Options Malvern View

About the service

Options Malvern View is a residential care home providing personal care to 22 people at the time of the inspection. The service can support up to 33 people living with a learning disability and/or autism.

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

Right Support: Risks associated with medicines were not always monitored or managed consistently. Staff did everything they could to avoid restraining people. The service recorded when staff restrained people, and staff learned from those incidents and how they might be avoided or reduced. Staff supported people to make decisions following best practice in decision-making. Staff communicated with people in ways that met their needs.

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.

Right Care: People received kind and compassionate care. Staff protected and respected people’s privacy and dignity. Staff understood and responded to people's individual needs. People who had individual ways of communicating, using body language, sounds, pictures and storyboards could interact comfortably with staff and others involved in their care and support because staff had the necessary skills to understand them. People’s care and support plans were up to date and current. Staff were provided with detailed guidance to enable them to to provide personalised support to people.

Right Culture: There had been changes to the way the home was run since our last inspection. Relatives told us this had started to make a difference to the quality of care. The registered manager and provider had identified some improvements were needed in the way people’s medicines were managed and checked. Steps were being taken to address these. Management were open and visible and were committed to developing people’s care further. Staff knew and understood people well and were responsive, supported their aspirations to live a quality life of their choosing.

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 inadequate (published 6 July 2022) and there were breaches 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 some improvements had been made and the provider was no longer in breach of regulation 12 and regulation 18.

This service has been in Special Measures since 7 July 2022. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Responsive and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from inadequate to requires improvement based on the findings of this inspection.

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.

You can see what action we have asked the provider to take at the end of this full report.

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

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Options Malvern View is a residential care home that provides personal care and support for up to 33 people with a learning disability and autism. At the time of the inspection there were 25 people living at the service.

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

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right Support: The provider could not demonstrate how the service met the principles of right support, right care, right culture. This meant we could not be assured that people were always empowered to make choices and be involved in their care and support.

However, some improvements had been made since last inspection and some people were now having more access to community-based opportunities. There were also revised line management structures, which the provider told us would improve the oversight of the care that people received. These aspects of improvement were still under development and had not become fully embedded in people’s experiences.

Right Care: People were not always supported to have maximum choice and control of their lives and staff did not always support people in the least restrictive way possible and in their best interests. Partner agencies and the CQC have continued to receive concerns around aspects of restrictive practice.

Right Culture: Although the provider was taking steps to improve the governance and oversite of the service, these improvements had not yet become embedded and the CQC and partner agencies and continued to receive concerns relating to the culture in the service.

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 inadequate (published 6 July 2022)

Why we inspected

We undertook this targeted inspection to check on a specific concern we had about the culture in the service. The overall rating for the service has not changed following this targeted inspection and remains inadequate.

We use targeted inspections to follow up on Warning Notices or to check concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

About the service

Options Malvern View is a residential care home that provides personal care and support for up to 33 people with a learning disability and autism. At the time of the inspection there were 29 people living at the service. The service is on a large site which is separated into five distinct living areas called Stour, Brook, Everest, Severn and Avon.

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

The provider could not demonstrate how the service met the principles of right support, right care, right culture. This meant we could not be assured of the choices and involvement of people who used the service in their care and support.

Right Support

The service did not support people to have the maximum possible choice, independence or have control over their own lives.

Staff did not always do everything they could to avoid restraining people. The service did not always record when people were restrained, which meant that a review of the incident was not undertaken to assess how the need for restraint could be avoided or reduced. Staff were unable to learn from the review to improve their practice and people, were at risk of injury from inappropriate use of restraint or restrictive practices.

People did not always have the support they needed to meet their needs and keep them safe. This increased the risks to people’s health and wellbeing.

Right Care

The service did not have enough appropriately skilled staff to meet people’s needs and keep them safe.

Staff were carrying out restrictive actions with people without relevant training on how to do this safely or in line with the person’s own care plans and risk assessments. This placed people at risk of neglect or injury because care was not always provided by suitably qualified, skilled and experienced staff.

