Malvern House

Malvern House is a residential care home providing accommodation for persons who require nursing or personal care to up to eight people. The service provides support to older and younger adults, who may have a physical disability, learning disabilities or autistic spectrum disorder or require support with their mental health. At the start of our inspection there were three people living at the home.

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.

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

Right Support: The provider failed to have safe and robust systems to meet people’s individual needs when their behaviours were of such an intensity, frequency or duration that their physical safety was likely to be placed in serious jeopardy.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

Right Care: The provider failed to consistently help people have a good quality of life that supported their physical and mental health and emotional wellbeing while promoting their dignity and human rights.

Right Culture: The provider failed to act in a timely manner to ensure everyone living at Malvern House lived in a safe clean environment that promoted their privacy. The provider failed to ensure that staff interventions when people were in crisis were safe, proportionate and measurable through accredited training and comprehensive documentation.

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 24 May 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.

At our last inspection we recommended that audit systems be reviewed so the concerns we found could be identified by the provider. We also recommended the provider personalise policies and procedures to reflect the management structure of Malvern House. At this inspection we have found the same concerns and they were in breach of regulation 17.

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 inspection was prompted in part due to concerns received about the management of risk related to the support people received while living at Malvern House. A decision was made for us to inspect and examine those risks. As a result, we carried out a focused inspection to review the key questions of safe, effective and well-led only.

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

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.

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

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 people not being consistently protected from the risk of abuse. Systems did not always lessen risks for people and they were not consistently treated with dignity and respect and staff did not always act in accordance with the requirements of the Mental Health Act 2005. Staff had not received all the required training to support people safely and effectively at this inspection and governance systems failed to identify the concerns found at this inspection. We have imposed conditions on the providers registration as a result of this inspection.

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.

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.

Malvern House is situated in Heysham close to a number of facilities and amenities. All accommodation at the home is provided on a single room basis and all the bedrooms have en-suite facilities. Malvern House is registered to provide care and accommodation for up to eight persons.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided. At the time of this inspection two people lived at the home, only one person received personal care support.

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

The provider did not have effective systems to ensure all risks were identified and we found concerns regarding the management of some medicines. The provider did not always ensure people were adequately protected from unsafe recruitment of staff.

There were some ineffective governance systems. Records were not always accurate and completed in line with people’s assessed needs.

Audit systems did not highlight the concerns we found around, medicines management, risk management and recruitment. We have made a recommendation regarding good governance.

Although there were extensive policies and procedures to underpin safe care delivery, these were not always customised to the needs of the service. We have made a recommendation about service policies and procedures.

One person told us they were happy living at Malvern House. We observed they were happy and comfortable in the company of the provider and staff. Staff were able to explain how to raise a concern to safeguard people. During the inspection the provider worked to address concerns raised and minimise the risks identified during our visits.

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.

This service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

The person we spoke with had their own designated staff to support them. We observed the person we spoke with led conversations on what activities were occurring and when they would take place. Staff interactions were respectful, and staff never overpowered the situation, promoting the person’s involvement in conversations and decision making. The person told us they were happy in their home but was seeking to gain more independence.

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 (28 February 2018).

Why we inspected

The inspection was prompted in part due to concerns received about risk management, medication, staffing and governance. As a result, we carried out 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 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.

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

We have found evidence 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.

The provider has completed multiple actions, and this has reduced the risks for people living at Malvern House.

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

Enforcement

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 have identified breaches in relation to the management of risk, medicines management and the recruitment of staff at this inspection.

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

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 registered provider was an individual who also managed the home on a day to day basis. Registered providers 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.

At the last inspection on 26 January and 02 February 2017 the service was rated Requires Improvement. During the inspection we found improvements had been made and all breaches had been met from our inspection on 19 and 28 April 2016. However further work was required to embed the changes made to care records and for the registered provider to seek further clarification on the principles of the Mental Capacity Act 2005. We made recommendations about this.

At this inspection carried out on 31 January 2018 we have rated the service Good.

