We carried out a review of the data available to us about St Margaret's Nursing Home on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about St Margaret's Nursing Home, you can give feedback on this service.
St Margaret's Nursing Home is a nursing home providing personal and nursing care to 20 people aged 65 and over at the time of the inspection. Some people were living with dementia, some had mobility difficulties, sensory impairments and some were cared for in bed. Accommodation is
arranged over two floors. There was a passenger lift for access between floors. The service can support up to 25 people.
People’s experience of using this service and what we found
People told us they felt safe. Comments included, “They make sure everything is okay for you. They check you are alright, so I feel safe” and “They sort out my medication for me and they ask me if I want any pain killers. They always wait with you when you take your medicine.”
Relatives told us they were happy with the care their loved one’s received. Comments included, “The staff are brilliant, [loved one] is extremely well looked after” and “They know what to do, you couldn’t want for better staff.”
Staff had been recruited safely to ensure they were suitable to work with people. People had regular staff who they knew well. People were well supported by competent, knowledgeable and well-trained staff. Staff were well supported by the management team.
The premises were clean and free from odours. We were assured that the provider’s infection prevention and control policy was up to date. People and relatives told us, “I think the cleanliness is excellent”; “The room has been redecorated and new carpet and when I used to visit it was spotless. You never get any unpleasant smells”; “The staff always wear their PPE, so I am protected” and “Cleaning is fantastic, no smells ever.”
Risks to people’s safety had been well managed. Risks to the environment had been considered as well as risks associated with people's mobility and health needs. The provider continued to have systems in place to monitor accidents and incidents, learning lessons from these to reduce the risks of issues occurring again.
The design and layout of the service met people’s needs. Sign posts were in place which helped people living with dementia.
Prior to people moving in to the service their needs were assessed. These assessments were used to develop the person’s care plans and make the decisions about the staffing hours and skills needed to support the person.
Meals and drinks were prepared to meet people's preferences and dietary needs. Most people told us they liked to the food, some people told us the food was alright. We discussed this with the registered manager who arranged to do a meal survey with people.
The service was well-led. The management team carried out the appropriate checks to ensure that the quality of the service was continuously reviewed, improved and evolved to meet people’s changing needs. The registered manager promoted an open culture and was a visible presence in the service, staff felt listened to and valued.
People were protected from abuse and avoidable harm. People’s medicines were well managed. If people or their relatives wanted to complain they knew how to do so.
People were treated with dignity and respect. People’s views about how they preferred to receive their care were listened to and respected. People and relatives told us staff were kind and caring.
People had access to a range of different activities throughout the week. People told us that they took part in these. Activities were also provided for people who received their care and treatment in bed.
People received good quality care, support and treatment including when they reached the end of their lives. People had been involved in planning and discussions about their wishes and preferences in relation to their end of life care.
When people needed medical attention, this was quickly identified, and appropriate action was taken. For example, if people were losing weight referrals were made to dieticians, or if people fell regularly, they were referred to a fall’s clinic. Nursing staff worked closely with the GP and other health professionals.
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.
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 21 May 2019).
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 regulations.
Why we inspected
The inspection was prompted in part due to concerns received about staff training, moving and handling practice and some risks not being effectively managed. This inspection was also carried out to follow up on action we told the provider to take at the last inspection.
We found no evidence during this inspection that people were at risk of harm from this concern.
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 coronavirus and other infection outbreaks effectively.
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.
St Margaret's Nursing Home accommodates up to 25 people. At the time of our inspection, 20 people lived at the service. There were 21 people residing at the service on the first day of the inspection as one person was staying for respite care. They had returned to their own home by the second day of inspection. Some were older people living with dementia, some had mobility difficulties, sensory impairments and some were younger adults. Most people living on the top floor of the service were cared for in bed. Accommodation is arranged over two floors. There was a passenger lift for access between floors.
People’s experience of using this service:
People told us they did not always feel safe at St Margaret's Nursing Home. Relatives we spoke with felt staff knew people well and understood their support needs.
Potential risks to people’s health and welfare had been assessed, there was guidance for staff to reduce risks and keep people as safe as possible. However, risk assessments had not always been updated in a timely manner when people’s needs and health had changed.
Staff had not always been recruited safely. Staff files contained unexplained gaps in their employment history.
We observed people not always being treated with kindness, dignity and respect.
People told us there were issues with the water temperature throughout the service, staff and the manager confirmed this. Staff told us there were days when they were unable to support people with baths or showers because the water was too cold. After the inspection staff told us that the hot water problem was a consistent and reoccurring problem. The manager arranged for a plumber to revisit the service to address the issue.
Medicines were stored, managed and administered safely. PRN protocols were in place for most people to detail how they communicated pain, why they needed the medicine and what the maximum dosages were. However, one person did not have PRN protocols in place for two medicines which would be required if they had an asthma attack or angina attack. This is an area for improvement.
People were not always supported to have maximum choice and control of their lives. Staff supported them in the least restrictive way possible; however, the policies and systems in the service did not always support this practice. Mental capacity assessments were inconsistent and did not always follow the Mental Capacity Act 2005. Assessments made were not decision specific.
