The inspection was carried out on 15 and 16 January 2018, and was an unannounced inspection.

This service 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 Old Malthouse provides accommodation and personal care without nursing for up to 34 older people. Accommodation was provided in an old detached building which had been added to with newer purpose-built wings. At this inspection, there were 28 people living in the service.

The service was all mainly on the ground floor with some areas being slightly higher than others and there were gentle slopes for people to walk up and down. There were five bedrooms on the second floor.

People living in the service required care and support and had varying needs. Some people were living with dementia and some people had medical conditions, such as diabetes or mobility issues. Some people required the support of one staff member to move around whilst others required the support of two staff using hoisting equipment.

There was a registered manager. However, they were not available on the days of the inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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 home is run. In the registered managers absence the deputy manager supported the inspection throughout the two days of the site visit.

At the last Care Quality Commission (CQC) inspection on 7 July 2015 the service overall was rated as Good. Although the Effective question was rated as ’Requires Improvement’ at that inspection. This was because we found at that time the provider and registered manager were not acting in accordance with the legal requirements of the Mental Capacity Act (MCA)2005 and Deprivation of Liberty Safeguards (DoLS).

At this inspection we found they had met their legal requirements. With the basic principles of the Mental Capacity Act 2005 had been followed to ensure people's rights were upheld. Deprivation of Liberty Safeguards applications had been made and the registered manager kept these under review. People's interests and preferences were identified and recorded.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care services. Restrictions imposed on people were only considered after their ability to make individual decisions had been assessed as required under the Mental Capacity Act (2005) Code of Practice. The manager understood when an application should be made. Decisions people made about their care or medical treatment were dealt with lawfully and fully recorded.

During this inspection we found that medicine administration, storage and documentation was not robust and could have meant some people may not be receiving their medicines as prescribed or may have received more of a medicine than what was considered as safe within a time period.

Safe recruitment procedures to ensure only suitable staff were employed to provide care and support to people living in the service were also not consistently followed.

People's needs were not regularly assessed to ensure the appropriate care and support was being delivered. Where people's needs had changed, care plan reviews did not capture this to make sure staff were given the most up to date information on people’s needs. Individual risk assessments were in place to give the guidance necessary to staff when providing care to keep people safe and prevent harm, however, these had not been changed when people’s care needs changed. People being cared for on an air mattress were not having the pressure of these checked and rec

This inspection was carried out on 7 July 2015 and was unannounced. The Old Malthouse Nursing home provides care and accommodation for older persons with physical care needs, and people living with dementia. The home recently changed the regulated activities it is registered to provide and no longer provides nursing care. The home provides accommodation and personal care for up to 34 people. Accommodation is provided over two floors and there was a lift available to access all floors. There were a total of 29 members of staff employed plus a deputy manager and the registered manager. On the day of our visit 30 people were living at the home.

The service had a registered manager in place. A registered manager 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.

The CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The registered manager understood when an application should be made and how to submit one. We found that although the provider had suitable arrangements in place to establish, and act in accordance with the Mental Capacity Act 2005 (MCA) this was not always applied in full. Staff had a basic understanding of the Mental Capacity Act (MCA) 2005 however not all people who may lack capacity to make decisions had been assessed and had this documented in their care records. We have made a recommendation concerning the MCA.

People told us they felt safe. Relative’s told us they had no concerns about the safety of people. There were policies and procedures regarding the safeguarding of adults and staff knew what action to take if they thought anyone was at risk of harm.

Care records contained risk assessments to protect people from any identified risks and helped to keep them safe. These gave information for staff on the identified risk and guidance on reduction measures. There were also risk assessments for the building and emergency plans were in place to help keep people safe in the event of an unforeseen emergency such as fire or flood.

Recruitment checks were carried out on newly appointed staff to check they were suitable to work with people. Staffing levels were maintained at a level to meet people’s needs. People told us there were enough staff on duty.

We received differing opinions of the food provided. Some people told us the food at the home was good while others said there could be more choice. There was a four week rolling menu displayed in the kitchen and the cook went round each morning to check people’s choices for lunch and supper. Information regarding meals and meal times were displayed in the dining room.

