An unannounced comprehensive inspection took place of Margaret Roper House on 14 & 15 November 2017.
The previous inspection was conducted on 8 March 2017. This was a focused inspection to follow up on two previous breaches for the safe administration and management of medicines. At that inspection although we found some improvements we raised a new concern around the management of medicines for people outside of the care home. For example, people going on 'home leave' or for trips out from the care home. Medicine audits (at service and senior management level) were completed, however, monitoring and audit arrangements for supporting people to receive their medicines when outside of the care home were not robust to assure people's health and wellbeing. The existing audits and governance arrangements had not identified the shortfalls we found during this inspection.
Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the administration and management of medicines for people who were taking their medicines out of the home to at least good. We found at this inspection that improvements had been made to ensure this practice was adhered to safely to enable people to take their medicines outside of the service. A policy and procedure was in place which staff understood and followed. Medicine audits were completed to ensure the safe management of medicines in and outside of the care home. This breach of regulation was met.
Margaret Roper House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Margaret Roper House provides nursing care and accommodates people who have mental health care needs. The accommodation is registered for 23 people. The registered provider (owner) is Nugent Care.
There was a new registered manager in post at the time of our inspection. ‘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's needs were recorded in a plan of care. Where a change in a person's needs had been identified their care plan was updated to reflect this. Information was made available to people in an accessible format.
Care records showed that people's health care needs were addressed with appropriate referral and liaison with external health care professionals when needed.
People's medicines were managed safely. Staff received medicine training to ensure they had the skills and knowledge to administer them.
Risks to people’ safety were assessed and risk management plans were in place to support people safely.
The environment and home’s equipment were maintained and subject to safety checks and service contracts.
Staff knew the different types of abuse and how to recognise and report any concerns they had.
Staff were aware of how to respect people’s rights to independence and staff told us how they empowered people to make their own decisions where able.
When people were unable to consent, the principles of the Mental Capacity Act 2005 (MCA) were followed. This included an assessment of a person's mental capacity and decisions made in the person's best interest. This could be further developed by better evidencing assessment around individual decisions for people.
People's consent was obtained prior to the delivery of any care and support though this was not consistently recorded in people’s plan of care.
People told us they were able to make individual menu requests and that their dietary needs were met by the staff. People were complimentary regarding the menu choices available to them.
Recruitment was safely and effectively managed within the home. Staff personnel files which were reviewed during the inspection demonstrated robust recruitment practices.
There were enough staff on duty to help ensure people's care needs were consistently met. People told us the staff supported them at the appropriate time.
We found staff were trained in a range of subjects which were relevant to the needs of people living at the home. Staff told us they received good support from the registered manager.
People were treated with dignity and respect and staff supported people to maintain positive and close relationships with relatives and friends.
Social activities were planned and well managed. People told us how much they enjoyed the social aspect of the home and in and outside of the care home. A person said, “There is so much always going on, it’s great.”
People at the home had access to a complaints policy and procedure should they wish to raise a concern. People told us they felt confident in raising any issue and that this would be addressed by the registered manager.
Quality assurance systems and processes were in place to maintain standards and drive forward improvements within the service. This included a number of audits (checks) on how the service was operating. Staff were complimentary regarding the new registered manager and the changes made within the service.
Feedback from people living in the home was sought to ensure they were satisfied with the overall service provision. This included the provision of meetings and surveys. The feedback we received was very positive. People told us how much they liked living at Margaret Roper House.
The registered manager was aware of their responsibilities and had notified the Care Quality Commission (CQC) of events and incidents that occurred in the home in accordance with the CQC's statutory notifications procedures.
Ratings from the previous inspection were on display within the home and these were also available for the public to review on the provider website, as required.