Friends of the Elderly Malvern

Friends of the Elderly Malvern is a residential care home providing personal and nursing care to up to 97 people. The service provides support to older people living with dementia. Care is delivered across three separate buildings: Davenham is a residential unit, Bradbury Court accommodates people living with dementia and Perrins House provides nursing care. At the time of our inspection there were 53 people using the service.

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

Since our last inspection improvements had been made. Environmental risks had been identified and assessed. However, systems to manage people’s care and risks required further development and embedding into staff practice. The registered managers acknowledged governance systems required further improvement.

The provider had effective safeguarding systems in place and staff knew what actions to take to ensure people were protected from harm or abuse. There were enough staff to meet people’s needs and ensure their safety. The provider used agency staff to cover any shortfalls in staffing levels. The registered managers pre booked agency staff in advance to ensure consistency of the same agency staff as much as possible. The provider continued to recruit safely.

People’s needs and risks had been assessed. Staff had the skills and knowledge to support people appropriately. Staff were supported through induction, training, and regular supervision. People were able to choose their meals and were supported to maintain a healthy diet. People had access to healthcare professionals when they needed them. 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 were treated with compassion. Staff were kind and caring. They respected people’s privacy and dignity and supported people to be as independent as possible.

The provider had a complaints policy in place. People and relatives were aware how to raise any concerns and felt comfortable in doing so should any arise.

The registered managers and staff worked closely with health and social care professionals to plan and deliver an effective service to people to meet their needs. People and their relatives’ views were sought and considered to help drive through improvements.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 13 June 2019). 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 inspection was prompted by a review of the information we held about this service.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

The overall rating for the service has changed from requires improvement to good based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Friends of the Elderly Malvern on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

People’s experience of using this service: During our inspection we found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to the safety of the premises, management of risks people may face and the effectiveness of governance arrangements. Details of action we have asked the provider to take can be found at the end of this report.

The provider did not have sufficient oversight of the service. Environmental risks had not always been identified and assessed. One unit was not safe, as people were at risk of falling from windows which were not safely secured. Individual risks to people had not been fully assessed and reduced to help keep people safe. Health and safety principles were not being followed and people had access to unsafe liquids such as cleaning products.

The safety and quality checks of the service were not always effective. The management team completed audits and created action plans to improve the service. However, these did not include actions to avoid and reduce the risks we found with regards to the premises. The provider and registered manager took immediate action to resolve the concerns we raised.

People gave positive feedback about the care they received and relatives confirmed this. People received person-centred care from staff who knew them well. Staff were caring and respected people’s privacy and dignity.

Care records contained assessments of people’s needs which were detailed and reflected their individuality. Staff worked closely with other health and social care professionals to deliver a high standard of personalised care.

People and their relatives were involved in care planning and had their needs reviewed regularly. Staff used an electronic system to record and review people’s support needs. This allowed for instant updates to be shared throughout each unit.

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 practice. People were supported to attend activities within the service and within the local community. People were encouraged to maintain social relationships.

Staff recruitment continued to be safe and staff received regular training. New staff received a thorough induction which provided them with the knowledge and skills to safely support people. Staff were encouraged to attend additional training to help provide a higher quality of care to people.

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

Rating at last inspection: Good (report published March 2016).

Why we inspected: This was a planned inspection based on the rating at the previous inspection.

Follow up: We will continue to monitor the service through information we receive from the service, provider, the public and partnership agencies. As part of our process we will be requesting an action plan to be completed to address the issues identified. We will re-visit the service in line with our inspection programme. If we receive any concerning information we may inspect sooner.

Friends of the Elderly Malvern is located near to the town of Malvern. The service comprises of Davenham which provides personal care and accommodation for older people and Bradbury Court which is a purpose built unit providing personal care and accommodation to people who have a dementia illness. This service accommodates 54 people. On the day of our inspection there were 45 people living at the home. There were 22 people living at Bradbury Court and 23 people at Davenham.

