Margaret's Rest Home

Margaret's Rest Home is a residential care home providing accommodation and personal care for up to 27 people. The service provides support to older and younger people, people living with dementia and people with physical disabilities. At the time of our inspection there were 26 people using the service.

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

People and their relatives felt the service was safe, and people were cared for by staff who understood safeguarding procedures.

Improvements had been made and the previous recommendation and breaches had been met. Risks associated with people’s individual care and health needs were assessed and measures were in place to reduce the risk. Care plans had been reviewed, updated and personalised to reflect individual preferences, routines and wishes. Staff had detailed guidance of the action required to provide safe and effective care. People received their medicines in a safe way and in the way they preferred. There was improved guidance to enable staff to support people with their medicines.

People had enough to eat and drink and their dietary needs were met. People were supported to access health care services when required.

Staff had been safely recruited. There were enough staff working at the service to keep people safe. Staff were trained for their role. Staff felt supported by the registered manager and received feedback on their performance through supervisions.

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.

Systems were in place to ensure the premises and equipment used in the delivery of care were serviced and maintained. People lived in a clean and hygienic environment. Improvements had been made to the recording of incidents and accidents. These were detailed and included any actions taken to reduce the risk of reoccurrence. Any learning was shared with staff.

The new registered manager had made significant improvements and understood their responsibilities. Staff and people had confidence in the registered manager. There were new and improved systems and processes were in place to monitor all aspects of the service provision and when shortfalls were found action was taken. People were involved in the review of their care and their equality and diversity needs were considered and respected. Feedback about the quality of service was sought from people, their relatives and staff and used to make improvements.

The service worked in partnership with other professionals and followed best practice guidance within the sector.

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 18 May 2023) and there were breaches of regulations. 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

We carried out an unannounced focused inspection of this service on 22 June 2022. 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 management of risks, medicines and good governance.

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

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

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

Follow up

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

Margaret’s Rest Home is a residential care home providing accommodation and personal care for up to 27 people. The service provides support to older and younger people, people with dementia and people with physical disabilities. At the time of our inspection there were 22 people using the service.

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

Risk assessments and care plans did not always record all the information staff required to ensure safe care was provided. Not all risk assessments were in place and some care plans held conflicting, wrong or missing information within them. We have made a recommendation that the provider reviews and updates all care plans and risk assessments.

Unexplained injuries were not investigated to establish a cause or to identify any mitigating strategies to reduce the risk of reoccurrence.

Medicine management required improving. Records were not consistently kept to evidence why a particular medicine was administered. When staff gave people a higher dosage records did not include their rationale for not giving the lower dosage first.

Support tasks were not always recorded as completed. We found gaps in the records of oral care, support with repositioning, continence care and person hygiene.

Systems and processes to ensure good oversight of the service were not always effective. Audits completed did not identify the concerns found on inspection.

People, staff and relatives felt able to discuss and raise any concerns with the registered manager. Complaints had been dealt with effectivity and within the provider's time frames.

Staff were recruited safely and completed an induction and shadow shifts before working alone. Staff had mixed views about the effectiveness of the training provided. Staffing levels were sufficient during the site visit.

The provider followed government guidance on COVID-19, visitors, testing and procedures.

People were supported to access health professional as required. The service had a GP who completed weekly visits and referrals were made to professionals as needed.

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 September 2021) and there was one breach of regulation. 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 not enough improvements had been made and the provider was still in breach of regulations.

Why we inspected

We received concerns in relation to oversight, risk management and dignity. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

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 not changed from requires improvement based on the findings of this inspection.

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

Enforcement

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 oversight of the service, medicine management and risk management at this inspection. We issued a warning notice in relation to the oversight of the service, which required the provider must make improvements to meet the regulation.

Please see the action we have told the provider to take at the end of this report.

Follow up

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

Margaret's Rest Home provides nursing and residential care for up to 27 older people, including people living with dementia. There were 26 people receiving care at the time of the inspection.

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

Systems and processes had not always identified areas that required improvement, such as cleanliness and safety. The registered manager updated audits at the time of inspection to improve the quality monitoring of the service. The provider needs to ensure these changes are embedded into the service.

The provider was not always responsive to people’s feedback. The premises require refurbishment and a plan of ongoing decoration.

Staff did not always follow infection control guidelines, and the guidelines were not always in line with current government guidelines. The registered manager updated their policies and procedures and put additional checks in place to monitor staff practices.

