St Margarets Care Home

We found the following examples of good practice.

The registered manager had completed service visit risk assessments for all residents who received visitors. These detailed how to safely manage the visit for each person according to their needs and abilities.

For people who were in their rooms and either unable or chose not to access the communal areas, there was a social isolation risk assessment in place. These were regularly reviewed by staff to try and improve people’s wellbeing and reduce the risk of isolation. Care staff had taken on the role of providing activities during the pandemic and had thought of creative ways to keep people engaged and active.

All staff were responsible for cleaning and signed an infection control form when they had cleaned certain areas of the home. It was common practice that whenever staff went anywhere in the home, they cleaned regularly touched surfaces as they went along.

An automatic hand washing station had been installed outside the front door of the service with instructions on the screen for safe hand washing. The hand washing station was touch free and sensors identified where soap and water was required.

The registered manager had changed several household items for disposable items in order to promote good infection control. This included paper doilies on food trays and paper napkins for use at meal times. The registered manager had also installed paper towel dispensers in all individual and communal bathrooms.

Further information is in the detailed findings below.

St Margarets Care Home is a residential care home providing care and support to 19 people aged 65 and over at the time of the inspection. The service can support up to 22 people living with dementia, frailty and physical disabilities.

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

Fire safety was assessed and people had personal evacuation plans in place. These lacked detailed on how a person would be safely evacuated. Guidance was not always available on what equipment a person would require to aid a safe evacuation and the number of staff required. Accurate documentation was not always maintained. For example, policies referred to out of date legislation and care plans were not always updated following a change in a person’s care needs.

Systems were in place to manage infection control. However, these systems were not always effective and best practice guidelines were not always followed. For example, the provider’s clinical waste bin was unlocked.

There were enough staff working to provide the support people needed, at times of their choice. Recruitment procedures ensured only suitable staff worked at the service. People had access to healthcare services and input from specialist professionals when required. Their needs in relation to their personal care, nutrition and medicines were met.

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 felt staff were caring, kind and respectful when supporting them. People told us they felt their opinions mattered and they were listened to. People's cultural and spiritual needs were encouraged and respected. The registered manager recognised the importance of meeting people’s psychological and emotional needs. The service had a range of animals including a cat, chickens and a budgie. People were observed making a fuss of the cat. People’s privacy and dignity was respected. Friendships had blossomed between people and people were observed chatting and nattering away.

There was also a positive, friendly and caring culture amongst the staff. Links with the local community had been established and people had access to a range of activities. People’s wishes around end of life care were respected and staff worked in partnership with healthcare professionals to achieve positive outcomes for people.

People and their families were provided with information about how to make a complaint and details of the complaint's procedure were displayed at the service.

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

Rating at last inspection:

The rating for the service was Good (report published 8 March 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.

St Margarets is a large domestic-style house. It is set in its own grounds on a residential street in Eastbourne. Accommodation is provided over three floors. Chair lifts are available to support people in getting between each floor. A lounge and separate dining room are provided on the ground floor, with a garden to the rear.

St Margarets has 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. The provider for the service is Total Support Solutions Limited.

St Margarets was last inspected on 7 and 8 June 2016. At that inspection, it was rated as requires improvement. The service was in breach of Regulations 9, 12, 17 and 18 of the HSCA Regulations 2014 which relate to person-centred care, safe care, governance and staffing. Following the inspection, the provider sent us an action plan to outline how they would address these areas. At this inspection, we found the provider and registered manager had been successful in making most of the necessary improvements.

Only one area required improvement. This related to ensuring all people’s care records were accurate and updated when their conditions changed. There was no written agency induction to ensure temporary staff understood key areas relating to safety. Responsibilities for ensuring effective cleaning of all parts of the laundry to reduce risk of infection were not clear. This last issue was dealt with during the inspection.

The provider and registered manager had been effective in taking action in other areas. Improvements included ensuring the home environment was safe for people and risks to people, such as risk of falling, were assessed regularly. Where risk was identified, relevant action plans or care plans had been put in place to ensure people’s safety.

People’s safety at night had improved because of increased staffing levels. People now said they felt safe at night and were responded to when they needed assistance. People and staff said staffing levels during the day met their needs. New staff were recruited in a safe way.

The registered manager had ensured people had care plans about their needs, including people who were living with dementia and where people had continence needs. These were regularly reviewed. People were supported in taking their prescribed medicines in a safe way. District nurses commented on the effective working relationship between the home and themselves.

Activities for people had improved since the last inspection. The activities were clearly enjoyed by people. People’s families and friends were encouraged to visit.

Improvements had been made to the meals service, and meals were now a social occasion. A range of choices were offered to people at each meal. People said how much they enjoyed their meals. Where people needed additional support to eat and drink, this was provided.