There was manager at this home who was in the process of registering with us. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered providers and registered managers 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 and their relatives said they were happy with the support that staff provided people that lived at the home. They told us staff were caring and promoted people’s independence. People told us they were able to maintain important relationships with family and friends. We saw people had food and drink they enjoyed and had choices available to them, to maintain a healthy diet. They were supported to eat and drink well in a discreet and dignified way. People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage them. People told us they had access to health professionals as soon as they were needed.

Relatives we spoke with said they felt included in planning the support their relative received and were always kept up to date with any concerns. The unit manager at Bradbury Court had identified that relatives were not consistently involved with what was happening on the unit. So they had set up meetings to improve communication and involvement. People living at the home were able to see their friends and relatives as they wanted. They knew how to raise complaints and felt confident that they would be listened to and action taken to resolve any concerns. The manager ensured people were listened to, we saw that complaints were investigated and action taken to resolve them.

Staff we spoke with were aware of how to recognise signs of abuse, and systems were in place to guide them in reporting these. They were knowledgeable about how to manage people’s individual risks, and were able to respond to people’s needs. Staff had up to date knowledge and training to support people. We saw staff treated people with dignity and respect whilst supporting their needs. Staff knew people well, and took people’s preferences into account and respected them. Staff had the knowledge and training to support people they provided care for. Staff ensured people agreed to the support they received.

The manager had made applications to the local authority to deprive people of their liberty, to ensure they did not treat people unlawfully. The manager promoted an inclusive approach to providing care for people living at the home. People who lived at the home and staff were encouraged to be involved in regular meetings to share their views.

The provider and manager had systems in place to monitor how the service was provided. The management team had identified areas of improvement and were providing the resources to complete these actions. The management team reviewed accidents and incidents and took steps to learn from these.

We considered all of the evidence that we had gathered under the outcomes that we inspected. We used that information to answer the five key questions that we always ask:-

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well led?

Below is a summary of what we found. The detailed evidence supporting our summary can be read in our full report.

Is the service safe?

We saw that a comprehensive risk and needs assessment had taken place before people had gone to live at the home. Care plans reflected assessed risks. We saw that when people had been assessed as requiring a hoist to help them to move, care plans were in place. Where equipment was used to care for people, this had been serviced regularly and staff knew how to use it. There were enough hoist slings of the appropriate size but there was no system in place to allocate slings for individual use. At Bradbury Court, the appropriate size of hoist for each individual was shown on a chart. At Davenham, the correct size of sling was not recorded. Carers that we spoke with knew the correct size of sling for each person who needed one which showed us that the equipment was used safely. However, the lack of documentation showed us that there was a potential risk that the wrong sized sling could be used.

Before staff had started work at the service all the appropriate checks had been completed. This ensured that people were safely cared for by staff who were suitably qualified, honest, reliable and trustworthy. All staff had received the appropriate training to meet people's needs, which included training about infection control and caring for people with dementia. Measures were in place to safeguard people from abuse.

Staff understood what to do in the event of a fire or other emergency.

Is the service effective?

A person using the service said, 'I'm so glad I came here.' A relative that we spoke with said, 'I am very happy with the home.' They told us that they believed their relative could not have been cared for as well anywhere else. They told us that their relative was not eating when they had come to the home but had put on weight since being there. This was because the service had implemented a plan to help the person to receive better nutrition. A person told us how their ability to walk had improved since being at the home. Other people said that they thought that the exercise classes provided two or three times a week had improved their mobility.

We saw that satisfaction surveys had been completed by people, their relatives and professionals who had visited the service. One person had commented that one of the things they liked most about the home was, 'The freedom to live my life as I have always led it.' Nearly all of their comments were positive and responses to questions about the quality of care at the home were all either 'good' or 'very good'. All of the people surveyed said that they would recommend the home to others.

We saw that care and support had been carefully planned to meet people's needs and included personal preferences. This showed us that the service was effective.

Is the service caring?

