Archived: The Old Malthouse Care Home

The Old Malthouse Care Home is a residential care home providing personal care to 24 people aged 65 and over with various support needs, including both physical needs and dementia, at the time of the inspection. The service can support up to 34 people.

The building consists of a converted older building with additional wings added. The separate wings have various communal areas, including lounges and a garden.

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

People at the home were safe. People we spoke to were happy and there were enough staff to support people when they needed it. Healthcare professionals who worked with the service told us they had no concerns about staff or safety at the home. Medicines were managed safely using a new electronic medicines administration system. Staff knew people well enough to be able to tell if they were becoming distressed and to modify the care they gave, a staff member told us “We are like a family and you know if someone is getting upset.”

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.

The registered manager and the deputy manager were supportive of the staff and staff told us they were happy to work at the home. Healthcare professionals who worked with the service told us the home was well managed by a “professional” registered manager. One health care professional said, “In my experience with working with the Old Malthouse, I have found them to be professional and compassionate to their residents.” Another told us, “I think the service is safe and that the staff work well with the GPs.”

The registered manager and the senior team carried out audits to monitor safety. Information received from audits was used to improve the service. The registered manager kept relatives informed about changes within the service due to COVID-19, for example visiting arrangements. Relatives and friends were informed where appropriate about the care needs of people and were asked for their input via surveys.

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 good (published 13 August 2019).

Why we inspected

We received concerns in relation to the safety of people’s care, and the management of the service. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

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 found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe and well-led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Old Malthouse Care Home on our website at www.cqc.org.uk.

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

The Old Malthouse Care Home is a residential care home providing personal for up to 34 older people with various support needs, including people living with dementia, physical or sensory impairment. At the time of our inspection, 25 people were in residence. The building, originally a working granary and malthouse from the 16th Century, retains many of its original features. The accommodation has been adapted and there are a range of communal areas. A new decking area leading to an enclosed garden provides a safe outdoor space for people to enjoy.

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

People felt safe and told us they enjoyed living at the service. One person said, "They look after us very well". Risks to people had been assessed and staff followed guidance to keep people safe. Staffing levels were sufficient to meet people's needs. Medicines were managed safely. The home was clean and staff had been trained in infection prevention and control. Lessons were learned if things went wrong.

People spoke positively about the staff who supported them and had confidence in their skills and experience. One person said, “All the workers are good and kind to us all, they are doing a good job”. Staff had regular supervisions and were able to further their careers through training and development. People enjoyed the food and were able to make suggestions for the menu. Snacks and drinks were readily available. People had access to a range of healthcare professionals and support. Premises were suitable and comfortable and met people's 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.

People were looked after by kind and caring staff who knew them well. People were encouraged to be involved in decisions relating to their care and were treated with dignity and respect. A relative told us, “I genuinely feel that this home does care about its residents very well”. People received personalised care that was responsive to their needs. Staff used a ‘stop and watch’ system to monitor any changes in a person’s health or wellbeing. There was a range of activity on offer, including group and one to one time. Several activities involved visitors from the local community or people going out to local events.

People could spend the rest of their lives at the home, if their needs could be met and this was their wish. People considered the home was well-organised. The registered manager provided a visible presence at the home. People were involved in the development of the home and their feedback was encouraged. One person told us, “The check on me all the time to make sure that I am well. I talk to them about everything”.

The registered manager had systems of quality assurance to measure and monitor the standard of the service and drive improvement. There were links with the community and people participated in activities aimed at making the local town more dementia-friendly. The home worked proactively with healthcare professionals and other local care services in order to share ideas and learn from best practice.

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 (Report published 27 July 2018) 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 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.

The overall rating for the service has changed from Requires Improvement to Good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for The Old Malthouse Care Home on our website at www.cqc.org.uk

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.

The inspection was carried out on 15 and 16 January 2018, and was an unannounced inspection.

This service is a care home. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The Old Malthouse provides accommodation and personal care without nursing for up to 34 older people. Accommodation was provided in an old detached building which had been added to with newer purpose-built wings. At this inspection, there were 28 people living in the service.

The service was all mainly on the ground floor with some areas being slightly higher than others and there were gentle slopes for people to walk up and down. There were five bedrooms on the second floor.

People living in the service required care and support and had varying needs. Some people were living with dementia and some people had medical conditions, such as diabetes or mobility issues. Some people required the support of one staff member to move around whilst others required the support of two staff using hoisting equipment.

