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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.

Reports


Inspection carried out on 15 February 2017

During a routine inspection

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 carried out on 20 September 2016

During a routine inspection

The inspection took place on 20 September 2016 and was unannounced.

Malmesbury House provides accommodation and personal care for up to 19 older people. There were 13 people living at the service at the time of our inspection, all of whom were living with dementia.

There was a registered manager in post at the time of our inspection who had been registered since 9 December 2014. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

People were not adequately protected from the risk of fire. The provider had not implemented the actions required in the fire risk assessment they had commissioned to maintain appropriate standards of fire safety. Fire drills had not been carried out as often as they should and some staff had not attended fire training to enable them to adequately evacuate people from the home.

People were not protected from avoidable risks and 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 adequately protected by the provider’s recruitment procedures. The provider had not made all necessary checks on staff to ensure they were suitable and eligible to work at the service. People were not adequately protected against the risk of abuse because staff had not been made aware of their responsibilities to report concerns.

People’s medicines were not managed safely. There were no protocols in place to guide staff about the administration of ‘as required’ medicines.

The provider did not support staff to gain the skills they needed to provide people’s care effectively. Staff had not received all the training required for their role and this had an effect on the care people received. Staff did not receive feedback about their performance or have opportunities to discuss their training and development needs.

People’s care was not always provided in line with the Mental Capacity Act 2005. There was a lack of understanding of the Act and its principles at all levels and we found that decisions had been made on behalf of people without their mental capacity being established.

People were not cared for in a clean and properly maintained environment. There was a pervasive smell of urine and mattresses and bedding were old and stained. Pest control treatment to eradicate bed bugs was ongoing. The carpets in many areas were threadbare, the curtains stained and items of furniture were missing handles.

People were not always supported to maintain their dignity. Some people were dressed in stained and dirty clothes. Other people were visibly unkempt and had not been supported to maintain their personal hygiene. There was no guidance for staff about how to support people who refused personal care to maintain their appearance and personal hygiene. Staff had positive interactions with people but spent periods of time together when they could have been engaging with people.

People’s needs were not always accurately assessed before they moved in to the service. This had resulted in some people being unnecessarily restricted due to a lack of appropriate equipment and staff training. Care plans did not always record people’s individual needs, which put them at risk of receiving inappropriate care and treatment.

People did not have access to meaningful activities. There was a lack of appropriate activities to keep people occupied and engaged and there were no opportunities to go out.

The service was not well led. None of the registered providers were involved in monitoring the service. Concerns identified that had been identified by the registered manager’s audits had not been addressed. People were not given opportunities to have their say about the service. Concerns that had been raised were not addressed by

Inspection carried out on 26 September 2014

During an inspection to make sure that the improvements required had been made

We carried out this inspection to check whether the provider had taken action to address the concerns we identified at our previous visit, where we found that some areas of the home were not adequately maintained. Some of these issues were cosmetic but others compromised people’s health and safety. For example rucked carpets in some areas presented a trip hazard and broken light fittings were potentially unsafe.

At this inspection we found that the provider had addressed the concerns related to health and safety. New carpets had been installed where necessary and fixtures and fittings repaired. Safety measures had been implemented and issues relating to electrical safety addressed.

Inspection carried out on 26 February 2014

During an inspection in response to concerns

We carried out this inspection because a relative of someone living at the home had raised concerns about the condition and security of the premises. The relative also had concerns about some aspects of life at the home, including the availability of activities.

During the inspection we spoke with eight residents, two visitors and the senior member of staff on duty. We checked the condition of communal areas and a sample of bedrooms.

We observed that people had been supported to maintain their appearance and relatives told us that their family member was always well-presented when they visited. Staff told us that there were always enough staff on duty to meet people’s care needs but that they were not always able to spend time speaking with people due to the demands of their role.

The home did not employ an activities co-ordinator and we found that there were limited opportunities for people to take part in activities or to go out.

We found that some areas of the home were not adequately maintained. Some of these issues were cosmetic but others posed a potential health and safety risk to people. We had no concerns about the cleanliness of the home and we found that there were appropriate measures in place to monitor people entering the premises.

One relative said of the home, “It could do with a facelift” and another described the décor as “Very tired.” There was no evidence that the provider had a planned programme of redecoration in place for the home.

Inspection carried out on 3 January 2014

During a routine inspection

At the time of our inspection there were 17 people living in the home all of which had severe dementia. Due to this we were unable to talk to any of the people using this service.

People had up to date care plans and risk assessments that were regularly reviewed and that met their support needs.

We found that staff received annual safeguarding training and had a good understanding of their responsibilities regarding this.

We saw that the premise were safe, suitable and adequately maintained.

