This inspection took place on 11 and 18 October 2018 and was unannounced.

Mallard Court is a care home that provides both nursing and personal care and is situated in the town of Bridlington. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided and both were looked at during this inspection. The home is registered to provide personal care and accommodation for up to 70 older people, including those with dementia related conditions or a physical disability. At the time of our inspection 59 people were receiving a service.

The service had a manager in place who was registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the 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 2008 and associated Regulations about how the service is run.

A caring culture was demonstrated by some staff throughout the inspection. However, this was not always consistent. At times we observed that not all people were treated with dignity and people were left waiting for their basic needs to be met. Some people, their relatives and professionals felt that whilst most staff were kind and caring some staff members were not. This was observed by inspectors during the inspection and discussed with the registered manager and senior management team.

We identified that one person’s risks in relation to pressure area care had not been addressed in line with risk assessments and best practice. This led to the development of a pressure sore. The registered manager was in the process of completing an internal investigation into this matter.

Some people’s records indicated delays in access to services such as chiropodists and GP advice. Whilst no impact to people was noted, these observations were shared with the registered manager and we were given assurances this would be closely monitored in the future.

There was a complaints policy and procedure made available to people who received a service and their relatives. We received mixed feedback from people and relatives regarding how the service addressed concerns and complaints. Our observations and findings during the inspection demonstrated that some ongoing concerns regarding the provision of care were justified.

People’s wider support needs were catered for through the provision of activities provided by dedicated activity workers and visiting entertainers. However, some people felt this provision wasn't accessible for all.

Medicines were managed safely and staff had a good knowledge of the medicine systems and procedures in place to support this. We found staff had been recruited safely and training was provided to meet the needs of people. Staff received regular supervision and appraisal and told us they felt supported in their roles.

Staff received training on safeguarding adults from abuse and understood their responsibilities in respect of protecting people from the risk of harm. Accidents and incidents were responded to and monitored by the management team. The service was clean and infection control measures were in place.

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.

People’s nutrition and hydration needs were catered for. A choice of meals was offered and drinks and snacks were made readily available throughout the day.

There was a range of quality audits in place completed by the management team. These were completed on a regular basis. Some audits had failed to identify our concerns. We received mixed feedback in relation to whether people and their relatives felt the service was wel

We carried out an unannounced comprehensive inspection of this service on 22 and 23 February 2016 and we found a breach of legal requirement in respect of risk assessments and medicines management. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to this breach. We undertook this focused inspection to check that they had followed their plan and to check that they now met legal requirements. This report covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection by selecting the 'all reports' link for Mallard Court our website at www.cqc.org.uk

The focussed inspection of Mallard Court took place on 09 January 2017 and was unannounced. At the last inspection on 22 and 23 February 2016 the service met all but one of the regulations we assessed under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At that inspection the registered provider was in breach of Regulation 12: Safe care and treatment, with regard to monitoring and recording of risk assessments and the appropriate arrangements for the safe handling of medicines.

At the last inspection in February 2016 we saw that risk assessments were carried out and followed in line with the registered provider’s procedures, but detailed evidence-based rationales for risk assessments were not always recorded. This meant there was no clear indication as to how the risk assessment had been established or if mitigation strategies appropriately reflected these. Information in related risk assessments was sometimes inconsistent. Risk assessment document updates were made each month, but there were gaps in some updates. Incident reports did not always show that appropriate follow-up action had been taken or the time that the incident occurred.

At the last inspection we also saw that medicines were not administered in a timely manner, pain relief patches were not always administered according to instructions, one medicine was administered for more days than instructed and medicines held did not always tally with the stock count recorded. In addition to this topical charts for applying creams were not always clear enough to ensure safe application and they were sometimes not signed for when applied.

Mallard Court provides both nursing and personal care to older people who may have dementia or a physical disability. The home is situated in the town of Bridlington. Seventy people can be accommodated in a mix of single and double rooms that are located on two floors, with lift and stair access. There are lounges and a dining area on each floor. The grounds of the premises are designed to be accessible to people with mobility difficulties. There is parking for approximately 20 cars. At the time of this inspection in January 2017 there were 65 people receiving the service.

The registered provider is required to have a registered manager in post. On the day of the inspection there was a manager that had been registered and in post for the last three years. 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 2008 and associated Regulations about how the service is run.