There was a registered manager. However, they were not available on the days of the inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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 home is run. In the registered managers absence the deputy manager supported the inspection throughout the two days of the site visit.

At the last Care Quality Commission (CQC) inspection on 7 July 2015 the service overall was rated as Good. Although the Effective question was rated as ’Requires Improvement’ at that inspection. This was because we found at that time the provider and registered manager were not acting in accordance with the legal requirements of the Mental Capacity Act (MCA)2005 and Deprivation of Liberty Safeguards (DoLS).

At this inspection we found they had met their legal requirements. With the basic principles of the Mental Capacity Act 2005 had been followed to ensure people's rights were upheld. Deprivation of Liberty Safeguards applications had been made and the registered manager kept these under review. People's interests and preferences were identified and recorded.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care services. Restrictions imposed on people were only considered after their ability to make individual decisions had been assessed as required under the Mental Capacity Act (2005) Code of Practice. The manager understood when an application should be made. Decisions people made about their care or medical treatment were dealt with lawfully and fully recorded.

During this inspection we found that medicine administration, storage and documentation was not robust and could have meant some people may not be receiving their medicines as prescribed or may have received more of a medicine than what was considered as safe within a time period.

Safe recruitment procedures to ensure only suitable staff were employed to provide care and support to people living in the service were also not consistently followed.

People's needs were not regularly assessed to ensure the appropriate care and support was being delivered. Where people's needs had changed, care plan reviews did not capture this to make sure staff were given the most up to date information on people’s needs. Individual risk assessments were in place to give the guidance necessary to staff when providing care to keep people safe and prevent harm, however, these had not been changed when people’s care needs changed. People being cared for on an air mattress were not having the pressure of these checked and recorded daily.

The provider had a system in place to monitor the quality and safety of the home. However, these were not effective enough to identify the failings or improvements required.

People and their relatives said they knew how to complain. However, the complaints procedure on view, in the entrance to the service, was not up to date and did not give time scales for action. We made a recommendation about this.

Policies and procedures were not up to date and had not been reviewed since 2015. Some of the policies and procedures were also written for a different service that is no longer part of the provider’s group.

People were offered a choice of meals each day. Mealtimes were staggered so that staff were able to assist people who needed to help. People had several different places they could eat their meals within the service or they could have meals in their bedrooms.

There were suitable numbers of staff to provide the care and support needed. Staff had a good understanding of their responsibilities in safeguarding people from abuse and where they would report any concerns they had. Staff knew people well and spent time with people to make sure they were not rushed. People were supported to maintain their independence and they told us they were treated with dignity and respect.

Staff were supported by regular staff supervision, staff also had undertaken training when they were new as part of their induction, they said the training included, health and safety, infection control, safeguarding and equality and diversity training. Training was on going and staff had development opportunities to take vocational awards.

Infection control procedures were robust and the service was clean and free from odour.

All servicing of systems and equipment had been carried out by the appropriate professional contractors.

Activities were an important part of the care being provided within the service.

People were able to express their views of the service through regular meetings and annual surveys. The registered manager made changes where necessary based on people's feedback.

Positive feedback was given about the management team and how the service was run. Staff felt supported and listened to.

During this inspection we found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations. You can see what action we told the provider to take at the back of the full version of this report.

Another person told us, "They do a good job here, it will never feel quite like home but it's the next best thing'. They went on to say, 'The staff are always on hand and keeping an eye on us and I think we are well cared for."

The relative that we spoke to said. 'The home is always clean, that's one thing I am very aware of as I didn't want my relative living somewhere that smelt of urine. This home always looks clean and smells fresh'.

We spoke with two staff members during our visit. Both of the staff that we spoke with felt that they were able to care for residents. They told us that communication was good at the home, and that they had the necessary skills and resources to meet people's needs effectively. One staff member said, "We do a good job here, I love working with the people here".

We found that people were cared for in a clean environment by staff that understood their needs. We also saw that the organisation had systems in place to effectively monitor the quality of care that they were providing to people.

Everyone told us that they were happy with the care and support they received. One person told us, "They are very nice here, the staff are look after me well".

Another person said, "I don't want to be here, but I have no choice because I cant cope at home. They couldn't do any more for me here I am well looked after".

As one family member explained, "I come in most days and I have only ever seen good care here, staff are friendly and kind".

People also told us that staff treated them with respect and promoted their privacy. They told us that they felt safe from harm living at the home and that they would be listened to if they raised any concerns. Our evidence gathered during this inspection supports the comments made by people who were receiving a service.