Although care plans were in place to describe the care and support people needed, they did not always include some important information individual to the person. Care plans had been reviewed on a monthly basis and had been updated when people’s needs had changed. People did not always receive care that met their needs and preferences. People felt that activities could be improved, some people told us they were bored.
When people were anxious or agitated and needing reassurance we observed that there were not enough staff to provide the reassurance and support needed. One person told us, “All night people are shouting and that’s terrifying for me.” We made a recommendation about this.
Staff had not always received appropriate training, induction and supervision. We made a recommendation about this.
Infection control practice within the service required improvement. We made a recommendation about this.
There were systems in place to check the quality of the service. However, these systems were not always robust, they had not identified the concerns we raised in relation to risk management, safe recruitment practice, consent to care, dignity and respect and providing care and treatment to meet people’s needs and preferences.
Accidents and incidents were recorded, investigated and action taken to reduce risk.
Staff and the manager understood their responsibility to protect people from abuse. Staff spoken with could explain how any suspected abuse would be reported.
People received access to healthcare professionals.
People told us that they did not feel confident to raise concerns. A complaints policy was in place which was displayed in the service. The manager planned to create an accessible version of the complaints policy.
People had been involved in planning and discussions about their wishes and preferences in relation to their end of life care. Staff knew and understood how to make sure people were comfortable at the end of their life.
Rating at last inspection:
The service was rated Requires improvement at the last inspection on 20 March 2018 (the report was published on 28 April 2018). This service has been rated Requires Improvement at the last two inspections. This is the third consecutive time the service has been rated as Requires Improvement.
Why we inspected:
This inspection was a scheduled inspection based on previous rating.
Enforcement:
We found six breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations. You can see what action we told the provider to take at the back of the full version of this report. Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.
Follow up:
Following the inspection, we requested an action plan and evidence of improvements made in the service. This was requested to help us decide what regulatory action we should take to ensure the safety of the service improves.
We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
St Margaret's Nursing Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. St Margaret's Nursing Home provides nursing care and accommodation for up to 25 older people, who were living with a range of care needs; including some of whom were also living with dementia. Some people needed support with all of their personal care and some with eating, drinking and their mobility needs. Other people were more independent, needing less support from staff. The service is a detached building set in the centre of Hythe alongside the Royal Military Canal. Accommodation is provided on two floors, the upper floor is accessed by stairs and a passenger lift. Eighteen people were living at the service.
At the last Care Quality Commission (CQC) inspection on 17 and 18 November 2016, the service was rated Required Improvement in Safe, Effective, Responsive and Well Led domains. Rated Good in Caring domain with an overall Required Improvement rating. We found breaches of Regulations 9, 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We found that the provider had not ensured care and treatment was person centred to meet with people's needs and reflect their preferences. The provider had not ensured medicines were properly managed; arrangements were not fully implemented to safeguard against the risks of Legionella and practices did not always follow planned care and treatment pathways to mitigate risk. The provider had not ensured systems or processes were operated effectively to assess and improve the quality and safety of the services provided; or operated effectively to ensure complete, contemporaneous records were kept for each service user; including a record of care and treatment provided. We also recommended that the provider adopted a best practice ethos to ensure health care plans are individually fully completed for each person in relation to their particular condition to meet published guidelines as set out by organisations such as Diabetes UK and the National Institute for Health and Care Excellence (NICE).
We asked the provider to take action to meet the regulations. We received action plans on 10 February 2017, which stated that the provider will be meeting the regulations by 31 March 2017.
At this inspection, we found the service Required Improvement.
There was a registered manager at the 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 and associated Regulations about how the service is run.
Risk assessments were in place. However they were not always individualised to the person. We made a recommendation about this.
People were supported to eat and drink enough to meet their needs. However, people did not always received food and drink at an appropriate time and temperature. We have made a recommendation about this.
Records relating to people’s care were not always well organised and adequately maintained. We have made a recommendation about this.
People gave us positive feedback about the service they received. People told us they felt safe and well looked after. Relatives who we spoke with during our visit were satisfied with the service.
People continued to be safe at St Margaret's Nursing Home. Staff knew what their responsibilities were in relation to keeping people safe from the risk of abuse but these were not always followed.
Medicines were managed safely. Medicines were recorded, stored or monitored effectively.
Staff encouraged people to actively participate in activities, pursue their interests and to maintain relationships with people that mattered to them.
People received the support they needed to stay healthy and to access healthcare services.
People and staff were encouraged to provide feedback about how the service could be improved. This was used to make changes and improvements that people wanted.
There were enough staff to keep people safe. The registered manager continued to have appropriate arrangements in place to ensure there were always enough staff on shift. The provider followed safe recruitment practice.
Each person had an up to date care plan, which set out how their care and support needs should be met by staff. These were reviewed regularly.
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.
Staff received regular training and supervision to help them to meet people's needs effectively.
The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards. The provider and staff understood their responsibilities under the Mental Capacity Act 2005.
Staff showed they were caring and they treated people with dignity and respect and ensured people's privacy was maintained particularly when being supported with their personal care needs.
