The Mallards is located in Bedford and provides personal care and accommodation for up to 23 older people who may also have dementia care needs. The service is situated over three floors and has communal areas which include a lounge, dining room and conservatory. On the day of our inspection there were 21 people living in the service.

At the last inspection, the service was rated Good.

The inspection was undertaken as part of our routine re-inspection programme, to review the rating from the first comprehensive inspection completed on 11 November 2014. At this inspection we found the service remained Good.

People told us that the service was extremely caring and that staff consistently went the extra mile in ensuring they received support that was kind, courteous and always considerate. People and their relatives were forthright in their praise for the gentle and empathetic care provided at the service. They told us that people’s individual needs were considered to be supremely important by staff and that each member of staff supported people in a dignified and gracious manner. People said that without fail, staff went above and beyond to ensure that they received care that was right for them.

Staff had nurtured meaningful and trusting relationships with people which had a significant impact upon their health and well-being. People were exceptionally happy and we observed that they spent large parts of the day with big smiles on their faces, laughing and engaging with staff and each other in a really sincere and positive manner. People were valued for their contribution towards the service and their involvement was never forgotten, even when they had left.

People were inspired and empowered to be as independent as possible and made to feel as though their contribution was extremely important. Staff enabled people to take on small, but valuable roles and people were supported by exceedingly dedicated staff that were very knowledgeable about how to meet their needs. Staff instinctively knew how people preferred to be supported, and were skilled in communicating with them and facilitating them to make as many decisions for themselves as possible. People were fervent in their belief about the positive impact that staff had made to their lives and how much their support had changed their lives for the better. People told us they could always rely upon staff to be there for them and provide support, affirmation and a friendly, caring face at all times. People and their relatives were placed firmly at the heart of the service, with all aspects of care being focused on them.

People felt safe in the service. 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 to ensure they had as much independence as possible. Staff were recruited using a robust process and numbers of staff were appropriate to meet people’s needs. There were safe systems in place for the administration, disposal, storage and recording of medicines.

Staff received an appropriate induction and regular refresher training to make it possible for them to perform their roles appropriately. People were supported to have choice and control and staff cared for them in the least restrictive way possible; the policies and systems in the service support this practice. Where appropriate people living at the service had their freedom lawfully restricted under a Deprivation of Liberty Safeguard (DoLS) authorisation. People enjoyed a choice of dietary intake and were able to access healthcare professionals, such as their GP and dentist to maintain their health and well- being.

People received person-centred care, based on their likes, dislikes and individual preferences and care staff were guided in the delivery of care through robust care records. People’s hobbies and interests had been identified and were supported by staff in a way which involved people to prevent them from

The Mallards is registered to provide accommodation and support for up to 23 people who require personal care and may have a range of social, physical and dementia care needs. On the day of our visit, there were 23 people living in the home.

The inspection was unannounced and took place on 11 December 2014.

The service had a registered 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 and associated Regulations about how the service is run.

People who used the service and their relatives told us that they were happy with the care they received from staff, and felt that they were involved in decisions about their care and day to day choices.

We found that safeguarding procedures had been followed and that action was taken to keep people safe, minimising any risks to health and safety. Staff knew how to manage risks to promote people’s safety, and balanced these against people’s rights to take risks and remain independent.

Our observations confirmed that there was sufficient on duty staff to meet people’s needs and keep them safe. Staff numbers were based upon people’s dependency levels and were flexible if they changed. We found that staff had been recruited using a robust process, with effective recruitment checks completed so that people were kept safe and free from harm.

Systems were in place to ensure that medicines were stored, administered and handled safely. Staffing arrangements meant there were enough staff to manage medicines appropriately and to meet people’s needs safely.

Staff were knowledgeable about the specific needs of the people in their care, so that the service was effective in meeting people’s individual needs. People’s personal views and preferences were responded to and staff supported people to do the things they wanted to do.

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 make decisions for themselves were protected. Records we looked at that confirmed that where people lacked the capacity to make decisions about something, best interest meetings were held.

People could make choices about their food and drink and were provided with a choice of food and refreshments, with support to eat and drink where this was needed.

People had access to health and social care professionals as and when they needed, and we saw that prompt action was taken in response to illness or changes in people’s physical and mental health.

The home had an effective complaints procedure in place. People and relatives told us that the staff were responsive to their concerns and that when issues were raised these were acted upon promptly.

We found that the service was well-led and that staff were well supported and consequently motivated to do a good job. The registered manager and senior staff consistently monitored and reviewed the quality of care people received and encouraged feedback from people and their representatives, to identify, plan and make improvements to the service.

When we visited The Mallards on 4 November 2013, we spoke with six people about the care and support they received from staff. People told us they were happy with the intervention they were offered. One person said, "It's a lovely home."

We spent time observing people and saw they were engaged in activities of their choice and at a level appropriate to them. We observed staff engaging positively with people and supporting them to read the newspaper or watch television. We found staff were respectful in their approach to people and treated them with dignity and respect, calling them by their preferred name. People appeared relaxed in the presence of staff and there was a friendly atmosphere in the home.

We saw from care records that the provider ensured that people were referred to appropriate professionals and attended relevant appointments to ensure their general health and well-being. On the day of our inspection, we observed a doctor visiting someone and were aware of staff talking to the dietician about another person.

We found that equipment used within the home was fit for use and well-maintained. Staff had access to on call maintenance for repairs should this be required.

We reviewed training records and spoke with three staff and the registered manager about their experiences of staff training. We found that staff training was up to date which ensured that staff had the appropriate skills and knowledge to provide care for the people they supported.

We visited The Mallards on 17 December 2012 and spoke with six of the 19 people currently living in the home; we also spoke with three members of staff.

Everyone we spoke with told us they enjoyed the home and atmosphere, and one person said “you wont’ find anything wrong here, it’s lovely”. Another person said “I am looked after well and the staff are really caring”.

We observed a relaxed, friendly environment with positive engagement and involvement between staff and residents. People were spoken to respectfully at all times and involved in decisions related to their care and support.

We saw that relatives and visitors were made to feel welcome on arrival and one person said “I feel part of the family”.

During our visit on 4 January 2012, people living in the home told us that the staff were lovely and that they were happy living in the home. A relative told us that they were very happy with the care provided to their relative and that they had, "No concerns whatsoever".

We observed staff providing support and care to the people living in the home. We heard staff taking time to explain to people what they were doing and asking their views about how they received care. We also saw staff supporting people, when they were distressed, in a kind and patient manner.