St Marguerite

St Marguerite provides care and accommodation for up to 24 older people with care needs associated with older age, including dementia and memory loss. There were 18 people living at the service on the day of our inspection, two of whom were in hospital. Some people were on a period of respite care. St Marguerite is an adapted building in a residential area of Eastbourne.

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

People told us they felt safe and well cared for. Relatives were confident that people were safe and had their needs attended to. Staff were trained on safeguarding and understood how to respond to any suspicion or allegation of abuse or discrimination. A relative said, “Staff are really switched on to him, ensuring he is relaxed, safe and happy”.

Systems were in place to manage medicines safely; records were clear and ensured people received their prescribed medicines at the correct time and at the correct dose.

Staffing arrangements ensured people had their needs attended to in a timely way, and the service was clean and tidy. People told us, “The place is kept clean and staff are so nice. I am happy here”. Recruitment was documented and included a police check, and two references to support safe practice. Relatives and health care professionals were positive about the staff working in the service. One relative said, “I feel staff genuinely care about people”.

People’s individual risks were assessed, and actions were taken to reduce any risks. The service was clean, and measures had been taken to minimise the risk from COVID-19.

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.

There was a stable management structure and staff felt well supported and valued. There was a strong team spirit. Feedback from staff, relatives and visiting professionals was positive about the leadership of the service.

The registered manager and provider were committed to developing and improving the service and promoting individual quality care.

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 October 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 regulation 17. At our last inspection we recommended that guidelines on PRN medicines were updated. At this inspection we found improvements had been made.

Why we inspected

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

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.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

St Marguerite provides care and accommodation for up to 24 older people with care needs associated with older age, including dementia and memory loss. There were 18 people living at the service on the day of our inspection, including three people staying for a period of respite care. St Marguerite is an adapted building in a residential area of Eastbourne with a large patio and garden area.

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

We have made recommendations about the management of some medicines.

Audits and quality checks completed included internal and external audits. We found concerns relating to documentation which had not been identified by internal checks and audits. Actions identified in external audits had not been addressed promptly. A medicines audit identified that ‘as required’ or PRN medicines were not being consistently recorded when given, and a health and safety audit identified a window restrictor was required to a hallway window. However, these actions had not been addressed at the time of the inspection.

There was an over reliance on verbal information sharing between staff and management. People’s daily records were not consistently recorded to include all relevant information about people’s care. Staff told us they shared information and discussed peoples care needs. However, this information was not consistently documented.

At the time of the inspection the registered manager had not completed up to date safeguarding training and did not have access to local authority policies. They did not demonstrate a clear understanding regarding incidents which should be referred to The Care Quality Commission (CQC) should they occur.

People felt safe living at St Marguerite. One told us “I like my room, staff are lovely they look after me very well. Relatives said the registered manager was approachable and staff were caring. Commenting, “Staff have got to know mum, they are very nice.”

People were supported to have 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.

Risks to people’s health had been identified and recorded in care plans to ensure risk was minimised. There were systems for staff to follow in the event of an accident or incident. Staff told us if they saw anything that concerned them they would speak to a senior member of staff. A complaints procedure was in place. People and their relatives were aware of the process.

Staff knew people well, they treated them with kindness and respect and demonstrated an understanding of their needs. People were assisted to access healthcare services when needed.

Care plans included peoples care and support needs and personal preferences. The registered manager supported staff to meet people's care needs. Staff felt there were enough staff working to provide the support people needed, at times of their choice.

People were supported to continue with hobbies and activities of their choice. There was a programme of activities available for people to attend if they chose.

Recruitment procedures ensured only suitable staff worked at the home. Staff completed an induction which included mandatory training and had further training provided.

People told us staff were available when they needed assistance. Relatives felt that consistent staff meant staff knew people well.

People had the opportunity to feedback and discuss their needs. This included residents and staff meetings. Relatives told us the registered manager was available to speak to if needed.

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 8 December 2016).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified a breach in relation to the governance of the service.

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 governance and safety. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The service had a registered manager in place. 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. The registered providers for this service maintained regular contact with staff and people who use the service.

St Marguerite was inspected in August 2015. We found the provider was in breach of two regulations. Improvements were required to ensure accurate and correct records were used to inform the care of people. Staff needed further training to ensure they were fully aware of what procedures to follow when an allegation or suspicion of abuse was raised. The provider sent us an action plan and told us they would address these issues by November 2015.

This inspection took place 30 November and 8 December 2016 and was unannounced. At the time of this inspection, 20 people were living in the home. This was a full comprehensive inspection to see what improvements the provider had made to ensure they had met regulatory requirements. We found improvements had been made. The provider had ensured people’s care records had improved. Staff had a good understanding of safeguarding procedures and how to protect people from abuse.

The quality monitoring systems needed further development to make sure they were used to promote best practice and to identify areas of improvement and any actions that may be required. This included the use of suitable guidelines for all medicine administration and to demonstrate staff delivered these in a consistent way. In addition although care records had improved some care documentation was not completed to record the care required and provided. This could lead to staff not having up to date guidelines on people’s needs and the appropriate care to be provided.

