The inspection took place on the 8 and 9 February 2016 and was unannounced.

Friends of the Elderly Malvern is located near to the town of Malvern. The service comprises of Davenham which provides personal care and accommodation for older people and Bradbury Court which is a purpose built unit providing personal care and accommodation to people who have a dementia illness. This service accommodates 54 people. On the day of our inspection there were 45 people living at the home. There were 22 people living at Bradbury Court and 23 people at Davenham.

There was manager at this home who was in the process of registering with us. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered providers and registered managers 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 and their relatives said they were happy with the support that staff provided people that lived at the home. They told us staff were caring and promoted people’s independence. People told us they were able to maintain important relationships with family and friends. We saw people had food and drink they enjoyed and had choices available to them, to maintain a healthy diet. They were supported to eat and drink well in a discreet and dignified way. People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage them. People told us they had access to health professionals as soon as they were needed.

Relatives we spoke with said they felt included in planning the support their relative received and were always kept up to date with any concerns. The unit manager at Bradbury Court had identified that relatives were not consistently involved with what was happening on the unit. So they had set up meetings to improve communication and involvement. People living at the home were able to see their friends and relatives as they wanted. They knew how to raise complaints and felt confident that they would be listened to and action taken to resolve any concerns. The manager ensured people were listened to, we saw that complaints were investigated and action taken to resolve them.

Staff we spoke with were aware of how to recognise signs of abuse, and systems were in place to guide them in reporting these. They were knowledgeable about how to manage people’s individual risks, and were able to respond to people’s needs. Staff had up to date knowledge and training to support people. We saw staff treated people with dignity and respect whilst supporting their needs. Staff knew people well, and took people’s preferences into account and respected them. Staff had the knowledge and training to support people they provided care for. Staff ensured people agreed to the support they received.

The manager had made applications to the local authority to deprive people of their liberty, to ensure they did not treat people unlawfully. The manager promoted an inclusive approach to providing care for people living at the home. People who lived at the home and staff were encouraged to be involved in regular meetings to share their views.

The provider and manager had systems in place to monitor how the service was provided. The management team had identified areas of improvement and were providing the resources to complete these actions. The management team reviewed accidents and incidents and took steps to learn from these.

When we visited the service there were 54 people living at Davenham Residential home and Bradbury Court. People with dementia are cared for in Bradbury Court. The homes are next to each other and are managed by the same manager. We spent time in both homes. We spoke with different people about this service to gain a balanced overview of what people experienced, what they thought and how they were cared for and supported. We spoke with four people who used the service, a relative, four carers, the manager and a domestic. Some people using the service were unable to answer complex questions and we spent time observing people, to see how they were cared for and how staff interacted with them.

We considered all of the evidence that we had gathered under the outcomes that we inspected. We used that information to answer the five key questions that we always ask:-

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well led?

Below is a summary of what we found. The detailed evidence supporting our summary can be read in our full report.

Is the service safe?

We saw that a comprehensive risk and needs assessment had taken place before people had gone to live at the home. Care plans reflected assessed risks. We saw that when people had been assessed as requiring a hoist to help them to move, care plans were in place. Where equipment was used to care for people, this had been serviced regularly and staff knew how to use it. There were enough hoist slings of the appropriate size but there was no system in place to allocate slings for individual use. At Bradbury Court, the appropriate size of hoist for each individual was shown on a chart. At Davenham, the correct size of sling was not recorded. Carers that we spoke with knew the correct size of sling for each person who needed one which showed us that the equipment was used safely. However, the lack of documentation showed us that there was a potential risk that the wrong sized sling could be used.

Before staff had started work at the service all the appropriate checks had been completed. This ensured that people were safely cared for by staff who were suitably qualified, honest, reliable and trustworthy. All staff had received the appropriate training to meet people’s needs, which included training about infection control and caring for people with dementia. Measures were in place to safeguard people from abuse.

Staff understood what to do in the event of a fire or other emergency.

Is the service effective?

A person using the service said, “I’m so glad I came here.” A relative that we spoke with said, “I am very happy with the home.” They told us that they believed their relative could not have been cared for as well anywhere else. They told us that their relative was not eating when they had come to the home but had put on weight since being there. This was because the service had implemented a plan to help the person to receive better nutrition. A person told us how their ability to walk had improved since being at the home. Other people said that they thought that the exercise classes provided two or three times a week had improved their mobility.

We saw that satisfaction surveys had been completed by people, their relatives and professionals who had visited the service. One person had commented that one of the things they liked most about the home was, “The freedom to live my life as I have always led it.” Nearly all of their comments were positive and responses to questions about the quality of care at the home were all either ‘good’ or ‘very good’. All of the people surveyed said that they would recommend the home to others.

We saw that care and support had been carefully planned to meet people's needs and included personal preferences. This showed us that the service was effective.

Is the service caring?

The service was very caring. All of the people that we spoke with mentioned how caring the staff were. A person told us that, “The staff are marvellous and can’t do enough for you.” Another person said, “It is ever so good, we are like one big happy family.” People living at the home who completed the survey commented, “Warm and caring, superb staff.” and “Excellent, very caring.”

A survey for stakeholders asked about the ‘caring attitude of our staff towards residents’ and all of the responses said it was good or very good. Several of the people that we spoke with referred to the atmosphere of the home being caring and supportive.

We spoke with care staff who told us about the needs of people using the service in a caring and affectionate way. A carer who had previously worked for an agency said, “I have never come across a team (of staff) that cared so much.”

We observed that when staff interacted with, or helped people they called people by name and were kind, patient and cheerful.

Is the service responsive?

The service was responsive to the changing needs of people using the service, to recommendations from safety inspections and to suggestions and comments made by people and relatives. A carer told us how they had listened to and acted on suggestions made by a relative when a person had become unable to talk about their preferences.