People’s risk assessments were completed with clear guidance for staff on how to mitigate the known risks. People received their medicines as prescribed.

People were supported by enough staff who knew them well and had been safely recruited. People were safeguarded by staff who knew how to look for and report concerns.

Staff and relatives knew the registered manager and felt comfortable raising any concerns with them.

The registered manager continually looked to improve the service and invested time in the development and support of staff.

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 requires improvement (published 16 October 2020). This service has been rated requires improvement in well led for the last four consecutive inspections.

Why we inspected

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.

We received concerns in relation to infection control and increased input from emergency services. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

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

Enforcement

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.

We have identified one breach in relation to management oversight of the home at this inspection.

Please see the action we have told the provider to take at the end of this report

Follow up

We have asked the provider to send an action plan We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Margaret’s Rest Home provides nursing and residential care for up to 27 older people, including people living with dementia. There were 24 people receiving care at the time of the inspection.

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

Systems and processes in place to maintain oversight of the service required improvement. Although audits were completed these did not always pick up issues or gaps in records.

People’s risks were assessed, and strategies were documented to mitigate the known risks. However, not all records evidenced these strategies were completed. Referrals to external professional were made when appropriate.

Medicine management required improvement. Not all documentation had been put into place. However, staff understood people’s medicine needs.

People were supported by staff who knew them well. Staff had received training to meet people’s needs and understood safeguarding processes to keep people safe.

Staff had been safely recruited and received support from the registered manager and provider. Staff were positive about working at Margaret’s Rest Home.

Infection control processes and procedures were in place and followed by staff. Staff wore appropriate personal protective equipment and supported people to reduce the transmission of COVID 19.

Staff and people were supported to feedback on the service delivered. We received mixed experiences from relatives regarding the sharing of information.

The registered manager was visible within the service and interacted with staff and people using the service regularly.

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 25 May 2018).

Why we inspected

We received concerns in relation to cleanliness, oversight and information sharing. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

We have found evidence that the provider needs to make improvement.

You can see what action we have asked the provider to take at the end of this report.

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

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’s Rest 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.

The service supports older people, including those living with dementia. Margaret’s Rest Home offers long-term residential care for up to 27 people including those living with dementia. At the time of our inspection, 27 people were using the service.

At the last comprehensive inspection on 14 and 15 March 2016, this service was rated as good. At this inspection, the service remained good overall but some areas of improvement were required under well-led.

The service had a registered manager 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.

The provider regularly checked the quality of care at the service through quality audits, however we have identified some areas where further work was needed to ensure accurate records were maintained.

People told us they felt safe at the service because there were always staff on hand to support and care for them. Written risk assessments had been prepared to reduce the likelihood of injury or harm to people during the provision of their care. There were enough staff employed to meet people’s needs. Communal areas were well staffed and if people were in their bedrooms staff regularly checked on them. The staff recruitment procedures ensured that appropriate pre-employment checks were carried out to ensure only suitable staff worked at the service.

People received their medicines safely and as prescribed. There were systems in place to ensure the premises were kept clean and hygienic so that people were protected by the prevention and control of infection. There were arrangements in place for the service to make sure that action was taken and lessons learned when things went wrong, to improve safety across the service.

People’s care needs were assessed prior to them moving into the service. Staff received an induction process when they first commenced work at the service and in addition received on-going training to ensure they were able to provide care based on current practice when supporting people. People received enough to eat and drink, had a choice of meals and snacks and were supported by staff to access a variety of other services and social care professionals.

People were supported to access health appointments when required to make sure they received continuing healthcare to meet their needs. 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 (do not) support this practice.

People developed positive relationships with the staff who were caring and treated people with respect, kindness and courtesy. People were encouraged to make decisions about how their care was provided staff had a good understanding of people's needs and preferences.

Care plans were personalised and gave clear information to staff about each person's specific needs and how they liked to be supported. People were satisfied with how their personal care was provided. Records showed that people and their relatives were involved in the assessment process and the on-going reviews of their care. There was a complaints procedure in place to enable people to raise complaints about the service.

People, their relatives and staff had confidence in the leadership of the provider and registered manager. The culture was open and honest and focused on each person as an individual. Staff put people first, and were committed to continually improving each person's quality of life

There was a registered manager in post. 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.