We spoke with one person who lived at the home and two people who were staying there on respite care. They all said they were happy, felt safe in the care of staff and were treated with kindness. One person said, “It’s been a good experience staying here. The staff have been brilliant with me.”

The service had sufficient staffing levels in place to provide support people required. We saw staff showed concern for people’s wellbeing and responded quickly when they required their help.

The service had systems in place to record safeguarding concerns, accidents and incidents and take necessary action as required. Staff had received safeguarding training and understood their responsibilities to report unsafe care or abusive practices.

Risk assessments had been developed to minimise the potential risk of harm to people during the delivery of their care. These had been kept under review and were relevant to the care provided.

Staff had been appropriately trained and supported. They had the skills, knowledge and experience required to support people with their care and social needs.

Medication procedures observed protected people from unsafe management of their medicines. People received their medicines as prescribed and when needed and appropriate records had been completed.

We saw there was an emphasis on promoting dignity, respect and independence for people who lived at the home. People told us staff treated them as individuals and delivered person centred care. Care plans seen confirmed the service promoted people’s independence and involved them in decision making about their care.

We looked around the building and found it had been maintained, was clean and hygienic and a safe place for people to live. We found equipment had been serviced and maintained as required.

The service had safe infection control procedures in place and staff had received infection control training. Staff wore protective clothing such as gloves and aprons when needed. This reduced the risk of cross infection.

People had been 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.

Staff knew people they supported and provided a personalised service in a caring and professional manner. Care plans were organised and had identified care and support people required. We found they were informative about care people had received.

People told us they were happy with the variety and choice of meals available to them. We saw regular snacks and drinks were provided between meals to ensure people received adequate nutrition and hydration.

We saw people who lived at the home had access to healthcare professionals and their healthcare needs had been met.

People who lived at the home told us they enjoyed a variety of activities which were organised for their entertainment. These included external activities in the local community including attending concerts, going for a meal and trips to Blackpool.

People told us staff were very caring towards them. Staff we spoke with understood the importance of high standards of care to give people meaningful lives.

The service had information with regards to support from an external advocate should this be required by them.

The service had a complaints procedure which was made available to people on their admission to the home and their relatives. The people we spoke with told us they were happy with the service and had no complaints.

The registered manager used a variety of methods to assess and monitor the quality of the service. These included regular audits and relative meetings to seek their views about the service provided.

At the last inspection on 19 and 28 April 2016 we asked the provider to take action to make improvements because we found breaches of legal requirements. This was in relation to risk management, care planning and management and governance of the home. We also found the service had not followed the principles of the Mental Capacity Act 2005 ensuring people’s rights were protected.

During our inspection visit on 26 January and 02 February 2017 we found improvements had been made and all breaches were met. However further work was required to embed the changes made to the care records and we have made recommendations about this.

Malvern House is registered to provide care and accommodation for up to eight persons who have a learning disability, mental health needs or autistic spectrum disorder. The home is situated in Heysham close to a number of facilities and amenities. All accommodation at the home is provided on a single room basis and all of the bedrooms have en-suite facilities. At the time of our inspection visit there were four people who lived at the home.

The registered provider was an individual who also managed the home on a day to day basis. Registered providers 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. At our inspection on 26 January and 02 February 2017 the provider informed us that they had appointed a manager for the service and the manager was in the process of applying to become the registered manager.

We spoke with three of the four people who lived at the home. They told us they felt safe and liked the staff who supported them. Comments received included, “I am leaving soon but have enjoyed my time here. They have done a lot for me and I appreciate that.” And, “The new manager is very nice and helpful.”

We observed staff providing support to people throughout our inspection visit. We saw they were kind and patient towards the people in their care.

The three people we spoke with told us they were happy with the variety and choice of meals available to them. We saw snacks and drinks were provided between meals. One person told us staff tried very hard to encourage them to eat a healthy diet.

We found people had access to healthcare professionals and their healthcare needs were met. We saw the service had responded promptly when people had experienced health problems.

We found the service had systems in place to record safeguarding concerns, accidents and incidents and take necessary action as required. Staff had received safeguarding training and understood their responsibilities to report unsafe care or abusive practices.