We saw that most care plans were regularly updated and were changed when people’s needs changed.

In the stakeholders’ survey, everyone had replied that the response of the service to complaints or comments had been ‘very good’. The manager told us that in response to comments that people had made about their first few weeks living at the service, a new ‘Welcome Pack’ was in progress. This would include a guide to the service for people and their relatives. We saw that recommended improvements and upgrades made following a fire safety inspection had been, or were in the process of being implemented. During our visit we took part in a fire drill which the manager told us, had been revised and improved following the fire safety inspection. We saw records of residents’ meetings that took place regularly and the manager told us how they had addressed concerns raised by people. We saw that changes to the food and drinks available for people had been changed in response to, or following consultation with people using the service. This included asking people for their own recipes which the chef then prepared.

Is the service well led?

The service was very well led. A person told us that the manager was always ready to talk and, “knows everyone’s name.” They said that, “Getting the atmosphere right is most important.” They felt that the manager had achieved an, “excellent ethos.” A relative said that the manager was, “inspirational” and “I think that she is the source of the caring attitude.”

Carers told us that the manager was, “approachable, helpful and always stays calm.”

There was an effective system in place to monitor and assess the quality of the service. This included annual surveys for people using the service and another for stakeholders, and separate meetings for staff, residents and relatives. The manager told us that they had reviewed the training that staff received, and in response to comments were in the process of changing the way training was delivered so that e-learning and face to face training would be better balanced. All staff took part in regular supervision meetings and had an annual appraisal. Independent and provider safety and quality assessments had taken place. We saw that action plans had been formed and implemented to address any shortfalls meeting the expected standard of safety and quality.

When we inspected 22 people lived at the Davenham and 24 people lived at Bradbury Court. We spoke with six people. They told us they were happy with the home and the staff. One person told us: “It’s brilliant here.” Another said: “I like it very much here.” We also spoke with two medical professionals, the registered manager and four members of staff.

We watched staff as they cared for people. People had given consent for care and staff always asked for permission before providing care. Where people could not give consent staff had spoken to their families and medical professionals so that knew how to act in people’s best interests. Staff provided care and support that met people’s needs. We found that staff knew about the needs of the people they cared for. We looked at care records for five people and found that these contained guidance for staff on how to meet their needs. We saw that people’s needs had been reviewed regularly.

We found that medicines were prescribed and given to people appropriately. We also found that medicines had been secured stored and managed safely.

The registered manager had taken reasonable steps to ensure that suitable people had been employed to work at the home although we found that sometimes full working histories had not been completed. Records had been maintained appropriately and stored securely.

The service is split into two separate units. Davenham provides residential care and Bradbury Court provides dementia care. Each unit is staffed separately.

During this inspection we spent time on both units and in total we spoke with eight people who used the service and six members of staff. We also spent some time observing the interaction between staff and people who used the service and reviewing care records.

People who lived at Davenham were complimentary of the service and told us that they were cared for well.

On Bradbury Court we carried out observations and saw that people who used the service had good relationships with staff and that staff appeared to know them well.

On both units we found that people who used the service were supported and encouraged to express their views and make decisions about their care and how they wanted to spend their time. The individual needs of people were assessed and supporting plans had been developed. This ensured people’s needs would be met by staff.

We found that people who used the service were supported by staff who had received appropriate training to enable them to meet their needs.

The service had arrangements in place for monitoring the quality of the service.

During our visit we spoke with nine residents and a relative. People spoke positively about the home. The atmosphere within the home was very calm and relaxed and staff were observed interacting with residents in a warm and friendly manner.

The home has a number of communal areas available to people which include: a lounge, library, dining room, chapel and a newly designated parlour room. In addition to this the home has access to extensive gardens.

During our visit we saw people moving about the home choosing where they wished to spend their time. People’s rooms were homely and personalised as per people’s individual wishes.

The environment was very clean and tidy and we saw evidence of ongoing improvement. This had included the provision of two new passenger lifts. At the time of our visit work was being carried out within the grounds of the home to construct a purpose built care home for people with dementia.

When we spoke with staff we found that they had a good understanding of the people they cared for and knew any specific likes and dislikes people may have.

An activities coordinator provided support to people for 20 hours per week. We were told that although there were some regular activities such as exercise sessions that take place, the majority of activities were determined by the needs and wishes of residents. People we spoke to told us that they had been taken on trips outside the home which had included visits to local shops, restaurants or out to local towns and villages.

Some of the people living in the home choose to remain in their rooms rather than use communal areas. One person we spoke to told us that they felt more could be done to support these people with any recreational opportunities or provide social interaction.

People told us that they could eat their meals where they wished. They said there was always food available to them if they became hungry. We saw menus on display which showed the choices available to people and details of any alternatives. Some of the people we spoke to commented that although they get a choice at meal times the quality of the food was not always as good as they would wish.

People were encouraged to provide feedback on the quality of meals served to them and a book for them to record their comments was located in the dining room.

When we asked people about staffing levels they told us that although over a period of time there had been a change in the level of care people in the home needed, most of the time they felt there were enough staff to care for them.

Staff working in the home also commented on increasing dependency levels in the home and the impact this has on the time available to them to sit and socialise with people.

When we spoke to the registered manager they told us that they were able to adjust staffing levels according to the needs of people. They said that staffing levels were under review and there were already plans to increase staffing by 30 hours.

People who lived in the home told us that they were satisfied with the care they received and that if they did have any concerns they would feel comfortable raising these to staff and the registered manager.

We were told that coffee mornings were held on a regular basis which residents enjoyed. These also provided an opportunity for people to discuss life in the home.