We carried out a review of the data available to us about Malden House on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Malden House, you can give feedback on this service.
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.
The inspection took place on the 8 and 13 October 2015 and was unannounced. We previously inspected the service in July 2013 and found the service was compliant with the standards we looked at and there were no breaches of regulations.
The service provides accommodation with personal care for up to 19 older people, many of whom are living with dementia. 16 people lived there when we visited and we met all of them.
Malden House is required to have a registered manager, as a condition of registration. The current registered manager had just left and the provider had notified us of the interim arrangements whilst a new manager was recruited. The notification showed the deputy manager was in an ‘acting manager’ role and a senior member of care staff was ‘acting’ deputy manager. 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 who used the service, relatives and health and social care professionals were impressed with the service and how people were treated. When we asked people what staff at the home did well, one person said, “Everything, they are always there,” another said, “Dance and sing well” and a third said, “Staff are kind and nice.” A relative said, “The team at Malden are exceptional in the care and service they provide.” Another said, “The manager has been wonderful and all the girls are brilliant.” A health professional said, “Staff are wonderful, they treat people like they were their own relatives, they love them to bits, it’s one big family. I love going there.”
People were treated with dignity and respect and staff were caring and compassionate towards them. Staff knew each person as an individual and what mattered to them. The service was organised around people’s needs and wishes. Staff respected each person’s privacy, dignity and independence. People were supported to express their views and were involved in decision making about their care.
People experienced a level of care and support that promoted their health and wellbeing. Staff were highly motivated, enthusiastic and skilled at meeting people’s needs, which enhanced their quality of life. People were supported to keep as fit and active as possible. Each person had a mobility and fitness care plan which showed any exercises and mobility aids they needed. Staff encouraged people to do as much as they could for themselves.
People were encouraged to socialise, pursue their interests and hobbies and try new things in a variety of inspiring and innovative ways. Care was focused on people’s individual needs, wishes and preferences and they were supported to remain active and independent. People’s care needs were assessed and care records had individualised information about their needs.
Staff knew each person well and had an excellent understanding of each person as an individual and how they wanted to be supported. Staff documented detailed life histories about each person, their life and family before they came to live at the home. These included the person’s achievements, what made them laugh as well as what made them sad.
The environment of care was adapted to meet the needs of people living with dementia. People were assisted to identify key areas such as toilets and bathrooms independently because they were well signposted with pictures and symbols, to help people find them. The home had lots of areas of interest for people to sit, enjoy and spend time in.
People received effective care, based on best practice, from staff that had the knowledge and skills needed to carry out their role. Health and social care professionals consistently gave us positive feedback about the care and support provided for people.
People praised the food choices available at the home. Staff supported people with poor appetites who needed encouragement to eat and drink, to stay healthy and avoid malnutrition and dehydration. Staff knew which people needed encouragement to eat and drink. They provided a variety of nutritious snacks, drink and milkshakes throughout the day to tempt people. Staff kept detailed food and fluid charts and monitored people’s weight and took action, where any concerns were identified.
People were offered day to day choices and staff sought people’s consent for care and treatment and ensured they were supported to make as many decisions as possible. Where people lacked capacity, staff confidently followed the Mental Capacity Act 2005 and its code of practice. They used good practice tools to assess people’s capacity for day to day decisions, and involved relatives, friends and professionals in best interest decision making.
The Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. DoLS provide legal protection for vulnerable people who are, or may become, deprived of their liberty. People’s liberty was restricted as little as possible for their safety and well-being and they could move around the home. The home had a large garden which was well laid out, with a safely enclosed and accessible patio area. It had had a variety of different trees, shrubs and themed seating areas, with paths for people to move freely around and a summerhouse to sit in.
People said they felt safe living at the home. Staff were aware of signs of abuse and knew how to report concerns, any concerns reported were investigated. A robust recruitment process was in place to make sure people were cared for by suitable staff. People knew how to raise concerns and were confident any concerns would be listened and responded to. The service had received numerous compliments but had not received any complaints.
People received their prescribed medicines on time and in a safe way. The environment was clean and hygienic, and there were no unpleasant odours. The home was well maintained and equipment was regularly serviced and maintained.
The service was well led. People, relatives and staff said the home was organised and well run. The provider promoted a culture of care, comfort and companionship for people. Staff said they worked well as a team and felt supported and valued for their work. Senior staff acted as role models to support staff to achieve high standards of care. The provider had a range of internal and external quality monitoring systems in place, which were well established. There was evidence of making continuous improvements in response to people’s feedback, the findings of audits, and of learning lessons following accidents and incidents.
We found that people were happy with the care provided and that they were treated with dignity and respect in a personalised way. Comments from people living at the home included 'I can have a fulfilling life here', 'I wouldn't change a thing, it's like being at home' and 'I'm enjoying the garden especially, it's lovely here'.
We saw that there was a robust recruitment procedure to ensure that staff were suitable to be able to meet people's needs and received support in their roles. This ensured that people were safe and their needs well met. Staff also enjoyed working at the home, often travelling some distance to work there. One staff member said, 'It's so lovely, it's worth it', another staff member added, 'It's so rewarding, I love it here'.
The environment was clean and hygienic and each room was personalised exactly how people chose.
We spoke to six people about what it was like to live at Malden House and during lunch we spent time talking to three people in depth. We spent time observing care delivery in the communal areas and looked at all areas of the home. We spoke to the interim manager and two staff and we also looked at records. People told us that it was 'a very nice home' and 'the girls are so kind and patient'. All the people we spoke to living at the home were very positive about their experience there and two relatives also expressed positive views of the service.
We saw that the home focussed on people's choice about how they wanted to live their lives. Staff were aware of people's likes and preferences and there was good communication between the staff and people living there. This included regular resident's meetings, choices of relevant activities, a relative's dementia awareness support group and a complaints book showing that concerns were acted upon and recorded in a timely way, no matter how small.
Staff were well trained and knowledgeable about people's needs and how to meet them. We saw that care records were detailed and that staff were caring for people in a person centred way.