We carried out an unannounced inspection of Malvern House on 24 January 2019. Malvern House is a ‘care home’ that provides nursing care for a maximum of 22 adults. 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 the inspection there were 19 people living at the service, some of these people were living with dementia.

The accommodation is on two floors, with access to the upper floor via stairs and passenger or chair lifts. Bedrooms have wash hand basins and vanity units. There are shared bathrooms, shower facilities and toilets. Shared living areas included a lounge, dining room, garden and outside seating area.

This was the first inspection for the service since it re-registered as a new legal entity in February 2018.

There was a registered manager in post who was responsible for the day-to-day running of the service. 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 and associated Regulations about how the service is run.

During the inspection we spent time in the shared living areas to observe staff interaction with people and how people responded to the care and support provided. We observed that people were relaxed and comfortable with staff, and had no hesitation in asking for help from them.

People and their relatives told us they were happy with the care they received and believed it was a safe environment. Comments included, “I came back here on respite because the staff make me feel safe”, “All the staff here work hard and are superb” and “The staff are so kind.”

People received care and support that met their needs because there was a stable staff team who had the skills and knowledge to provide responsive and personalised care. Staff knew how to recognise and report the signs of abuse. There were enough staff on duty to meet people’s needs.

Staff were supported in their roles by a system of induction, training, one-to-one supervision and appraisals. New staff completed a thorough recruitment process to help ensure they had the appropriate skills and knowledge.

Care plans contained personalised information about people’s individual needs and wishes. Risks were identified and included guidance for staff on the actions they should take to minimise any risk of harm. When people were assessed as needing to have specific aspects of their care monitored records showed this was well managed. Care plans and risk assessments were kept under regular review. Staff were provided with information about people’s changing needs through effective shift handovers and daily records.

Staff worked with healthcare professionals, such as tissue viability nurses, GPs and speech and language therapists to help ensure people had timely access to services to meet their health care needs. Care records were updated to provide staff with clear instructions about how to follow advice given by external professionals.

People were supported to eat a healthy and varied diet. Comments from people about their meals included, “The food’s pretty good”, “I like the bacon and egg sandwich I get for breakfast” and “It’s good to get lots of fresh vegetables.”

Management and staff had a good understanding of the Mental Capacity Act 2005 (MCA) and the associated Deprivation of Liberty Safeguards (DoLS). People were 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.

There were safe arrangements in place for administration, storage and disposal of medicines. People were supported to take their medi