People were looked after by staff that knew and understood their individual needs well. Staff treated people with kindness and compassion and supported them to maintain their independence. People’s dignity was protected and staff were respectful. All feedback received from people and their relatives was positive about the care, the atmosphere in the service and the approach of staff, registered manager and the providers. One person said “This is a wonderful place.” Two other people told us they would recommend St Marguerite to friends and family. “I would strongly recommend it to my friends.” All feedback from visiting professionals was positive. They told us staff worked with them to improve outcomes for people and to ensure their health was maintained.

Medicines were stored, administered and disposed of safely by staff that were suitably trained. People were protected from the risk of abuse because staff had a good understanding of safeguarding procedures and knew what actions to take if they believed people were at risk of abuse. Staff were trained on the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Senior staff had an understanding of DoLS and what may constitute a deprivation of liberty and knew the correct procedures to follow in order to protect people’s rights.

Staff were provided with a training programme which supported them to meet the needs of people. Staff felt well supported and on call arrangements ensured suitable management cover. Recruitment records showed there were systems in place to ensure staff were suitable to work with people who lived in the home.

Staff treated people with kindness and compassion and supported them to maintain their independence. They showed respect and maintained people’s dignity. People had access to health care professionals when needed.

People had the opportunity to take part in a variety of activities, both in and out of the service. The provider made sure they took people’s choices and preferences into account. Visitors told us they were warmly welcomed and people were supported in maintaining their own friendships and relationships. People had enough to eat and drink and their nutritional needs were well assessed and monitored when needed. People enjoyed a range of nutritious food and drink throughout the day and mealtimes were pleasant and relaxed occasions. People were supported to maintain their own friendships and relationships. Staff related to people as individuals and took an interest in what was important to them.

There was an open culture in the service the registered manager listened to the views of people and staff views. The open culture was promoted by the providers who were visible and approachable. Staff enjoyed working at the home and felt supported. Feedback was regularly sought from people, relatives and staff. People were encouraged to share their views on a daily basis and satisfaction surveys had been completed. People were given information on how to make a complaint and said they were comfortable to raise a concern or give feedback. A complaints procedure was available for people to use.

The provider sent an action plan informing us that systems had been put in place to ensure accurate and suitable records were put in place and maintained.

Evidence gathered at this inspection showed that the provider had achieved compliance.

Below is a summary of what we found. The summary describes what people using the service, their relatives, visiting professionals and the staff told us, what we observed and the records we looked at.

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

This is a summary of what we found:

Is the service safe?

People had been cared for in an environment that was safe, clean and hygienic. Equipment at the home had been well maintained and serviced regularly.

We saw that people's assessments, care plans and risk assessments were not accurate and did not always reflect the current needs of people who lived at the home.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications had needed to be submitted, staff demonstrated an understanding of what actions they would take if concerns were identified in relation to an individual. The manager had received appropriate training.

Is the service effective?

People told us that they were happy with the care they received and felt their needs had been met. It was clear from our observations and from speaking with staff that they understood people's care and support needs and that they knew them well. One person told us. "I am well looked after and I am very happy to live here.'

We saw from training records that staff had received appropriate training to meet the needs of the people living at the home.

Is the service caring?

People were supported by kind and attentive staff. We saw that staff were patient and gave encouragement when supporting people. People told us they were able to do things when they wanted to. Our observations confirmed this. One person told us, 'You can do what you like here.'

Is the service responsive?

People's needs had been assessed and records confirmed that people's preferences and interests had been recorded. Care and support had been provided that met people's wishes. People had access to activities that were important to them and had been supported to maintain relationships with their friends and relatives.

Is the service well-led?

People were asked for their feedback on the service they received. We saw that satisfaction surveys had been sent out the previous year. As a result of feedback received changes had been made to the food provided in the home. People and visitors told us if they had any concerns they spoke to the manager or senior member of staff on duty. They said any issues were dealt with immediately.

Staff were clear about their roles and responsibilities. They said they were well supported by the manager and provider. They told us they could talk to the manager at any time and their views and concerns were listened to and taken into account.

We examined four people's care plans, spoke to people and staff and observed care. We found that care was thoroughly assessed and reviewed and delivered to a consistently high standard.

We found that staff were appropriately trained regarding safeguarding vulnerable adults. People were protected because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

We examined medicine storage, administration and recording systems and found them to be safe and accountable. This meant that people were protected against the risks associated with the unsafe use and management of medicines.

We examined staff files and recruitment processes and found that robust systems were in place to ensure that the provider employed suitably qualified people of good character.

We saw that there was a well-advertised and transparent complaints system in place. People we spoke with told us, "There's nothing to complain about but if there was I would be happy to tell the staff."

People we spoke with enjoyed living at the home. One person told us, 'I like it here. The staff are very kind and do whatever I ask.' Another person said, 'I've been ill a couple of times and they've got me through it.' Others told us,' The food is very good and we go out for trips in the minibus.' The district nurse told us, 'This is a lovely home. I wish they were all like this.'

The staff we spoke with were well qualified, knowledgeable about people's needs and familiar with the support people needed.

We saw the service ensured that staff were able to deliver care and treatment safely due to the training and audits in place. The home had quality assurance systems to assess their performance and ensure improving standards. This included canvassing the views of people living who lived there, their relatives and visiting professionals.