The registered manager ensured the complaints procedure was made if people wished to make a complaint. Regular checks and reviews of the service continued to be made to ensure people experienced good quality safe care and support.
People were supported to maintain their relationships with people who mattered to them. Relatives and visitors were welcomed at the service at any reasonable time and were complimentary about the care their family member’s received.
The registered manager provided good leadership. They checked staff were focussed on people experiencing good quality care and support. Effective systems were in place to enable the registered manager to assess, monitor and improve the quality and safety of the service.
St Margaret's Nursing Home provides nursing care and accommodation for up to 25 older people, who were living with a range of care needs; including some of whom were also living with dementia. Some people needed support with all of their personal care and some with eating, drinking and their mobility needs. Other people were more independent, needing less support from staff. The service is a detached building set in the centre of Hythe alongside the Royal Military Canal. Accommodation is provided on two floors, the upper floor is accessed by stairs and a passenger lift. There were 23 people living in the service at the time of the inspection.
A registered manager was in post. 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.
St Margaret's Nursing Home was last inspected on 30 January 2014 and no concerns were identified at that time. However, this inspection highlighted some shortfalls where the regulations were not met. We also identified areas where improvement was required and made a recommendation the service should adopt.
Medicine quantities were not always recorded, this meant it was not possible to back track to ensure medicines were administered correctly because the starting quantity was unknown. Further guidance and records were required for the application of skin creams to ensure they were administered.
Most checks took place to reduce the risk of Legionella, a water borne bacteria, however, these checks did not meet the requirements of the service’s water management policy because they were incomplete.
Staff had not recognised an out of date Percutaneous Endoscopic Gastrostomy (PEG) feeding plan was being used. Mouth care was, in one case, ineffective and there were no records to support mouth care given.
Elements of some care plans were not tailored to individual preferences and clear links were not always made between some conditions and other associated care needs. This did not provide the service with the best and earliest opportunity to be responsive to changes in people’s needs.
Quality audits carried out by the registered manager and the provider were not fully effective because they had not provided continuous oversight of all aspects of the service.
Services and equipment including the electrical installation, gas safety certificate, portable electrical appliances, fire alarm and firefighting equipment were checked when needed to help keep people safe. The service was well maintained and comfortable.
The registered manager and deputy manager had a good understanding of the Mental Capacity Act 2005, and Deprivation of Liberty safeguards. They understood in what circumstances a person may need to be referred, and when there was a need for best interest meetings to take place. We found the service was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS) and that people’s rights were respected and upheld.
There were enough staff to meet people’s needs. Staff understood how to protect people from the risk of abuse and the action they needed to take to alert managers or other stakeholders if they suspected abuse to ensure people were safe.
New staff underwent an induction programme and shadowed experienced staff, until they were competent to work on their own. There was a continuous staff training programme, which included courses relevant to the needs of people supported by the service.
There were low levels of incidents and accidents and these were managed appropriately with action or intervention as needed to keep people safe. Risks were identified and strategies implemented to minimise the level of risk.
Care plans were reviewed regularly and included the views of the people and their relatives or advocates when needed. The service showed an awareness of people’s changing needs and sought professional guidance.
People were able to choose their food each meal time, snacks and drinks were always available. The food was home-cooked. People told us they enjoyed their meals, describing them as “good” and “first class”.
The service was led by a registered manager who worked closely with clinical staff and the care team. Staff were informed about the ethos of the service and its vision and values. They recognised their individual roles as important and there was good team work throughout the inspection. Staff showed respect and valued one another as well as people living at the service.
We found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.
People we spoke with who lived in the home told us that they were happy with the care and support they received. Comments included 'they look after me well; everything is nice' and 'I'm fine; they're very kind to me' and 'very good in here; couldn't get the care anywhere else'.
People told us that they were supported to make their own day-to-day decisions and were involved in how their care and support was provided.
We found that care plans contained details about people's daily routines, their care needs and the support they required from staff. Risk assessments were in place to identify and minimise risks as far as possible for people who lived in the home.
We found that the home was clean and had effective systems in place to help protect people from the risks of cross-infection. There was guidance and training for staff to help ensure they understood the importance of infection control.
We found that there were enough suitably trained and qualified staff to support people's needs. One person we spoke with who lived in the home told us 'there's enough staff; oh yes'. A visitor commented 'I think this home is well staffed'.
In this report, the name of one registered manager appears who was not in post and not managing the regulatory activities at the home at the time of our inspection. Their name appears because they were still registered with us at the time of our inspection.
People lived in an adequately decorated environment, which was warm throughout. The quality of the environment had been and was in the process of being improved. People were cared for by suitably trained staff who were supported in their roles by supervision. People told us 'Staff are very kind indeed and most helpful, they are a nice lot of people'. The manager knew about how to work with the authorities about any concerns or allegations of abuse. People who used the service, their representatives and staff were asked for their views about the service provided. These were acted on to make improvements. One person told us 'I have no complaints and am not unhappy about anything, if I was, it would be sorted out quickly'.
In this report, the name of one registered manager appears who was not in post and not managing the regulatory activities at the home at the time of our inspection. Their name appears because they were still registered with us at the time of our inspection.