Malvern View

Malvern View is a residential care home providing personal care and support to nine people in the home. The service can support up to ten people.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

The service was a large home, bigger than most domestic style properties. It was registered for the support of up to ten people. Nine people were using the service. This is larger than current best practice guidance. However, the size of the service having a negative impact on people was mitigated by the building design fitting into the residential area and the other large domestic homes of a similar size. There were deliberately no identifying signs, intercom, cameras, industrial bins or anything else outside to indicate it was a care home. Staff were also discouraged from wearing anything that suggested they were care staff when coming and going with people.

People’s experience of using this service and what we found

People told us they felt safe with the care and support they received. Relatives also said that people received care that was safe from staff who were knowledgeable and knew people’s needs. Staff felt supported and that training was of a good quality and appropriate to the roles they were undertaking. People had a diet that was varied, meeting people’s individual nutritional needs and choices. People’s needs were met through appropriate levels of staffing ensuring that people received the amount of support agreed through their care packages. There was a clear safeguarding process to ensure people were kept safe.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People’s care records were person centred and provided staff with detailed information on who they are and how they would like their needs met. People were supported to manage their health and well-being. Where needed there was input from relevant health and social care professionals to support people’s needs. People were provided with a range of opportunities to engage in activities both inside the home and local community, which were tailored to meet people’s individual needs and interests.

The systems to monitor and review the delivery of care were not always effective and required improvement. This included oversight of the completion of peoples’ care records and also of people’s medicines. The provider took action immediately to address our findings and reviewed the governance of the service to ensure procedures were more robust. People, staff and relatives were all positive about the management of the home and the manager’s relationship with people living at the home.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was requires improvement (published 10 April 2019) and there was a breach of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

People’s experience of using this service:

• People at the home were not always protected and supported to be safe, as the registered manager and the provider did not have full oversight of the service. There was a lack of systems and processes in place to effectively monitor and improve the quality and safety of support provided.

• Staff did not have guidance to follow in how to best support people whose behaviour may challenge.

• Although people said they received their medicines as prescribed. We found improvements were required in the recording of when people had received their medication.

• People’s right to confidentiality was not always respected. We found personal information on display in a communal area of the home.

• People’s care plans were currently being reviewed by the registered manager.

• People were supported to enjoy the best health outcomes possible, and staff were supported to do this by the systems the registered manager had put in place to promote good working with other health and social care professionals.

• People were supported in an individualised way that encouraged to remain as independent as possible.

• People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this.

• People were given the opportunity to have interesting and fun activities to do.

• Systems were in place to take any learning from complaints and to reflect on people’s needs and to further improve people’s care.

• The registered manager and provider sought suggestions for improving people’s care further and suggestions were listened to and acted on.

• The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

Rating at last inspection: Requires Improvement. The last report for Malvern View was on 27 November 2018 and the report was published 16 February 2018.

Why we inspected: [where relevant: improvement plan at last inspection; incidents or third-party investigations we were aware of at inspection and risks]; scheduled/planned inspection based on previous rating; inspection brought forward due to information of risk or concern;]

Enforcement We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have taken at the back of the full version of the report.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our inspection programme. If any concerning information is received we may inspect sooner.

There were eight people using the service when we inspected and 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 and associated Regulations about how the service is run.

People were safe in the home and staff supported people who had no concerns about their safety. People told us they knew staff and felt safe when they were with them and were available to assist and guide them where needed. Staff reported and recorded where a person was at risk of potential abuse and had taken steps to address any concerns with management support if needed.

Where people needed support to reduce their risk of accident or injury these had been identified and recorded in their care plans. This guidance assured staff knew how to respond and make changes or updates as people’s risk level changed. Staff were in place for people who needed continual support and there were enough staff for other people living at the home to provide their care and support needs. People medicines were administered and had been recorded when they had received them by staff who had been trained.

Staff were confident in their skills and knowledgeable and their responsibilities to look after people who lived in the home. Staff training had been provided regularly and supervisions helped assess their knowledge and skills to provide care to people they supported.

People are supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice People were involved in making decisions about their care and their consent was appropriately obtained by staff when caring for them. People who could not make decisions for themselves were supported to have a decision in their best interest.

Care plans had record people’s needs and wishes and included guidance for staff on how to support people. People were involved in their day to day support with meals preparation with staff. Healthcare appointments were in place for annual reviews or as needed appointment and staff would support a person to attend these with transport.

People had developed good relationships with the staff and were supported with their care needs. Involvement in people’s lives and choices were understood and promoted by the staff team, which also demonstrated how people’s dignity and privacy was respected.

People’s communication and sensory required review so to ensure that guidance and best practice from other agencies had been explored and utilised. Where guidance had been sought from health professionals, these had been implemented but not consistently followed by staff.

At the inspection on 20 October 2105 we found the service required improvement in leadership and governance. At this inspection we found that the improvement had been made and a new manager had registered in August 2017. However, further improvements are needed to demonstrate continual improvements and how these would make positive changes to how people were supported to live their lives now and in the future.