People were supported to take their medicines as directed by their GP. Records showed that medicines were obtained, stored, administered and disposed of safely. The provider’s medicines policy was up to date. There were appropriate arrangements for obtaining, storing and disposing of medicines

Each person had a plan of care which provided the information staff needed to support people. Staff received training to help them meet people’s needs. Staff received regular supervision including observations of staff carrying out their duties. Monitoring of staff performance was undertaken through staff appraisals which were conducted every 12 months.

Staff were supported to develop their skills through regular training. The provider supported staff to obtain recognised qualifications such as National Vocational Qualifications (NVQ) or Care Diplomas. These are work based awards that are achieved through assessment and training. To achieve these awards candidates must prove that they have the ability to carry out their job to the required standard. All staff completed an induction before working unsupervised. Staff had completed mandatory training and were supported to undertake specialist training from accredited trainers.

People’s privacy and dignity was respected and staff had a caring attitude towards people. We saw staff smiling and laughing with people and offering support. There was a good rapport between people and staff.

Staff were knowledgeable about people’s health needs and knew how to respond if they observed a change in their well-being. Staff were kept up to date about people in their care by attending regular handovers at the beginning of each shift. The home was well supported by a range of health professionals.

The registered manager operated an open door policy and welcomed feedback on any aspect of the service. Staff said that communication between staff was good and they always felt able to make suggestions and confirmed management were open and approachable.

The registered manager acted in accordance with the registration regulations and sent us notifications to inform us of any important events that took place in the home of which we needed to be aware.

The provider had a policy and procedure for quality assurance. The manager was visible and a group manager employed by the provider visited the home regularly. Weekly and monthly checks were carried out to help monitor the quality of the service provided. There were regular residents meetings and their feedback was sought on the quality of the service provided. There was a complaints policy and people knew how to make a complaint if necessary.

We spoke with five people and one relative of a person living at the home during our visit. People told us that they were happy living at the home. One person said, "Its nice here, they are kind to me". Another person said, "I get what I need, I only have to ask".

Another person told us, "They do a good job here, it will never feel quite like home but it’s the next best thing”. They went on to say, “The staff are always on hand and keeping an eye on us and I think we are well cared for."

The relative that we spoke to said. ”The home is always clean, that’s one thing I am very aware of as I didn’t want my relative living somewhere that smelt of urine. This home always looks clean and smells fresh”.

We spoke with two staff members during our visit. Both of the staff that we spoke with felt that they were able to care for residents. They told us that communication was good at the home, and that they had the necessary skills and resources to meet people's needs effectively. One staff member said, "We do a good job here, I love working with the people here".

We found that people were cared for in a clean environment by staff that understood their needs. We also saw that the organisation had systems in place to effectively monitor the quality of care that they were providing to people.

We conducted this compliance review to monitor the home’s progress in addressing concerns raised at a previous review of the service in May 2011.

On this occasion we focussed our review on the care and treatment of the most vulnerable people in the home. The people we saw were unable to voice an opinion about their care and treatment. Therefore we cannot report on what people using the service said.

The people we spoke with who lived in the home told us they were happy with the care they received. The people who were able, told us that they were treated with respect, that they were well looked after and that staff were kind. People told us that there were usually enough staff for the number of people living at the home; however there were busy times when they had to wait for some time for staff to answer their call bell.

The people we spoke with told us that although they were not always aware of the formal complaints processes, they did feel able to raise with staff any concerns that they had. One person who had newly arrived in the home told us that the new manager had been very helpful and they had been introduced to their key worker which they found very reassuring.

External agencies told us that the provider is receptive to suggestions on improving the service and responds in a positive way to reviews undertaken when safeguarding issues are identified.

During our visit we talked with five people, and one family member. We also gathered evidence of people’s experiences of the service by indirectly observing the care they received from staff.

Everyone told us that they were happy with the care and support they received. One person told us, "They are very nice here, the staff are look after me well".

Another person said, "I don’t want to be here, but I have no choice because I cant cope at home. They couldn’t do any more for me here I am well looked after".

As one family member explained, "I come in most days and I have only ever seen good care here, staff are friendly and kind".

People also told us that staff treated them with respect and promoted their privacy. They told us that they felt safe from harm living at the home and that they would be listened to if they raised any concerns. Our evidence gathered during this inspection supports the comments made by people who were receiving a service.