Staff spoken with and records seen confirmed training had been provided to enable them to support people in their care. They were knowledgeable about the support needs of people and how they wished their care to be delivered.

We found sufficient staffing levels were in place to provide support people required. We saw staff members could undertake tasks supporting people without feeling rushed. People who lived at the home told us they felt safe and staff were available when they needed them.

The manager and registered provider had completed training to help them understand the principles of the Mental Capacity Act 2005. People ’s capacity had been assessed however this was not required for each decision about their care and treatment. We have made a recommendation that the registered provider seeks further clarification on the principles of the Mental Capacity Act 2005.

There had been no new staff appointed to work at the home since we last completed a comprehensive inspection of the service in September 2015. We did not identify any concerns about the services recruitment procedures during that inspection.

We looked around the building and found it had been maintained, was clean and hygienic and a safe place for people to live. We found equipment had been serviced and maintained as required.

The service had a complaints procedure which was made available to people on their admission to the home and on display in the hallway. People we spoke with told us they were happy and had no complaints at present.

We found medication procedures at the home were safe. Medicines were safely kept with appropriate arrangements for storing in place.

We found systems and procedures were in place to monitor and assess the quality of their service. These included seeking views of people they support through resident meetings and annual satisfaction surveys.

Although the service had improved since the last inspection we still need to ensure the improvements will be sustained. This is because to do so requires consistent good practice over time. We will check this during our next planned comprehensive inspection.

This focussed inspection took place across two dates, 19 April and 28 April 2016. The first day of the inspection was unannounced. This means we did not give the registered provider prior knowledge of our inspection. The second day was announced. We also revisited the registered provider on the 16 May 2016 to give feedback of our inspection findings. We did this by prior arrangement.

Malvern House is registered to provide care and accommodation for up to 8 persons who have a learning disability, mental health needs or autistic spectrum disorder. The home is situated in Heysham close to a number of facilities and amenities. All accommodation at the home is provided on a single room basis and all of the bedrooms have en-suite facilities.

There was an individual registered provider in place. They became legally responsible for the home in June 2015. The registered provider manages the day to day running of the home. Registered providers have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At the comprehensive inspection of Malvern House in September 2015 the service was rated as ‘requires improvement’ overall, with ‘requires improvement’ ratings in two of the key questions ‘is the service safe?’ and 'is the service well – led?’ We identified a breach of Regulation 12, (Safe care and treatment) as risks to a person who lived at the home were not managed safely. We also identified a breach of Regulation 13, (Safeguarding service users from abuse and improper treatment) as referrals to safeguarding authorities were not always made. In addition we identified a breach of Regulation 17, (Good Governance) as there were ineffective systems in place to identify, monitor and assess the risks relating to the health, safety and welfare of people who used the service. We further identified a breach of Regulation 18 of the Care Quality Commission (Registration) Regulations 2009 as notifications to the Care Quality Commission were not always made.

We carried out this focussed inspection in April 2016 to check improvements had been made.

During the focussed inspection carried out in April 2016, we found risk assessments were not reviewed to ensure people received care and support which met their needs. In addition we found risks were not always suitably assessed and managed. This was a continued breach of Regulation 12, (Safe Care and Treatment).

We noted there were ineffective quality monitoring systems in place as areas for improvement had not been identified by the registered provider. This was a continued breach of Regulation 17, (Good Governance.)

We viewed care records to ascertain the care and support people received. We found information was sometimes difficult to find and there were gaps in some daily entries. In addition we noted care and support needs had not been fully documented to ensure staff knew people’s care and support needs and the reasons for these. We further found there was no documented evidence of agreements made with people regarding the purchasing of essential items. This was a breach of Regulation 17, (Good Governance.)

We found best practice guidance was not implemented in relation to supporting people who are living with a learning disability. We have made a recommendation regarding this.

We found the principles of the Mental Capacity Act 2005 were not always followed. This was a breach of Regulation 11, (Need for Consent.)

The overall rating for this service is ‘Inadequate’ and the service is in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

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