Archived: St Margaret's Residential Home

St Margaret's Residential Home is a care home providing accommodation for up 21 people in one adapted building. At the time of this inspection 21 people were using the service who had a range of needs including dementia and physical disabilities.

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

Improvements were needed to ensure safe processes were consistently followed regarding the use of PRN (as required) medicines and monitoring people’s falls.

We also found a number of areas that would benefit from further work to promote people’s safety and well-being. These included making sure cleaning products are always locked away, consent processes being followed when people share a bedroom, staff training, supporting people’s communication needs and people’s access to activities.

These areas had not been identified through internal quality monitoring systems. This meant opportunities to learn lessons and improve things when they went wrong were sometimes missed.

Staff understood how to keep people safe from harm and abuse. There were enough staff to meet people’s needs, and checks were undertaken to make sure new staff were suitable to work at the service.

People were supported to stay healthy. Staff ensured they had enough to eat and drink and supported people to access healthcare services when they needed to. They understood how to protect people through the prevention and control of infection.

Staff were motivated and caring. They knew people well and treated them with kindness, respecting their privacy and dignity . People were supported to have maximum choice and control of their lives in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Leadership at the service was open and visible. They regularly sought feedback from people, relatives and staff; to see how well the service was performing.

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 21 September 2017).

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

During this inspection we found evidence that the provider needs to make improvements. We found no evidence that people had come to any harm from these concerns. Please see the safe and well-led sections of this full report.

The overall rating for the service has therefore changed from Good to Requires Improvement. This is based on the findings at this inspection. This is the first time the service has been rated Requires Improvement.

The provider confirmed soon after this inspection they had already acted, or had plans to address, all the issues identified for improvement.

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.

At the time of the inspection, there were 20 people being supported by the service. There was a registered manager in post; the registered manager was on annual leave when we inspected 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 2008 and associated Regulations about how the service is run.

People were safe and the provider had effective systems in place to safeguard them. There were risk assessments in place that gave guidance to the staff on how risks to people could be minimised. People’s medicines were managed safely and administered in a timely manner by skilled and trained staff.

The provider had effective recruitment processes in place and there was sufficient staff to support people safely. Staff understood their roles and responsibilities in relation to the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Staff had supervision, support and effective training that enabled them to support people well.

People were supported to have sufficient food and drinks and were supported in a caring and respectful manner. They were also supported to access other health and social care services when required.

People’s needs had been assessed, and care plans took account of people’s individual needs, preferences, and choices.

The provider had a formal process for handling complaints and concerns. They encouraged feedback from people or their representatives. The provider acted on the comments received to improve the quality of the service.

The registered manager provided stable leadership and managerial oversight to staff who felt supported in their roles.

The provider’s quality monitoring processes had been used effectively to drive improvements.

Due to the complex needs of some people, we also spent some time observing people and saw that they were engaged in activities of their choice and at a level that was appropriate to them. Although no formal activities were taking place during our visit, we observed staff interacting with people and supporting them to listen to music, read the newspaper or watch television. One person told us, "It's my home. I like to watch the television."

We noted that staff were friendly in their approach to people and treated them with dignity and respect. They addressed them in a manner that was appropriate to them and which corresponded with their preferred method of address.

People appeared content in the presence of staff and there was a friendly and calm atmosphere. Care records showed that relatives were encouraged to participate in people's care reviews and were kept updated with any changes in condition.

We reviewed the medication records and saw that people received prescribed medication on time and that the medication was stored safely.

People we spoke with told us that they liked living at the home and said staff were very kind.

We were told by two people that the food was very good and they had plenty of it. We observed one person with complex needs who was being supported at lunch time by a staff member. This was carried out discreetly, in an unrushed manner and the staff member spoke respectfully to the person at all times.

Everyone spoke positively about the care they received and said staff spoke with them in a kind and respectful way.

One person told us that staff ensured their privacy and dignity was respected at all times.

A visiting relative told us they were happy that their relative was living in the home and said they were well cared for. The relative said the staff 'Don't just care for my mum, they care for me too. She always has a drink beside her and she only need to ask if she wants something.'

During our visit one person took hold of the manager's hand and told us, 'She's a good one. She always joins in with everything and always sorts out our problems.'

Another person told is if they had any worries or concerns they would talk to the manager without hesitation.