We carried out an unannounced comprehensive inspection of this service on 19 January 2017. After that inspection we received concerns in relation to an incident following which a person using the service died. As a result we undertook a focused inspection to look into those concerns. This report only covers our findings in relation to those concerns. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Mallard house on our website at www.cqc.org.uk

Mallard house is a residential 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.

At the time of inspection, Mallard house were providing care to 49 people.

Mallard house had 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.’

The staff we spoke with had an understanding of abuse and the safeguarding procedures that should be followed to report abuse. Risk assessments were in place to manage risk within people’s life, and identified how people should be supported. Assessments were regularly reviewed and updated when required.

The staff recruitment procedures ensured that appropriate pre-employment checks were carried out to ensure only suitable staff worked at the service. Adequate staffing levels were in place. We saw that people were responded to in a timely manner when they called for assistance.

The provider had systems in place to monitor the quality of the service as and when it developed and had a process in place which ensured people could raise any complaints or concerns. Incidents and accidents were recorded accurately and CQC were notified as required to incidents that took place.

Mallard House is a purpose built service for up to 55 people living with a range of different neurological conditions. The service is divided into two units, both of which provide nursing and personal care. The service also supports people to access the community on a regular basis and to develop their independent living skills.

At the last inspection on 13 October 2014, this service was rated Good.

The service helped people to stay safe. Staff knew about abuse and how to report it and other incidents or accidents which took place. Risks to people were regularly assessed and updated and there were systems in place to ensure there was enough staff to meet people's needs. People were supported to take their medicines safely and in accordance with the prescribed instructions.

Staff members received the training, support and development opportunities they needed to be able to meet people's needs. People were supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service supported this practice. There was a choice of food and drink at the service and people were encouraged to have sufficient meals to meet their nutritional needs. They were also supported to see healthcare professionals when required.

People had positive relationships with members of staff who were able to adjust their communication to meet their needs. People and their family members were provided with information about the service and were involved in making decisions about their care and support. Privacy was respected by members of staff and dignity was promoted.

There were systems in place to ensure care was person-centred. People had care plans in place which were reflective of their individual needs and preferences and were reviewed on a regular basis. A number of activities were carried out on a regular basis and people were able to access the community on a regular basis. Feedback, including complaints, was welcomed by the service and was acted upon.

The service had a clear ethos and a positive culture. Staff members were motivated to perform their roles and meet people's needs. The registered manager was known to people, relatives and staff members and was approachable to all. They, and the provider, carried out regular quality assurance processes to help the service develop and improve.

The inspection of Mallard House took place on 13 October 2014. It was unannounced.

Mallard House is a purpose built home that provides accommodation and care for up to 55 people with a range of neurological conditions. At the time of our inspection there were no vacancies within the home. There was a registered manager in post. This is a person who has registered with the Care Quality Commission (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 and associated Regulations about how the service is run.

For management purposes the home was divided into two units. Oakley Unit provided specialist nursing and palliative care to people with progressive terminal illnesses, neurological disorders and complex healthcare needs, such as Huntington’s disease, Multiple Sclerosis, Motor Neurone Disease, and Cerebral Injuries. Brunel Unit specialised in the provision of specialist nursing care to people with progressive neurological conditions with complex health care needs, acquired brain and spinal injuries, and those needing a form of rehabilitation. There was a two bedroom flat to support rehabilitation.

The team of care staff worked with a multi-disciplinary team to support people to achieve and maintain as much independence as possible within and outside Mallard House. Staff and visitors confirmed that the staffing levels were adequate and altered as the need arose in order to keep the people who used the service safe.

We observed that people looked happy and one person was able to tell us they felt safe living at Mallard House. Staff knew how to recognise and respond to abuse and acted correctly to prevent incidents that could put people at risk.

Some people who used the service did not have the ability to make decisions about aspects of their care and support. Staff understood the systems in place to protect people who could not make decisions and followed the legal requirements outlined in the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS).

The CQC is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) Deprivation of Liberty Safeguards (DoLS) and to report on what we find. We saw that there were policies and procedures in relation to the MCA and DoLS to ensure that people who could not make decisions for themselves were protected. Where people lacked the capacity to make decisions about something we saw how best interest decisions were made.

Residents were encouraged to personalise their rooms to their own taste and we observed that people who were mobile were able to move about the home and the gardens freely.

The staff supported people to have their personal needs met in accordance with their care plans. We observed that staff documented the care they provided in a timely fashion and people did not have to wait unduly for any aspect of their care.

The staff recruitment processes ensured that the staff team had been checked to confirm their suitability to work with vulnerable people before they commenced work.

Staff told us the provider supported and encouraged learning and we saw the staff team had the collective skills and knowledge to care for the diverse and complex needs of the people living at Mallard House.

The registered manager and the provider had systems in place to regularly check the quality the service provided and to ensure improvements to the service were well planned and involved those people who used the service and their relatives.

During our inspection of Mallard House we spent time on Brunel which is a 24 bedded unit for people with spinal injuries and neurological needs.

At the time of our visit, there was no registered or general manager working at the service. However, we found that the provider had appointed an interim and unit manager to provide the day to day management of the Brunel unit and Mallard House.

We spoke with three people and three relatives of people who used services. We also spoke with four staff and the unit manager. Most people and their relatives told us they were happy with the care received. One relative of a person using the service told us that their family member had been “transformed “since coming to the Brunel unit. They also told us that the staff had been “wonderful” and cared for their family member with “pure love”.

We found that when people lacked the capacity to make decisions the staff had undertaken mental capacity assessments and had made decisions in people’s best interest. We also saw that people received care in line with their assessed needs and that safeguarding policies and procedures were in place to safeguard people from the risk of abuse. The provider operated effective recruitment systems to make sure that staff were of good character. We also found that staff received training, supervision and appraisals to carry out their role.

We spoke with four people who use the service and they told us that all staff were friendly and helpful. One person told us that they enjoyed going out on day trips with staff and the food was very nice at the home.

We found that there were some concerns in relation to record keeping at the home. This was because the care plans and risk assessments for some people were not being updated regularly and therefore staff would not have up to date information to meet their needs.

People told us that they were able to make decisions about their care with support from family members. They said that the home’s staff organised regular social activities such as theme days. They told us they felt safe living at Mallard house

They said they were registered with the home’s general practitioner (GP) and the GP visited them if they were unwell. They told us they received their medicines at the right time.