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Archived: Malmesbury House Requires improvement

The provider of this service changed - see new profile

We are carrying out a review of quality at Malmesbury House. We will publish a report when our review is complete. Find out more about our inspection reports.

Inspection Summary


Overall summary & rating

Requires improvement

Updated 23 May 2017

The inspection took place on 15 February 2017.

Malmesbury House provides accommodation and personal care for up to 20 older people, some of whom are living with dementia. There were 12 people living at the service at the time of our inspection.

The registered manager had been granted an extended period of absence at the time of our inspection. The provider had appointed an acting manager to cover the registered manager’s absence. 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 our last inspection on 20 September 2016, we found the provider was breaching legal requirements. People were not adequately protected from the risk of fire or from avoidable risks. There was no evidence of learning from accidents and incidents. People were not adequately protected against the risk of infection because standards of infection prevention and control were poor. People were not protected by the provider’s recruitment procedures. People were not protected against the risk of abuse because staff had not been made aware of their responsibilities to report concerns. Medicines were not managed safely. Staff had not received the training required for their role and this had an effect on the care people received. People’s care was not always provided in line with the Mental Capacity Act 2005. People were not cared for in a clean and properly maintained environment and were not always supported to maintain their dignity. People’s needs were not always accurately assessed before they moved in to the service. People did not have access to meaningful activities. The service was not well led. None of the registered providers were involved in monitoring the service. People were not given opportunities to have their say about the service. The overall rating for the service was 'Inadequate' and the service was therefore placed in 'Special measures'.

Following the inspection, the provider submitted an action plan telling us how they would make improvements in order to meet the relevant legal requirements.

At this inspection we found some improvements had been made but these were not sufficient to ensure that people received consistently safe and effective care. Staff were not following relevant guidance on the safe handling of dirty laundry, which meant people were not adequately protected from the risk of infection. The en suite bathrooms in people’s bedrooms and a communal bathroom on the ground floor did not contain soap or disposable paper towels, which meant staff were unable to maintain appropriate hand hygiene after providing people’s care and support. Staff were not following relevant guidance on the Control of Substances Hazardous to Health (COSHH) or the provider’s policy on the use of COSHH products.

Staff had attended medicines training but there was no evidence that their competency had been assessed following this training and records showed that medicines errors occurred regularly. We found medicines errors on the day of our inspection that had not been identified by staff. A pharmacist had made recommendations to improve medicines practice following a medicines audit but these recommendations had not been implemented.

Adaptations and equipment had not been serviced regularly, which resulted in poor care for one person and unsafe practice being used by staff. The service had a hoist to enable staff to transfer people safely and an adapted bath but the safety certificates for these items had expired in December 2016. Staff were unable to use the hoist to transfer people, which meant they had to use a manual lifting technique when supporting one person during our inspection. There was evidence that people had been supported to use the bath since the e

Inspection areas

Safe

Inadequate

Updated 23 May 2017

The service was not safe.

People were not adequately protected from the risk of infection.

Staff did not following relevant guidance on the use of potentially hazardous substances.

Adaptations and equipment had not been serviced regularly.

People’s medicines were not managed safely.

People were protected by the provider’s recruitment procedures.

Staff understood safeguarding procedures and knew how to report any concerns they had about abuse.

There were enough staff to keep people safe and to provide the care they needed.

There were plans in place to ensure that people’s care would not be interrupted in the event of an emergency.

Effective

Requires improvement

Updated 23 May 2017

The service was not consistently effective.

Some people were not receiving the care they needed to keep them free of pain and discomfort.

Training had been provided for staff in key areas.

Supervision had been introduced for staff.

Staff implemented the principles of the Mental Capacity Act 2005 in their day-to-day work.

Applications for DoLS authorisations had been submitted where people were subject to restrictions to keep them safe.

People enjoyed the food provided and were supported to maintain adequate nutrition and hydration.

People were supported to maintain adequate nutrition.

People were supported to obtain medical treatment when they needed it.

Caring

Requires improvement

Updated 23 May 2017

The service was not consistently caring.

Care plans did not record people’s preferences regarding end of life care.

People were supported by kind and caring staff.

Staff treated people with respect.

Staff supported people in a manner that maintained their privacy and dignity.

Staff encouraged people to maintain their independence where possible.

Responsive

Requires improvement

Updated 23 May 2017

The service was not consistently responsive to people’s needs.

People remained without interaction or engagement for long periods outside the time of the planned activity.

The range of activities available to people had increased.

There were appropriate procedures for managing complaints.

Well-led

Requires improvement

Updated 23 May 2017

The service was not consistently well led.

Quality assurance checks were not effective in identifying shortfalls.

The registered manager was more accessible to people and staff than they had been previously.

The recording of accidents and incidents had improved.

Team meetings had been introduced, which provided an opportunity for staff to discuss the needs of the people they cared for.

Residents meetings had been introduced and surveys had been distributed to relatives, which gave people opportunities to have their say about the service.