Malvern View is registered to provide accommodation for personal care for a maximum of 10 people with learning disabilities or autistic spectrum disorder. There were 10 people living at the home on the day of our visit. At the time of our inspection there was not 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 were supported to maintain their safety and reduce the risk of harm. The staff had knowledge of how they would protect a person from the risk of harm and how to report any concerns. Staff were available to assist people when they asked or staff ensured they were available to help them when needed. Two staff checked people’s medicines before they received them and then recorded they had been taken.

Staff had been trained to understand people’s needs and were supported in their role by a manager. People got to decide about their care and treatment this had been recorded. Staff showed they listened and responded to people’s choice to choose or refuse care.

The registered manager had applied the Mental Capacity Act 2005 (MCA) and assessments of people’s capacity to consent and records of decisions had been completed. The provider had followed the correct procedure when a person was deprived of their liberty and staff understood the reason for the restrictions.

People choose their meals and were supported where needed. Alternative diets had been prepared to meet people’s nutritional needs. People accessed health and social care professionals with regular appointments when needed. Staff knew when people had appointments or meetings and supported people to attend these appointments.

People were familiar with the staff that supported them. People happily chatted and relaxed with them. Staff knew people and were aware of each individuals care needs. People were treated respectfully and staff help support and maintain their dignity. People’s relationships with their family and friends were encouraged and had been supported.

People spent time out the home and got to enjoy the things they liked to do and chose how they spent their days. People comfortably discussed their concerns or comments with staff and these were addressed. There were processes in place for handling and resolving complaints and guidance was available in alternative formats. Staff knew and would raise concerns on behalf of people at the home when required.

There was no registered manager in post and the operational manager was currently managing the home whilst they recruited a new manager for the home. The manager in post had not submitted all relevant notifications where required.

People were involved in the running and development of their home. The manager was available, approachable and known by people. Staff felt involved and were able to make suggestion in relation to people’s care needs. The provider ensured regular checks were completed to monitor the quality of the care delivered. The management team had kept their knowledge current and they led by example.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people who used the service, the staff supporting them and from looking at records.

Is the service caring?

People were supported by attentive staff who encouraged them to be as independent as possible. We saw that care workers showed patience and supported people in their decision making. People's preferences, interests and needs were recorded and staff regularly checked with people if they wished to change them or to introduce new objectives. Care plans and risk assessments were regularly reviewed so that staff had up to date information about people's needs. People who used the service and staff had completed satisfaction surveys to gain feedback for future service development.

Is the service responsive?

Before admission people were supported in making visits to the home. This gave them the opportunity to make a decision about moving in and for staff to observe their interactions with others who already lived in the home. This process included a full physical and mental health assessment. The home had its own car, which helped to keep people involved with their local community. People were supported by a range of external professionals who assessed and advised about care and support. Staff had responded positively to their recommendations and written guidance was incorporated into people's support plans.

Is the service safe?

People were treated with dignity and respect and staff asked for permission before carrying out a task. All staff had received training in the Mental Capacity Act 2005 and they respected the decisions made when a professional had assessed people. Staff ensured that the home was kept tidy and hygienic to ensure that people were protected from unnecessary infections. People who were assessed as being at risk were observed in the home and were escorted during outings. Staff were aware of individual risk management plans and we saw examples of where they had been followed. People's care files contained risk assessments that were relevant to them both in the home and the community.

Is the service effective?

People's physical and mental health needs were assessed upon admission and as an on going process. Other health needs had been assessed such as diabetes, mobility and nutrition. People's needs had been recorded and care plans developed, which were regularly reviewed. Where staff identified that further assessments were needed letters of referrals had been made to relevant external professionals. People's mobility needs were regularly assessed and equipment put in place to assist them in maintaining their independence.

Is the service well led?

The service worked in partnership with key organisations such as specialist nurses, psychiatrists and social workers to support care provision and service development. Staff told us they were clear about their roles and responsibilities. Staff also had a good understanding of the ethos of the home and the need to provide a good service. There was a quality assurance system in place that protected people who used the service and made on going improvements for their benefit. We found that people were able to influence the way they were cared for and were supported with their individual monthly meetings with their key workers and with monthly resident group meetings.

We saw that people appeared relaxed and comfortable. They were being cared for in a way that they preferred. The people we spoke with were positive about their experiences of living at Malvern View.

We found that medicines were being appropriately stored and administered.

There was a complaints policy in place and people were being supported to raise any concerns.

Appropriate checks were carried out before staff commenced employment.

We saw people were relaxed and comfortable within their environment. We also saw people were receiving their personal care in a way that included their personal preferences.

Families and carers views were regularly sought and they were being kept up to date with any changes. Monthly meetings ensured that people who used the service were supported to comment, discuss or make a complaint if they were not happy with the service provision. Where concerns had been raised by relatives, carers or people who were used the service they were quickly remedied.