Margaret House Care Home Ltd

Margaret House Care Home Ltd is a residential care home providing personal care for up to a maximum of 11 people in one adapted building. The service specialises in providing care and support for people with mental health conditions. There were 9 people accommodated in the home at the time of the inspection.

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

People were satisfied with the service and told us the staff were helpful and pleasant. Staff understood how to protect people from harm or discrimination and had access to safeguarding adults’ procedures. There were shortfalls in some people’s care plans and records and risks to people’s health safety and well-being had not always been assessed and managed. The home had a satisfactory standard of cleanliness. There were sufficient staff on duty and staff were attentive in responding to people’s needs. There were minor shortfalls in the recruitment records of new staff. The deputy manager assured us these issues would be addressed. Medicines were not always managed safely. Whilst a pre-planned fire risk assessment was carried out during the inspection, we were concerned about the fire arrangements and asked the local authority’s Fire and Rescue Service to carry out an audit. The nominated individual took immediate action to address issues highlighted during the fire assessment.

People were satisfied with the meals provided. However, dietary records were not consistently completed. 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. However, there were no supporting care plans in relation to Deprivation of Liberty applications. Staff received appropriate training and an annual appraisal of their work performance. We were told the manager was due to arrange supervision meetings with staff. People’s healthcare needs were recorded in their care plan. However, staff were provided with inconsistent advice about monitoring 2 people’s blood sugars, and were not maintaining a consistent record. Some areas of the home looked worn and damaged and would benefit from redecoration and refurbishment.

People’s rights to privacy and dignity were not always promoted and upheld. We noted people’s bedrooms were not always well presented and apart from 1 bedroom there were no curtains at windows. Whilst there were blinds, these were not in a good condition. We also noted there was no privacy glass on a bathroom window. People were satisfied with the care provided and we observed caring interactions throughout the inspection.

The provider had arrangements for planning care, however, one person did not have a care plan accessible to staff and other people’s care plans had not always been reviewed and updated. We noted the manager was in the process of developing new care plans which were stored on the computer. We made a recommendation about ensuring up to date care plans were readily accessible to staff. We saw limited evidence to demonstrate people were involved in the development and review of their care plan. People had few opportunities to participate in activities. Although there were arrangements for monthly discussions with people, records indicated these had not always taken place. The deputy manager assured us the discussions would be reinstated.

Whilst the management team had carried out a series of audits as part of the governance systems, we found a number of shortfalls during the inspection in respect to the management of risks and medicines and the maintenance of records. We also found people were given limited opportunities to express their views. There was evidence of only one residents’ meeting during 2022. Whilst the nominated individual explained satisfaction surveys had recently been distributed, we saw no evidence of previous surveys.

The manager was away on annual leave at the time of the inspection. Following our visit, the nominated individual sent us an action plan setting out their response to the inspection findings.

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

Rating at the last inspection

The last rating for this service was good (published 22/11/2019).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We have found evidence that the provider needs to make improvements. You can see what action we have asked the provider to take at the end of this full report.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Margaret House Care Home Ltd on our website at www.cqc.org.uk.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to the management of risks and medicines and the governance and record keeping systems. We also made a recommendation about making sure up to date care plan information to readily accessible to staff. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Margaret House Care Home Ltd is a residential care home providing accommodation and personal care for 11 people, including people living with dementia or a mental ill health. At the time of the inspection, there were 10 people living in the home.

The home is an older type extended property providing facilities on two floors which could be accessed by a stair lift. There is a lounge and dining room and nine of the single bedrooms had ensuite facilities. The home is located on a main bus route on the outskirts of the town of Burnley, Lancashire. Shops, pubs, churches and other amenities, including a park, are within walking distance. There are surrounding gardens and patio areas.

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

The registered manager provided good leadership and sought the views of people about the quality of care provided. The feedback was used to make improvements to the service. The quality of the service was monitored, and appropriate action was taken to improve the service when needed. Lessons had been learned and shared with staff when things went wrong.

People told us they felt safe and were treated well. They said staff were kind and caring. Staff understood how to safeguard people from abuse and knew how to report any concerns about poor practice. There were enough numbers of staff to meet people's needs and ensure their safety. The staff team was stable with very few changes to the team; staff were happy working at the service. Recruitment checks were carried out before new staff started to work in the home; improvements were being made to this process.

People received their medicines when they needed them from staff who had been trained and had their competency checked. People were protected from the risks associated with the spread of infection. People enjoyed the meals. They were supported to eat a nutritionally balanced diet and had access to various healthcare professionals, when needed.

Risk assessments were carried out to enable people to maintain their independence and receive care with minimum risk to themselves or others. 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.

Arrangements were in place for staff to receive induction and ongoing training. Staff were supported with regular supervisions and were given the opportunity to attend regular meetings to ensure they could deliver care effectively.

Staff treated people with kindness, dignity and respect and spent time getting to know them and their specific needs and wishes. People's care and support needs were assessed prior to them living in the home. Staff knew about people's routines and preferences and people had been consulted about their needs. We observed positive and caring interactions between staff and people. People were consulted about their care needs and involved in their care plans.

People enjoyed suitable activities and entertainments in accordance with their needs and preferences and they were supported to maintain contact with friends and family. People knew how to raise a complaint or concern if they needed to and had access to a complaint’s procedure.