We found that the provider had an adequate number of skilled staff in order to provide individualised care. All staff received regular training and were well supported. We saw that staff had appropriate qualifications and experience in order to meet the care needs of the people.

The provider had systems in place to assess and monitor the quality of the service people received.

Inspection carried out on 25 October 2012

During a themed inspection looking at Dignity and Nutrition in care homes

People told us what it was like to live in Malmesbury House. They described how they were treated by staff and their involvement in making choices about their care. They also told us about the quality and choice of food and drink available. This was because this inspection was part of a themed inspection programme to assess whether older people in care services were treated with dignity and respect and whether their nutritional needs were met.

The inspection team was led by a Care Quality Commission (CQC) inspector joined by a practising professional.

People using the service said that staff were polite and treated them with respect. They told us that staff were available when they needed them and that they provided good care. One person said, “I’m fortunate to be here” and another told us, “I like it here - everything’s very nice.” One person said, “They’re very kind. They help me get up and ready every morning” and another told us, “They’re all good ones – they’re all lovely.”

Most people told us that they enjoyed the food provided by the home and that could have alternatives to the advertised menu if they did not like the dishes prepared that day. One person told us, “There’s always something on the menu I like.” A visiting relative told us, “My mum enjoys the food here – she eats well.”

Inspection carried out on 25 October 2012

During a routine inspection

People told us what it was like to live in Malmesbury House. They described how they were treated by staff and their involvement in making choices about their care. They also told us about the quality and choice of food and drink available. This was because this inspection was part of a themed inspection programme to assess whether older people in care services were treated with dignity and respect and whether their nutritional needs were met.

The inspection team was led by a Care Quality Commission (CQC) inspector joined by a practising professional. We also used a short observational framework for inspection (SOFI) during a mealtime to observe people's experiences.

People using the service said that staff were polite and treated them with respect. They told us that staff knew their needs and how they liked things to be done. A visiting relative told us that their family member was always treated with respect and that staff understood her individual needs. The relative said, “They know her very well.”

People told us that they could have privacy whenever they wanted it. They said that they could choose how they spent their time and that staff respected their choices. One person said, “I’m fortunate to be here” and another told us, “I like it here - everything’s very nice.” A visiting relative said, “I like the place because it’s homely and my Mum likes it too – she’s very settled”.

We found that people’s needs and preferences were not always recorded in their care plans. We also found that people had not signed to record their agreement of their care plans and that relatives or advocates had not signed the care plans where the person using the service had been unable to do so. This means that there was no evidence that people had been consulted about or agreed to the care they received.

Most people told us that they enjoyed the food provided by the home and that they could have alternatives to the advertised menu if they did not like the dishes prepared that day. One person told us, “There’s always something on the menu I like.” A visiting relative told us, “My mum enjoys the food here – she eats well.”

People using the service told us that they felt safe and well cared for at the home. None of the people we spoke with, or their relatives, had ever had any concerns about their treatment at the home. The staff we spoke with had an appropriate awareness of their responsibilities around keeping people safe and reporting any incidents or practices which could constitute abuse.

People told us that staff were available when they needed them and that they provided good care. One person said, “They’re very kind. They help me get up and ready every morning” and another told us, “They’re all good ones – they’re all lovely.” A visiting relative told us, “There are enough staff around, and they’re consistent, which is important for my mum.”

The staff rota demonstrated that there were sufficient staff on duty at all times to meet people’s needs. The members of staff we spoke with knew the needs of the people they were supporting well.

Confidential personal information relating to people using the service was stored securely. The staff we spoke with were aware of the importance of maintaining confidentiality and returning records to safe storage after use.

During an inspection to make sure that the improvements required had been made

We did not, on this occasion, speak to people about this outcome so cannot report what people using the service said.

Inspection carried out on 28 April 2011

During a routine inspection

People said staff were friendly, helpful and respected their dignity. Some people could recall being involved in planning their care and other people told us they were happy for their carers to make decisions on their behalf. One person said their breakfast was served too early, at 6.30 a.m.

People expressed satisfaction with arrangements to meet their heath care needs. They saw their general practitioner, district nurses and other professionals, when necessary. They told us staff were supportive and responsive to their needs and felt they must be appropriately trained. People said there was a choice of meals and the standard of cooking was good. They told us the home was always clean and hygienic and found it comfortable and suitably equipped. People were aware of the complaint procedure. They said they would talk to their carers, staff or the registered manager if they had a complaint or concern. They felt confident action would be taken to resolve any problems.

People said the registered manager was approachable and took an interest in their wellbeing. They told us that from time to time the home’s management sought their views about the home. They felt their views and suggestions were listened to and valued.

Reports under our old system of regulation (including those from before CQC was created)