People and their relatives commented on how caring staff were. They said staff respected their privacy and dignity and also encouraged them in being as independent as they wanted to be. People said they felt safe in the home. Staff had a good awareness of how to ensure people were safeguarded from risk of abuse. Staff worked within the principals of the Mental Capacity Act 2005 (MCA). They supported people in choosing how to live their lives, and also took appropriate action to safeguard people from risk of being deprived of their liberties.

Staff said they were supported in caring for people by the range of training provided and were also supported in their roles. They said they liked working in the home and could raise matters when they needed to with the registered manager.

St Margarets was a large domestic-style house. It was set in its own grounds on a residential street in Eastbourne. Accommodation was provided over three floors. Chair lifts were available to support people in getting between each floor. A lounge and separate dining room were provided on the ground floor, with a large garden and terraced area to the rear.

St Margarets 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. The provider for the service was Total Support Solutions Limited.

St Margarets was last inspected on 28 April 2014. No issues were identified at that inspection.

At this inspection, we found the provider had not ensured there were always effective systems to ensure people’s safety. This was because there was only one member of staff on duty at night to care for 19 people and associated risks of this, including supporting people in the event of a fire, had not been identified. The provider had also not identified other risks. This included ensuring risk to people from falling was reduced. Provider’s systems had also not identified other areas, so they could ensure relevant action took place. This included audits of the quality of assessment and care planning, and some areas relating to hygiene and maintenance.

Some information known to the registered manager or staff had not been documented. This included the documenting of some bruising to people, information on how to support people in decision-making and information relating to certain staff’s recruitment and induction.

People had assessments and care plans in place, but the provider and registered manager had not ensured all relevant guidelines were being followed. This included supporting people with making choices, engagement where people were living with dementia, and continence care.

The registered manager reported they had identified some areas for action and was in the process of developing these areas. Activities provision had been commenced, but appropriate systems for care planning to support people in engagement with their preferred activities were still to be developed. The manager was also starting to take action to ensure further developments in records for administration of medicines.

People said they felt staff were trained in their roles and knew how to meet their needs. Staff reported on the supports they received, including training and one to one support. All staff had been trained in safeguarding adults who may be at risk of abuse and knew actions to take to safeguard people.

People said their healthcare needs were met. External health care professionals confirmed staff followed their directions.

People said they were treated with dignity and respect. They commented on the happy atmosphere in the home, saying they received the care and the meals they wanted. People said they could bring up issues of concern to them with staff. Staff were consistently polite and helpful to people when they supported them.

We found four breaches of the HSCA 2014 Regulations. You can see what action we told the provider to take at the back of the full version of the report.

The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. To see the evidence that supports our summary please read the full report.

Is the service safe?

People had been cared for in an environment that was clean and hygienic. Systems were in place to identify any maintenance or safety issue within the home and for these to be addressed in a timely fashion.

Risk assessments were in place to provide information to staff to help minimise the risk of any harm to people.

All feedback indicated that there was enough staff and they were competent in the work they undertook.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The manager was able to describe when a DoLS would be applied for. Staff had received training on the mental capacity act and DoLS.

Is the service effective?

We saw individual plans of care were in place. There was evidence to confirm that these were reviewed and updated to reflect any changing need.

It was evident from our observations and from speaking to staff that they had a clear understanding of people's needs. The people who used the service that we spoke with told us the staff looked after them well. One person said, 'We are all so well looked after here, it is an excellent place, book it dear.' Another said, 'We are helped when we need it, it could not be better.'

Training records seen confirmed staff had received appropriate training to meet the needs of people living at the home.

Is the service caring?

People were supported by kind and caring staff. We saw that staff were patient and pleasant at all times and showed affection and kindness in appropriate ways. For example, a birthday was highlighted and celebrated by staff and people living in the home.

Our observations confirmed that people were encouraged to be independent but were helped when they needed any support.

Is the service responsive?

We saw that people's needs had been assessed before they moved into the home. Individual care plans were developed for each person following admission. People were encouraged and enabled to make choices about their daily activity. Staff in the home provided activities and visitors were warmly received, supporting people to maintain relationships with their friends and relatives.

Is the service well-led?

We saw that a number of quality assurance processes were in place. These included feedback from people who used the service and their representatives.

People, visitors and staff told us that if they had any concerns they would speak with the manager or the owners. A staff member and a relative told us that issues they had raised had been dealt with effectively.

Staff told us they were clear about their roles and responsibilities. The manager was supported by a deputy manager and appointed senior care staff.

A visiting professional to the home told us that staff put the residents best interests first, they said 'Staff here are empowered to deliver person centred care.'

We saw that staff sought people's consent prior to undertaking any aspect of care or activity. Staff knew people well and delivered a high standard of care. People received appropriate care to meet their needs.

There were sufficient staff on duty to meet the needs of the people. There was a complaints procedure in place at the home.