Kalmia & Mallow

Updated 23 September 2022

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

This inspection was carried out by two inspectors on the first day onsite and by one on the second. One inspector carried out the feedback session on the final day of the inspection.

Service and service type

Kalmia and Mallow is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Kalmia and Mallow is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

At the time of our inspection there was no registered manager in post at the start of the inspection period but one registered during the inspection period. For the purposes of the report, they are referred to as the ‘manager.’

Notice of inspection

This inspection was unannounced on the first day and we told the provider we would be returning for the second day.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We used the information the provider sent us in the provider information return (PIR.) This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We used information gathered as part of monitoring activity which took place on 26 April 2022 to help plan the inspection and inform our judgements.

We used all of this information to plan our inspection.

During the inspection

Most people who used the service were not able to speak with us about their care and so we observed care and support being provided. We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

We spoke with four relatives, the managing director, the operations manager, the director of quality and governance and the manager. We also spoke with four care staff, three agency staff and one member of the domestic team. We received feedback from one healthcare professional who works with the service.

We reviewed a range of records. This included five people’s care plans, five sets of medication records, staff recruitment files and other records relating to the quality and safety of the service.

Updated 23 September 2022

About the service

Kalmia and Mallow is a purpose-built residential care home providing personal care to up to 13 people. The service provides support to people with learning disabilities and autistic people. The service is split into two bungalows which are linked together and share a garden. At the time of our inspection there were 12 people using the service.

People’s experience of using this service and what we found

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right support

The management of risks, including those posed by the environment, required further improvement. Recording and monitoring of known risks was not always accurate and staff knowledge of risk was not comprehensive. This placed people at risk.

Safeguarding incidents were investigated, and the provider took action to reduce future risks. Staff understood their safeguarding responsibilities and there were enough staff to meet people’s complex needs. Infection control practices were good but the poor state of some areas of the building made the risk of infection harder to manage. A scheduled refurbishment programme began during our inspection period. Medicines were administered safely.

Right care

Care plans reflected people’s needs and choices and people were involved in decisions about their care. Records did not always document how often people had been supported to access the community to follow areas of interest. The provider was continuing to prioritise access to outside activities and relatives told us they had noticed improvements since the new manager had been appointed.

The model of care and setting was designed to maximise people’s choice control and independence. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. People were included in decisions about their care and support.

Right culture

Staff treated people who used the service in a way which upheld their dignity, privacy and human rights. Some written and verbal language needed to be more person centred.

Oversight of some aspects of the service required improvement. The provider had recognised this and was introducing a new recording system to address this. The new manager had made a positive impact on the service in a short time, supported by staff and senior management. The provider gave us assurances they understood where the improvement priorities were and would continue to work on these. There was a clear ethos in place and the provider’s values promoted inclusion and empowerment for the people who used the service. There was still work to do to fully embed these values but the direction for the service was clear.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update.

The last rating for this service was requires improvement (published 11 January 2020). The service remains rated requires improvement. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulation. This service has been rated requires improvement for the last three consecutive inspections.

Why we inspected

We carried out an unannounced, comprehensive inspection of this service on 14 and 18 November 2019. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve standards of person-centred care and governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Responsive and Well-Led which contain those requirements.

We looked at infection prevention and control measures under the safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained requires improvement. This is based on the findings at this inspection. We have made a recommendation relating to good governance.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Kalmia & Mallow on our website at www.cqc.org.uk.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.