The service was very caring. All of the people that we spoke with mentioned how caring the staff were. A person told us that, 'The staff are marvellous and can't do enough for you.' Another person said, 'It is ever so good, we are like one big happy family.' People living at the home who completed the survey commented, 'Warm and caring, superb staff.' and 'Excellent, very caring.'

A survey for stakeholders asked about the 'caring attitude of our staff towards residents' and all of the responses said it was good or very good. Several of the people that we spoke with referred to the atmosphere of the home being caring and supportive.

We spoke with care staff who told us about the needs of people using the service in a caring and affectionate way. A carer who had previously worked for an agency said, 'I have never come across a team (of staff) that cared so much.'

We observed that when staff interacted with, or helped people they called people by name and were kind, patient and cheerful.

Is the service responsive?

The service was responsive to the changing needs of people using the service, to recommendations from safety inspections and to suggestions and comments made by people and relatives. A carer told us how they had listened to and acted on suggestions made by a relative when a person had become unable to talk about their preferences.

We saw that most care plans were regularly updated and were changed when people's needs changed.

In the stakeholders' survey, everyone had replied that the response of the service to complaints or comments had been 'very good'. The manager told us that in response to comments that people had made about their first few weeks living at the service, a new 'Welcome Pack' was in progress. This would include a guide to the service for people and their relatives. We saw that recommended improvements and upgrades made following a fire safety inspection had been, or were in the process of being implemented. During our visit we took part in a fire drill which the manager told us, had been revised and improved following the fire safety inspection. We saw records of residents' meetings that took place regularly and the manager told us how they had addressed concerns raised by people. We saw that changes to the food and drinks available for people had been changed in response to, or following consultation with people using the service. This included asking people for their own recipes which the chef then prepared.

Is the service well led?

The service was very well led. A person told us that the manager was always ready to talk and, 'knows everyone's name.' They said that, 'Getting the atmosphere right is most important.' They felt that the manager had achieved an, 'excellent ethos.' A relative said that the manager was, 'inspirational' and 'I think that she is the source of the caring attitude.'

Carers told us that the manager was, 'approachable, helpful and always stays calm.'

There was an effective system in place to monitor and assess the quality of the service. This included annual surveys for people using the service and another for stakeholders, and separate meetings for staff, residents and relatives. The manager told us that they had reviewed the training that staff received, and in response to comments were in the process of changing the way training was delivered so that e-learning and face to face training would be better balanced. All staff took part in regular supervision meetings and had an annual appraisal. Independent and provider safety and quality assessments had taken place. We saw that action plans had been formed and implemented to address any shortfalls meeting the expected standard of safety and quality.

We watched staff as they cared for people. People had given consent for care and staff always asked for permission before providing care. Where people could not give consent staff had spoken to their families and medical professionals so that knew how to act in people's best interests. Staff provided care and support that met people's needs. We found that staff knew about the needs of the people they cared for. We looked at care records for five people and found that these contained guidance for staff on how to meet their needs. We saw that people's needs had been reviewed regularly.

We found that medicines were prescribed and given to people appropriately. We also found that medicines had been secured stored and managed safely.

The registered manager had taken reasonable steps to ensure that suitable people had been employed to work at the home although we found that sometimes full working histories had not been completed. Records had been maintained appropriately and stored securely.

During this inspection we spent time on both units and in total we spoke with eight people who used the service and six members of staff. We also spent some time observing the interaction between staff and people who used the service and reviewing care records.

People who lived at Davenham were complimentary of the service and told us that they were cared for well.

On Bradbury Court we carried out observations and saw that people who used the service had good relationships with staff and that staff appeared to know them well.

On both units we found that people who used the service were supported and encouraged to express their views and make decisions about their care and how they wanted to spend their time. The individual needs of people were assessed and supporting plans had been developed. This ensured people's needs would be met by staff.

We found that people who used the service were supported by staff who had received appropriate training to enable them to meet their needs.

The service had arrangements in place for monitoring the quality of the service.