Malden House

Updated 23 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.

This comprehensive inspection took place on 27 February and 5 March 2018. The first day was unannounced and the second visit day was announced to ensure we met with the registered manager. The inspection team comprised of 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 services for older people.

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

We met all 16 people using the service, spoke with eight visiting relatives and looked in detail at three peoples’ care records. Our observations around the home enabled us to see how staff interacted with people and how care was provided. A number of people using the service were unable to provide detailed feedback about their experience of life at the home. We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

We spoke with the registered manager, deputy manager, a director, and with seven staff which included care staff, the cook and an activity co-ordinator. We attended a staff handover meeting and looked at five staff records, which included staff recruitment, training, supervision and appraisal records. We looked at the provider’s quality monitoring systems such as audits of medicines, records, health and safety audits, and at action taken in response to feedback from people, relatives and staff.

We sought feedback from health and social care professionals who regularly visited the home including GP’s, community nurses, other therapists and commissioners. We received a response from nine of them.

Updated 23 May 2018

This comprehensive inspection took place on 27 February and 5 March 2018. The first day of our visit was unannounced and we agreed the date of the second day with the registered manager.

Malden House 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 home is a two storey building in the town of Sidmouth and is registered to provide care for up to 19 older people, many of whom are living with dementia. There were 16 people living at the home when we visited.

The service had a registered manager, who had been appointed since we last visited the service. A registered manager is a person who has registered with CQC 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.

At the last inspection, in October 2015, the service was rated good overall, with no breaches of regulations. At this inspection we found the service rating had improved from Good to Outstanding.

People received effective care, based on best practice evidence. The service used ‘lead roles’. Staff developed their expertise through additional training, shared their knowledge with people and staff and promoted best practice. Lead roles included falls prevention, nutrition, dignity, helping people develop new interests and hobbies and staff wellbeing.

Staff developed exceptionally positive caring and compassionate relationships with people. The ethos of the home was that of an extended family. The service used the national 'Dignity in Care' good practice steps. For example, by supporting people with the same respect they would want for themselves or a member of their family. A dignity lead promoted dignity issues. For example, by paying attention about how people and staff communicated with one another.

People and relatives consistently spoke about the “family atmosphere” at Malden. People’s comments included; “It’s delightful living here”, “It feels as though one’s being cared for by one’s own family, not people who are doing a job”, “It’s easy to forget you’re not still living in your own home. It’s so relaxed and easy going.

The service had developed an innovative weekly ‘Tiny feet club’ where children and grandchildren of relatives and staff spent time together. These sessions invoked happy memories of nurturing and parenting and improved people’s wellbeing.

People were supported to have a peaceful, comfortable and dignified end of life care in line with national best practice guidance. They consistently commented on the kind words, reassurance and compassion of staff towards them and their loved ones.

People experienced a level of care and support that promoted their physical and mental wellbeing and enhanced their quality of life. Staff focused on people's wellbeing and having a sense of purpose. Staff knew about people's lives, their interests and talents and encouraged them to share them with others.

People mattered and they received care personalised to their needs. For example, when a person who loved the outdoors became frail, and spent most of their time in bed, staff moved them to a room with a large window. They enjoyed looking out of the window and the winter sunshine. Staff brought a container of compost to the person’s room, so they could plant sweet peas, watch them grow and smell their scent. When it snowed, they brought a snowball in for the person so they could see and touch it.

People were encouraged to socialise, pursue their interests and hobbies and try new things in a wide variety of inspiring and innovative ways. For example, art, pottery classes, cookery and gardening clubs, Yoga, Pilates and Zumba (dance to music) classes.

People were supported to have maximum choice and control over their lives and staff supported them in the least restrictive way possible. Staff confidently adhered to the principles of the Mental Capacity Act (MCA) 2005 in their day to day practice. For example, the service used the ‘Hampshire mental capacity toolkit’ to assess people’s mental capacity to make decisions. This required staff to use the tool at different times of the day on three separate occasions, before they concluded whether or not a person had capacity to make that decision. The environment of care was adapted to meet the needs of people living with dementia, for example, through use of picture and word signage.

The CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. DoLS provide legal protection for those vulnerable people who are, or may become, deprived of their liberty. The service had made appropriate applications to the local authority DoLS team for people they had assessed as needing to be deprived of their liberty.

Improvements had been made to enhance people’s dining experiences. For example, by making each meal more of an occasion and by encouraging people to help one another and socialise. The service had also introduced food moulds for people with swallowing difficulties. This presented pureed meals in shapes of each food which made meals more attractive and appetising.

People, relatives and professionals spoke about the exceptional quality of care provided at Malden House. Staff were motivated, enthusiastic and felt proud to work at Malden House. They consistently commented on good teamwork, communication and approachable and supportive management. Surveys of people, relatives and Care Home UK reviews consistently demonstrated positive feedback on all aspects of care at Malden House. People and relatives were 'extremely likely' to recommend the home to others. A relative said, “He is happy and confident here, there are open lines of communication.”

The service had a positive culture that was person-centred, open, inclusive and empowering. The provider was committed to developing staff through their ‘Stars of the Future’ leadership and development programme. The registered manager set clear expectations of the standards expected, through coaching, goal setting and positive role modelling. A ‘Hartford Heroes’ provider award scheme recognised, re-enforced and rewarded positive staff values, attitudes and behaviours.

People received a consistently high standard of care because the service used evidence of what works best to continually review and improve their practice. The service had robust quality monitoring arrangements which demonstrated the service was high performing. They continually reviewed, evaluated and improved people's care.

People’s needs were supported because the service had sufficient numbers of suitable skilled staff to meet their needs. The atmosphere in the home was peaceful, calm and organised and staff spent time with people. People received their medicines safely and on time from staff who were trained and assessed to manage medicines safely.

People participated in a meaningful way in recruiting staff. Robust recruitment checks were in place and new staff had a probation period to ensure they demonstrated the skills and values needed. People knew how to raise concerns and were confident any concerns would be listened and responded to. Staff were trained to be aware of signs of abuse, any concerns were appropriately reported to appropriate agencies, with action taken to protect people.

There was an ongoing programme of repairs, maintenance and servicing to maintain safety and continually improve the environment of the home. The premises were well managed to keep people safe. For example, staff were familiar with actions to take to protect people in the event of a fire or other emergency. People were protected from cross infection by good standards of cleanliness and hygiene.