People’s care, treatment and support plans did not always reflect their range of needs or promote their wellbeing and enjoyment of life.

People who had behaviours that may challenge themselves or others, had proactive behaviour strategies in their care records. However, this did not provide detail on the specific actions staff should take to ensure practices were least restrictive to the person and reflective of a person’s best interests.

Right culture

Care was not always person centred and people were not empowered to influence the care and support they received. One person told us, “I am talked through and not to.”

The systems for reporting were not always open and transparent. For example, commissioners of care were not always notified how people’s care and support was managed therefore had no oversight.

The governance systems the provider had in place were not always effective. Governance systems did not ensure people were kept safe and received a high quality of care and support in line with their personal needs.

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 14 October 2021) and there were breaches 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 the provider remained in breach of regulations.

Why we inspected

We undertook this inspection to assess that the service is applying the principles of Right support, right care, right culture.

We received concerns in relation to staffing, management and care for people that lived there. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to inadequate based on the findings of this inspection.

We have found evidence the provider needs to make improvements. Please see the safe and well-led sections of this full report.

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.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to safe care, staffing, safeguarding and governance at this inspection.

You can see what action we have asked the provider to take at the end of this full report.

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

Follow up

we wrote to the provider and requested some information to be sent to us urgently, outlining what they were going to do to mitigate the risks identified and to keep people safe. The provider responded demonstrating some immediate actions taken.

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Options Malvern View is a residential care home on a campus. The home is split up into four units, flats and an individual bungalow, providing personal care to up to 33 people with a learning disability and/or autism aged up to 65 and over at the time of the inspection. The service had 28 people living there at the time of the inspection. The service is on a large site with each unit providing accommodation to a small number of people. The units and flats are called Stour, Brook, Everest, Severn and Avon.

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

The management and recording of individual risks had not always been assessed or plans implemented. People said they were happy living at Options Malvern View. People told us they liked living at the service. Families highlighted concerns about low staffing levels and the impact this had on activities and people with epilepsy not being as closely monitored as they would like them to be. The provider had taken measures to improve recruitment and retention of staff, but this was a new initiative and it was too soon to see evidence of the impact this would have.

Lack of oversight and governance meant leaders were not always identifying potential risks or taking action to improve the quality of care being provided. Recent improvements had not been fully embedded in to practice for care staff and systems were not in place for this to be improved.

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.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

Based on our review of safe and well-led the service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture.

The model of care did not always maximise people’s choice, control and independence. This was due to staffing levels which did not always allow for one to one or two to one support so that activities and time in the community could take place. Leaders had not always had enough oversight of areas such as epilepsy care plans and how they are used which could be a risk to people’s safety. Some areas of the environment needed to be updated or repaired. The management team confirmed they had been allocated additional money to continue with their programme of updating the buildings, but it was not clear if this would include the areas identified on inspection.

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 18 November 2019) and there were multiple breaches 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 enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

We received concerns in relation to staffing, management and recording relating to epilepsy and bowel management for residents. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We have found evidence the provider needs to make improvements. Please see the safe and well-led sections of this full report.

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.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

We have found evidence that the provider needs to make improvement. Please see the safe and well-led sections of this full report

You can see what action we have asked the provider to take at the end of this full report.

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

We have identified breaches in relation to the maintenance of the buildings in the following units Brook, Everest and Severn, low levels of staffing and the management of epilepsy across the site.

Please see the action we have told the provider to take at the end of this report.

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Options Malvern View is a residential care home on a campus, the home is split up into four homes, flats and an individual bungalow, providing personal care to 29 people with a learning disability and/or autism aged up to 65 and over at the time of the inspection. The service can support up to 33 people.

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

The service was a large home, bigger than most domestic style properties. It was registered for the support of up to 33 people. 29 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.

The service didn’t always consistently apply the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

The outcomes for people did not fully reflect the principles and values of Registering the Right Support for the following reasons people were not always represented by an independent advocate or relative where decisions about their medication was made.

