Mallands Residential Care Home

Updated 4 May 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

The inspection took place on 01 and 02 February 2018 and was unannounced. It was carried out by an adult social care inspector and an expert by experience. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Prior to the inspection we reviewed information we held about the service, including notifications, previous inspection reports and safeguarding reports. A notification is information about specific events, which the service is required to send us by law. We used information the provider sent us in the Provider Information Return. This is information we require providers to send us at least once annually to give some key information about the service, what the service does well and improvements they plan to make

We looked at a range of records related to the running of the service. These included staff rotas, four staff files, medicine records, meeting records and quality monitoring audits. We also looked at four care records for people living at Mallands Residential Care Home.

We spoke with six people and four visitors to ask their views about the service, and one person being supported in the community. We spoke with eight staff, including the providers, registered manager and cook. We had feedback from three health care professionals who supported people at Mallands Residential Care Home.

Some people living with dementia were not always able to comment directly on their experiences. We therefore used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people living with dementia.

Updated 4 May 2018

Mallands provides accommodation and personal care for a maximum of 38 older people. 31 people were living there at the time of the inspection. People who use the service include people with dementia and people with physical needs, as well as people staying for a short while for respite or convalescence. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Mallands also provides personal care support to people in their own homes in the community. Five people were receiving this support at the time of our inspection.

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 2008 and associated Regulations about how the service is run.

People, relatives and staff expressed a very high level of confidence in the leadership and management of the service. Comments included, “I truly believe you have a fabulous leader as someone who understands how care homes should be run and how the patients need to be treated” and, “It’s the first home I’ve worked in and I think it’s amazing. The directors are really supportive, not just sitting in the office and telling us what to do.”

The providers and registered manager were passionate and committed to developing a service where people received genuinely person centred care. Their ethos was influenced by current evidence based approaches such as ‘Dementia Care Matters’ and the ‘Eden Alternative’, and shared across the staff team. This approach saw ageing as a continued stage of development and growth and supported people to play a full and active role in their community by challenging loneliness, helplessness and boredom.

The providers had considered the layout and décor of the building and taken advice from a leading academic in dementia care, to create a dementia friendly environment. This meant they were challenging helplessness by enabling people living with dementia to find their way around independently. They had also considered how technology could be used to promote people’s independence through the provision of a ‘smart device’ which people could ask to play music, tell them the time or the weather forecast. This would be particularly useful for people with a visual impairment, or who were cared for in their rooms.

Activities were developed according to people’s history and interests and often had a purpose, enabling people to contribute to the life of the home and community. For example, people supported the homes’ cooking club and sewing club by growing lavender in the herb garden for the sewing club to make scented pouches, and spices for use in the cooking club. This challenged loneliness and boredom, giving people opportunities to socialise and a sense of purpose and wellbeing. Community links were established, which meant people could access life outside of the home.

People received care from staff who had received comprehensive relevant training and induction. There were sufficient numbers of staff on duty to meet the needs of people using the service and spend quality time with them. This meant that ‘impromptu’ and unplanned activities could take place like a walk in the garden followed by a hot chocolate. The service supported people to develop close relationships with each other and with care staff and we saw lots of positive interactions during the inspection. Staff ran clubs including weaving, cooking and painting after people had said they would like to spend more time speaking with them.

People’s nutritional needs were met because staff followed people’s support plans to make sure people were eating and drinking enough and potential risks were known. The service had taken action to improve quality of life at mealtimes through increasing social interaction, promoting choice and encouraging independence. This meant people now enjoyed eating together rather than alone, and food and fluid intake had improved, as well as independence with eating.

Policies and procedures ensured people were protected from the risk of abuse and avoidable harm. Staff had safeguarding training, and were confident they knew how to recognise and report potential abuse. Staff, were recruited carefully and appropriate checks had been completed to ensure they were safe to work with vulnerable people.

There were systems in place to ensure risk assessments were comprehensive, current, and supported staff to provide safe care while promoting independence. The computerised care planning system ensured that information about people’s risks was shared efficiently and promptly across the staff team. This meant staff had detailed knowledge of people’s individual risks and the measures necessary to minimise them. The registered manager had an oversight of the support being provided at all times. This system could also be accessed by relatives with the persons consent.

Systems were in place to ensure people received their prescribed medicines safely, including when people wanted to manage their own medicines. People were supported to access health care professionals to maintain their health and wellbeing.

People received care which was responsive to their needs. People and their relatives were encouraged to be part of the care planning process and to attend or contribute to care reviews where possible. This helped to ensure the care being provided met people’s individual needs and preferences. Support plans were personalised and guided staff to help people in the way they liked.

The service placed a strong emphasis on a ‘person centred approach’, and ensured people, and their advocates where appropriate, were fully consulted and involved in all decisions about their lives and support. This meant people’s legal rights were protected. People’s individual communication needs were understood and information provided in a format appropriate for them, which meant they could participate fully.

Policies, procedures and staff training were in place to ensure people were treated equally and fairly. People told us the staff were kind and caring and treated them with dignity and respect. The service recognised the importance for people of maintaining close family relationships and provided the support required to make this happen.

The service was proactive in identifying and meeting the information and communication needs of people living with dementia and/or experiencing sensory loss. A braille version of the fire procedures had been developed for a person who was registered blind, and the activities programme could be provided in a different format such as tape or braille, for people with sight problems. There were plans to use the ‘smart device’ in the lounge to tell people the day’s activities or menus.

The service was very well led by the registered manager and providers, supported by a dedicated team. There were quality assurance systems in place to help monitor the quality of the service, and identify any areas which might require improvement. The registered manager and providers promoted the ethos of honesty and admitted when things had gone wrong.