation for up to 22 older people who are living with dementia or who may have physical and mental health needs. On the day of the inspection 20 people were living at the care home. At our last inspection in July 2013 the provider was meeting all of the Essential Standards inspected.
The home was on two floors, with access to the upper floor via stairs, a lift or a chair lift. Bedrooms have wash hand basins and vanity units. There are shared bathrooms, shower facilities and toilets. Communal areas included one lounge, a dining room, garden and outside seating area.
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 told us staff were kind and caring, and treated them with respect. Staff were knowledgeable and spoke fondly of people. There was enough staff to meet people’s needs. People received care from staff who had received training and ongoing support to help them in their role. Staff were encouraged to follow their interests and empowered to develop their knowledge base.
People told us the food was nice and that they were offered alternatives if there was something they did not like. People’s care plans provided details to staff about how to meet people’s individual nutritional needs. People were supported to eat and drink enough and maintain a balanced diet. The chef was knowledgeable about people’s individual nutritional needs. People who required assistance with their meals were supported. When concerns about people’s nutrition had been identified, responsive action had been taken.
People felt safe living at Malvern House. The registered manager and staff understood their safeguarding responsibilities. People were supported by suitable staff. Robust recruitment practices were in place and records showed checks were undertaken to help ensure the right staff were employed to keep people safe.
People were protected from risks associated with their care because staff had guidance and direction about how to meet people’s individual care needs. People had personal evacuation plans in place, which meant people were able to be effectively supported in an emergency. The environment was regularly assessed and monitored to ensure it was safe at all times.
People had their mental capacity assessed, which meant care being provided by staff was in line with people’s wishes. People who may be subject to deprivation of their liberty (DoLS) had been assessed and applications applied for. The registered manager and staff had a good understanding of the MCA and DoLS which helped ensure people’s rights were protected.
People had care plans in place to address their individual health and social care needs. People’s end of life wishes were documented and communicated. People’s medicines were managed safely. External health professionals were complimentary of the registered manager, the care provided by staff and the competence of nursing staff. They told us, advice was always implemented as directed.
People’s confidential and personal information was stored securely and the registered manager and staff were mindful of the importance of confidentiality when speaking about peoples care and support needs. People had a lock on their bedroom door to protect their privacy and security of their belongings.
People lived in a clean environment which was free from odours. People were protected by effective infection control procedures and practices because staff had received training and were provided with protective equipment such as gloves and aprons.
People knew who to speak with if they had any concerns or complaints and felt confident their concerns would be addressed. Staff felt the registered manager and deputy manager were supportive. Staff felt confident about whistleblowing and told us the registered manager would take action to address any concerns.
The registered manager had systems and processes in place to ensure people received a high quality of care and people’s needs were being met. There were formal and informal opportunities for people to provide their feedback about the service, to help ensure the service was meeting their needs as well as assisting with continuous improvement. The Commission was notified appropriately, for example in the event of a person dying or a person experiencing injury.