The provider's quality checking arrangements were not consistently strong enough and effective in ensuring there was a sufficient oversight of the home. The potential risks to people's safety and welfare were not effectively identified and reduced by the management teams own checking procedures. The provider had not acted to ensure all infection control measures and fire prevention requirements had been met.

The outcomes for people did not fully reflect the principles and values of Registering the Right Support for the following reasons people were not always represented by an independent advocate or relative where decisions about their medication was made.

People received their medicines as intended from trained staff, but the booking out of medicine procedures when people went home on home leave needed to be strengthened.

People’s environment and furniture needed to be improved to ensure it was safe for them to use.

Not all staff had completed their health and safety and infection control training.

People were supported by staff who had received training and knew how to report witnessed incidents of potential abuse.

The provider’s complaints procedures were followed, by the registered manager .

Staff felt supported by the registered and deputy manager.

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 good (published 25 February 2017)

Enforcement

We have identified three breaches in relation to potential risks to people’s safety and monitoring, the environment/premises and oversight of the service.

You can see what action we have asked the provider to take at the end of this full report. For requirement actions of enforcement which we are able to publish at the time of the report being published.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The service provides a residential service for up to 33 people with learning disabilities requiring personal care. There were 25 people living at the home when we visited 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 appeared at ease and comfortable in the company of staff and responded positively to staff. Staff understood what it meant to protect a person from harm and to keep them safe and had received training and guidance on the subject. Staff recruited to work at the home underwent checks of their background to ensure the registered manager had enough information to make a decision about their suitability for working at the home. People were supported to take their medicines as they needed and regular checks were made to ensure people received the support they needed.

Staff had access to training and supervision to enable them to support people. The provider acted in accordance with the Mental Capacity Act (2005) (MCA) and Deprivation of Liberty Safeguards (DoLS). The provisions of the MCA are used to protect people who might not be able to make informed decisions on their own about the care or treatment they receive. People were offered choices in the meals prepared for them and supported to maintain a healthy diet. Where people required the support of additional health professionals to support their wellbeing, people were helped to access this support.

People were supported by a team that understood the registered provider’s expectation of care. We saw systems that had been embedded to review and monitor people’s care. Where action was required by either staff or the management team, this was highlighted on the computer system so that all necessary tasks were completed. People’s care was also reviewed to check for trends, so that if adjustments were needed to people’s care, these could be made.

People told us they were happy living at the home and supported by caring staff. People’s independence was promoted. Visitors were welcome to see their family members or friends when they wanted.

Quality audits were undertaken by the registered manager and the provider to develop people’s care further. The provider and registered manager took account of people’s views and suggestions to make sure planned improvements focused on people’s experiences.

We spoke with the registered manager, the acting manager, head of service, the day services' manager, flat managers, team leaders and support workers. We spoke with a small number of people who used the service. During our inspection many people who used the service had gone out to take part in activities. We observed the care and support provided to some people. One person who used the service told us that staff supported them with: 'Independent living'.

We found that staff had a good awareness of the needs of people they cared for and supported.

We found that people received their medicines. The records to evidence that people had received their medicines were not however always fully maintained.

Systems were in place to ensure that people employed to work at the service were checked to ensure their suitability prior to them starting work.

We found that improvements were needed to ensure that people's records were maintained and up to date. This meant that people were at risk of receiving inappropriate care and support.

We found that staff had an understanding of the needs of people and they supported them to meet those needs. Steps had been taken so that care was planned and delivered in a way that met people's needs.

We found that people were protected from the risk of abuse. Staff had a kind and caring approach towards the people they supported.

Staff received training provided by the provider which assisted them to meet and support people’s needs. The formal supervision of staff had taken place to provide staff with support.

The provider had systems in place to assess and monitor the quality of the service that people received. This was to make sure that appropriate care was provided.

In this report the name of one registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. The name appears because they were still a Registered Manager on our register at the time.