The provider did not have suitable systems in place to monitor all aspects of the environment to maintain people’s safety. They did not always ensure that the access to the kitchen was secure.

The registered manager had not submitted the required notifications to the Care Quality Commission. The manager immediately provided the notifications and undertook to continue to provide the notifications as required by the regulations.

People who had behaviours that challenged others had risk assessments carried out and staff followed the plans designed to mitigate these identified risks. Staff were vigilant in providing close supervision for people during the times they displayed challenging behaviour. Staff took appropriate action to protect people from others who had episodes of behaviour that challenged. Staff referred people to appropriate healthcare professionals for assessment where people’s behaviours had become more frequent.

People’s risks were assessed and care plans that mitigated these risks were followed by staff. There were enough staff to provide for people’s needs.

People had enough to eat and drink to maintain their health and well-being.

Margaret’s Rest Home is a residential care home registered with The Care Quality Commission (CQC) to provide the regulated activity, accommodation for persons who require nursing or personal care. The service provides care for up to 27 older people, including people living with dementia and physical disabilities. On the day of our inspection 27 people were using the service.

The service had 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.

Each person had a mental capacity assessment (MCA) completed, although as set out in the Mental Capacity Act 2005 code of practice, 'specific decision' MCA assessments were not always considered.

People received their medication as prescribed and the systems to receive, store and administer medicines were appropriately maintained.

The provider notified the Care Quality Commission (CQC) of events, such as serious injuries, deaths and other events as required by law. They had also notified CQC of people placed under Deprivation of Liberty Safeguards (DoLS) authorisations also required by law.

Staff were aware of what constituted abuse and of their responsibilities to report abuse. Risks to people using the service and others were assessed, and control measures were in place to reduce any identified risks.

Staffing levels were adequate to meet people’s current needs. The staff recruitment procedures ensured that appropriate pre-employment checks were carried out to ensure only suitable staff worked at the service. Staff induction training and on-going training was provided to ensure they had the skills, knowledge and support they needed to perform their roles.

Consent was gained from people before any care was provided. People had a choice of meals, nutritional assessments were carried out and special diets catered for, and people were supported to see healthcare professionals as and when they needed to.

Staff treated people with kindness, dignity and respect and spent time getting to know them and their specific needs and wishes. The views of people living at the service and their representatives were sought and areas identified for improvement were acted upon to make positive changes.

People and their families were fully involved and in control of their care. Care was based upon people’s individual needs and wishes. The care plans were reviewed and updated, to ensure they reflected the most recent and up-to-date information regarding people’s care.

Social, leisure and recreational activities were provided for people to participate in if they wished.

The service had a complaints procedure in place, to ensure that people and their families were able to provide feedback about their care and to help the service make improvements where required.

Regular management audits were carried out to assess and monitor the quality of the service. The vision and values of the service were person-centred and made sure people were at the heart of the service.

Is the service safe?

Is the service caring?

Is the service responsive?

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, discussions with people using the service, their relatives, the staff supporting them and looking at records.

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

Is the service safe?

Equipment at the home had been well maintained and serviced regularly therefore not putting people at unnecessary risk. The provider also had systems in place in case of an emergency. The systems included a call bell system to enable people who chose to remain in their rooms to call for staff assistance.

Is the service caring?

We saw that staff interacted with people in a kind and supportive way. We saw people enjoying some activities and laughing with staff that were supporting them. People were happy with the care that had been delivered, one person said 'the staff are lovely and are very friendly; they know exactly what I like'.

Is the service responsive?

People received care that met a range of individual needs and these included supporting people's nutritional, continence, mobility and skin care needs. We found that referrals were made promptly to health care professionals when required.

Is the service effective?

Specialist dietary, mobility and equipment needs had been identified in care plans where required to meet people's needs. It was clear from our observations and from speaking with staff that they had a good understanding of the care and support requirements of people that used the service.

Is the service well led?

We saw that the registered manager had used a system of audits to continuously monitor the quality of service at the home. We found that records were regularly updated so that people's requirements were accurate. We also found that staffing rotas were arranged in advance by the registered manager which ensured that staffing levels met people's needs. We found the service to be well led.

We spoke with two members of staff who told us that there were enough staff on duty to meet people's needs.

We found that people received care that was planned to meet their individual needs. There were safeguarding measures in place to protect people from harm. We found that staff had been employed who had relevant experience and there were enough staff on duty to meet people's needs. The records at the service were organised and well maintained.