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

Rating at last inspection

The last rating for this service was good (published 22 June 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Margaret House Care Home Ltd provides accommodation and personal care for up to 11 people, including people living with dementia or a mental illness. There were 11 people accommodated in the home at the time of the inspection.

Margaret House Care Home Ltd is an older type extended property providing facilities on two floors which could be accessed by a stair lift. There is a lounge and dining room and nine of the single bedrooms had en-suite facilities. The home is located on a main bus route on the outskirts of the town of Burnley, Lancashire. Shops, pubs, churches and other amenities, including a park, are within walking distance. There are surrounding gardens and patio areas.

The service was managed by a registered manager. The registered manager had been in post since February 2015. 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 our last inspection visit on 17 and 18 May 2016 we found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to medicines management, providing a clean and well maintained environment, recording and managing the risks to people's health, safety and welfare and ineffective quality assurance systems. Following the last inspection the infection control lead nurse visited the service and advice and support was provided. We asked the provider to take action to make improvements and to send us an action plan. During this inspection we found the necessary improvements had been made.

People told us they felt safe and staff were kind and caring. Safeguarding adults' procedures were in place and staff understood how to safeguard people from abuse. The registered manager and staff were observed to have positive relationships with people living in the home. People were relaxed in the company of staff and there were no restrictions placed on visiting times for friends and relatives.

We found staff were respectful to people, attentive to their needs and treated people with kindness and respect. The atmosphere in the home was comfortable and relaxed. From our observations it was clear staff knew people well and were knowledgeable about their individual needs, preferences and personalities.

Appropriate Deprivation of Liberty Safeguard (DOLS) applications had been made to the local authority and people's mental capacity to make their own decisions had been assessed and recorded in line the requirements of the Mental Capacity Act 2005. People were supported to have 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.

Each person had a care plan that was sufficiently detailed to ensure they were at the centre of their care. People’s care and support was kept under review and, where appropriate, they were involved in decisions about their care. Risks to people’s health and safety had been identified, assessed and managed safely. Relevant health and social care professionals provided advice and support when people’s needs changed.

There were enough staff to support people in a timely and unhurried way. The registered manager followed a safe recruitment procedure to ensure new staff were suitable to care for vulnerable people and arrangements were in place to make sure staff were trained, supported and supervised.

Medicines were managed safely and people had their medicines when they needed them. Staff administering medicines had been trained and supervised to do this safely.

Appropriate aids and adaptations had been provided to help maintain people’s safety, comfort and independence. People were happy with their bedrooms and had arranged them as they wished.

Activities were appropriate to each individual. People told us they enjoyed the meals. They were provided with a nutritionally balanced diet that catered for their dietary needs and preferences.

People were encouraged to be involved in the running of the home and were kept up to date with any changes. People were aware of how to raise their concerns and were confident they would be listened to.

People considered the service was managed well. There were systems in place to monitor the quality of the service to ensure people received a good service that supported their health, welfare and well-being.

Margaret House provides accommodation and personal care for up to 11 people, including people living with dementia or a mental illness. There were 11 people accommodated in the home at the time of the inspection.

This was the first inspection of the service following a change of ownership in January 2015.

During this inspection visit we found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to medicines management, providing a clean and well maintained environment, recording and managing the risks to people’s health, safety and welfare and ineffective quality assurance systems. You can see what action we told the registered provider to take at the back of the full version of the report. We also made recommendations about assessing staffing levels.

The service was managed by 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 2008 and associated Regulations about how the service is run.

People and relatives told us they did not have any concerns about the way they or their relatives were cared for. They were happy with the care and support provided and they felt safe. Staff were aware of the action they would take if they witnessed or suspected any abusive or neglectful practice and had received training on the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards.

People told us they were given their medicines when they needed them. However, we found areas where improvements were needed to ensure people’s medicines were always managed safely.

We found that not all risks to people’s health, safety and welfare had been recognised or recorded. This meant staff may not respond quickly to any increased risks or changes to people’s health.

We found some areas of the home were not clean and hygienic. We noted some improvements had been undertaken but other areas were in need of maintenance and redecoration. People told us they were happy with the facilities available in the home. They had arranged their bedrooms as they wished and had brought personal possessions with them.

The number of shortfalls we found indicated quality assurance and auditing processes had not been effective as matters needing attention had not always been recognised or addressed. This meant the provider had not identified risks to make sure the service ran smoothly.

The service had recruitment and selection policies and procedures although they needed to be reviewed to reflect current guidance. Staff had been recruited safely and received training and support to help them look after people properly. However, they had not received specialised training such as mental health awareness and dementia training.

People were happy with the staff team and told us there were sufficient numbers of staff to meet their needs in a safe way. Staff told us they had a stable team and they worked well with each other. Staffing levels were not formally assessed although staff were confident additional staff would be made available if people’s needs changed.

People told us they enjoyed the meals. We noted the atmosphere was relaxed with chatter throughout the meal. Staff were aware of people’s dietary preferences and professional advice and support had been sought when needed.

People were involved in the running of the home and were kept up to date. They told us they had no complaints and were aware of how to raise their concerns if they needed to.

Everyone had a care plan, which had been kept up to date about their needs and preferences. People told us they were kept up to date and involved in decisions about care and support.

People made positive comments about the management of the home and about the staff. We found a relaxed and caring atmosphere where people were comfortable and at ease.