At this inspection in January 2017 we found there was an improvement in the way the registered provider recorded risk assessments and in the auditing of these. Risks were managed and reduced on an individual and group basis so that people avoided injury of harm wherever possible. Systems had been developed to ensure detailed recording was taking place and analysis of information was being acted upon.

We found that improvements were made in the handling of medicines: storage, administration and recording so that med

This inspection took place on the 22 and 23 February 2016 and was unannounced. At our last inspection of the service on 10 June 2014 the registered provider was compliant with all the regulations in force at that time.

Mallard Court provides both nursing and personal care for older people who may be living with dementia or a physical disability. The home is situated in the town of Bridlington. Seventy people can be accommodated in a mix of 64 single and three double rooms that are located on two floors with lift and stair access. All but two rooms are en-suite and there are supplementary bathrooms and shower rooms. There are lounges and a dining area on each floor. The grounds of the home are designed to be accessible to people with mobility difficulties.

The registered provider is required to have a registered manager in post and there was a registered manager at this 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 2008 and associated Regulations about how the service is run.

During this inspection we found that the home was not always safe. Risks to the health and safety of people using the service were not always thoroughly assessed and effectively managed and this placed people at risk of otherwise avoidable harm. This was a breach of Regulation 12 (2) (a) (b) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (Part 3)

The recording and administration of medicines was not being managed appropriately in the service. This was a breach of Regulation 12 (1) (2) (g) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (Part 3).

You can see what action we told the provider to take at the back of the full version of this report.

People told us that they felt safe living at the home. We found that staff had a good knowledge of how to keep people safe from harm and that there were enough staff to meet people’s needs. Staff had been employed following appropriate recruitment and selection processes.

People had their health and social care needs assessed and plans of care were developed to guide staff in how to support people. The plans of care were individualised to include preferences, likes and dislikes. People who used the service received additional care and treatment from health professionals based in the community.

People spoken with said staff were caring and they were happy with the care they received. They had access to community facilities and most participated in the activities provided in the service.

Staff received a range of training opportunities and told us they were supported so they could deliver effective care; this included staff supervision, appraisals and staff meetings.

The registered manager monitored the quality of the service, supported the staff team and ensured that people who used the service were able to make suggestions and raise concerns. Immediate action was taken by the registered manager with regard to the concerns we raised with them during our inspection.

At our last inspection to the service in June 2014 we issued the provider with a compliance action. Our inspector visited the service to see what action the provider had taken to become compliant with regulation 13 of the Health and Social Care Act 2008. The information collected by the inspector helped answer one of our five questions: 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 summary is based on our observations during the inspection, speaking with staff and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People told us they received their medicines in a timely manner and as prescribed by their GP. We found that appropriate arrangements were in place in relation to recording, handling and safely administering medicines to people who used the service.

Is the service effective?

Not applicable.

Is the service caring?

Not applicable.

Is the service responsive?

Not applicable.

Is the service well-led?

Not applicable.

The inspector carried out this inspection to answer our five questions: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people who used the service, the staff who supported them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People were treated with respect and dignity by the staff. People told us they felt safe. Systems were in place to make sure that managers and staff learnt from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risk to people and helped the service to continually improve.

The home had policies and procedures in relation to Deprivation of Liberty Safeguards (DOLS) and one application had needed to be submitted in the last three months. The manager had a good understanding of when an application should be made and in how to submit one. This meant that people were safeguarded as required.

People told us “We get our medicine on time and when we need it”, but we found that appropriate arrangements were not in place in relation to recording, handling and safely administering medicines to people who used the service.

The manager set the staff rotas. Records showed the manager had taken people’s care needs into account when making decisions about the number of staff the service required; the particular qualifications, skills and experience staff would need and the layout of the building.

The home was designed to meet the needs of people who lived there and the provider ensured the environment was regularly maintained, safe and fit for purpose. The doorways to bedrooms, communal spaces and toilet/bathing facilities were wide enough for wheelchairs or people with walking frames to mobilise comfortably through them. People who used the service were pleased with the facilities offered by the service.

People were protected from unsafe or unsuitable equipment because the provider had ensured the equipment used in the service was serviced and maintained and service certificates were available for inspection.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to safe management of medicines.

Is the service effective?

People’s health and care needs had been assessed and care plans were in place. There was some evidence of people being involved in assessments of their needs and planning of their care. People said they could discuss their care with the staff or manager and on the whole felt well supported and cared for.

People’s needs were taken into account with signage and the layout of the service enabled people to move around freely and safely. The premises had been sensitively adapted to meet the needs of people with dementia and conditions relating to old age.

Our checks of the records and documents within the service showed that staff received training in safe working practices. Health and safety risk assessments were in place with regard to fire, moving and handling and daily activities of living.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. We spoke to five people about the care and support they received from staff. One person told us “The staff are lovely, I have not had much of an appetite lately and the staff have been tempting me with lots of different snacks and drinks.” Another person said “I am well looked after by the staff, they are very good to me and I am very comfortable in my bed.”

One visitor said “My relative does not always recognise me. However, they enjoy a laugh and a joke with the staff and that lifts my spirits. X gets all the care and support they need, they eat well and I can relax knowing they are being looked after.”

Feedback from people who used the service, relatives and staff was obtained through the use of satisfaction questionnaires, meetings and one to one sessions. This information was usually analysed by the provider and where necessary action was taken to make changes or improvements to the service.

Is the service responsive?

Individuals who spoke with us during the inspection said they were involved in decisions about their care and were able to discuss their care and support needs with the staff. One visitor told us “I know all about my relative’s care file. The staff are always there to answer any questions about X’s health and they discuss their care and treatment with me.”

People and relatives we spoke with said they were confident of using the complaints system if they needed to. They told us that they would speak to the staff or the manager about any issues and that action was taken quickly to resolve any problems.

Is the service well led?

The service had a quality assurance system, records seen by us showed that identified shortfalls were addressed promptly. As a result the quality of the service was continuingly improving.

The service had a registered manager in post and staff told us they were clear about their role and responsibilities. Staff had a good understanding of the ethos of the home and quality assurance processes were in place. This helped to ensure people received a good quality of service at all times.

We used a number of different methods to help us understand the experiences of people who used the service. During the day we observed daily activities including lunchtime and observed interactions with staff and people who used the service. We spoke with people who used the service, two relatives, a visiting health professional and staff including the manager. We reviewed documentation including four care plans.

From what people told us, what we observed, and noted as part of the review staff cared for the people who used the service appropriately. Food and drinks were specially prepared to ensure that people had a nutritious and balanced diet. During our visit we saw that the home looked clean and tidy and there were infection control procedures in place. One person said “There’s always choice, I like the food” and another person said “The staff are nice they look after us well”.

There were effective recruitment procedures in place which ensured staff were employed with the appropriate qualifications, skills and experience necessary for them to carry out their role. There were appropriate systems in place to monitor and improve the quality of the service. Records were found to be accurate, detailed and regularly reviewed.

The relatives we spoke with said that the staff were good and they were involved in the reviews of care. The visiting health professional said “The staff know the needs of the people and keep the commissioners informed”.

From what people told us, what we observed and noted as part of the review staff cared for the people who used the service appropriately. We saw that care needs were discussed with people and that before people received care their consent was asked for.

Staff were suitably trained and supported to ensure they could offer the appropriate care to people. People were protected from harm and the risk of harm through staff training and risk assessments. Staff could tell us what they would do if they saw abuse happening or someone reported abuse to them.

Staff told us they tried to ensure that people's dignity and human rights were respected and we saw evidence of this during our inspection. There were appropriate systems in place to respond to and learn from complaints and comments.

The people we spoke with said “It’s very good here", and “The staff were all nice”. A relative said “I like the atmosphere. There is no smell. I recommend it to other people”.

We did not speak directly with people who used the service during this follow up visit.

We did not speak to people directly regarding this outcome.

People that were able to talk to us said that choice was promoted in relation to food and getting up and going to bed. One person said, ‘we can get up when we like and sit where we like’. Relatives told us that people were consulted during meetings and included in decisions about the home.

People told us that they were happy in the home and that they were looked after. The staff were described as caring, kind and patient.

We spoke to relatives who said that the home was safe with regard to the environment, but there was a restriction in some people’s movement because the dementia care unit was situated on the first floor and people were reliant on staff availability to support them outdoors.