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Archived: Margaret Allen House Residential Home Requires improvement

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Reports


Inspection carried out on 24 August 2017

During a routine inspection

Margaret Allen House is a residential care home for 15 people, including people living with dementia. There are two floors accessed by a passenger lift and the lounge and dining room are based on the ground floor. An unannounced inspection took place on 24 and 30 August 2017. At the time of the inspection, 15 people were living at the home.

When we visited there was 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 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. However, during our inspection the registered manager was unavailable. The service was being overseen by a senior manager who was assisted by a team leader from another service. Since the inspection, the team leader has been promoted to manager.

After our inspection, we received information from the provider about a safeguarding alert, which was being investigated.

People living at the home were positive about living at the home and said they would recommend it to others. However, some people said they would like more to do to fill their time. People had good relationships with staff and they said staff were usually kind and caring. There had been some changes in the staff team but people mainly described the staff team as stable. Agency staff were being used to supplement the care team until newly recruited staff had completed their induction. People had not been provided with an opportunity to formally provide feedback on the service in the form of a survey. However, they felt informed about changes relating to the service.

The provider had created a Learning and Development Team that had set up an academy induction which starts staff on the Care Certificate. This ensured all newly recruited staff had received mandatory training before arriving on their first shift. This training took 6.5 days. The whole induction process takes six months once the staff member has completed further training on site in the care home. However, staff did not benefit from regular on-going support such as supervision, team meetings and observation of their practice. Staff morale was described by some team members as low, which they said negatively impacted on how the staff group worked as a team.

People were offered a choice of meals. They were supported with their health needs and had access to health professionals, when necessary. They told us staff respected their privacy and dignity. However, there were occasions when some staff practice undermined people’s privacy.

Staff knew how to recognise and respond to allegations of abuse. During the inspection, we shared feedback with the senior manager about concerns regarding staff practice, which a staff member said had not been managed appropriately. Subsequently the senior manager completed an investigation. Staff confirmed they had been spoken to about their practice but records were not found to corroborate this action. After our inspection, the senior manager completed an unannounced spot check visit to the home to monitor staff practice.

Staffing levels were based on a tool to assess the level of people’s care needs. Changes had been made to increase staffing availability at night in recognition of people’s increased needs. Following feedback during the inspection, the senior manager said the way the afternoon and evening shift was run would be reviewed. It had been identified that the staff rota had been poorly managed resulting in a risk of staff working excessive hours; this rota was now being overseen by senior staff to ensure there was an appropriate mix of staff skills and experience.

Quality assurance reports had highlighted improvements were needed in the running of the service. Care records and staff practice were not reviewed regularly to ensure they were meeting the needs of people. Risks to peo

Inspection carried out on 29 April and 6 May 2015

During a routine inspection

An unannounced inspection took place on 29 April and 6 May 2015. It was carried out by one inspector.

At our previous inspection on 25 and 27 June 2014 we found staffing levels needed to be improved. Risks identified for people’s care and welfare also needed to be improved. The registered manager provided us with an action plan to address the compliance actions, which recorded that improvements would be made by September 2014. During this inspection, we judged these issues had been addressed.

Margaret Allen House provides accommodation and 24 hour care for up to15 people. When we visited there was 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.

People living at the home were positive about how the home was run. Their feedback was sought and suggestions were acted upon. Staff were kind and caring; people’s privacy and dignity was promoted. Staff were knowledgeable about people’s individual needs. Staff had received appropriate training and supervision to ensure they could carry out their job safely and effectively. Staffing levels met people’s needs and the registered manager worked with commissioners to increase them when people needed additional support.

People’s safety and well-being was promoted and there were risk assessments in place to try and reduce potential harm to people. Care plans and staff practice was reviewed regularly to ensure they were meeting the needs of people. Medicines were managed safely and people received their medicines appropriately. Staff knew how to recognise and respond to allegations of abuse.

People were offered a choice of food in accordance with their dietary needs. Staff were knowledgeable about people’s dietary requirements. People had access to activities that complemented their interests. There were links with the outside community.

The home was well-run by a committed registered manager who supported her staff team and knew the people living at the home well. The registered manager provided a positive role model to provide person centred care; she valued people’s individual histories and understood how care needed to be tailored to recognise their chosen lifestyles. There were robust systems in place to ensure the registered manager could monitor that the staff group were providing a safe and responsive care. People living at the home had the opportunity to influence the way the service was run.

The Care Quality Commission (CQC) is required to monitor the operation of the Mental Capacity Act (2005) (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are put in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way, usually to protect themselves or others. At the time of the inspection no applications had been made to the local authority in relation to people who lived at the service. But the registered manager was clear when this application would be applicable.

Inspection carried out on 25, 27 June 2014

During a routine inspection

The inspection was unannounced and took place over two days. We spent approximately ten hours at Margaret Allen House. There were 13 people living at the home and we spoke with nine people about their experiences. We also met with the registered manager and their line manager, one relative and spoke with two staff members. After the inspection, we also spoke with a health professional who regularly visited the home.

Is the service safe?

The service was safe because improvements had been made to the management of medication. The registered manager recognised their responsibility to ensure equipment was well maintained and safe. However, we had some concerns around the management of identified risks to people's health and well-being. For example, the quality of records, relating to hydration and pressure area care, needed to be improved to show these risks were being managed to ensure people�s safety and well-being. CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have needed to be submitted, the registered manager understood when an application should be made, and how to submit one.

Is the service effective?

People living at the home told us they were happy with the care at the home. People's health and care needs were assessed, and people were happy with the quality of their care. People living at Margaret Allen House told us there were residents� meeting, and said they generally felt listened to by staff, although their request for social activities to be increased had not been effectively addressed. People told us there was not enough to do and people said they were bored.

Is the service caring?

People were treated with respect and their dignity was maintained by the staff. People were supported by caring staff. People�s opinions were sought by staff and people told us they felt listened to at residents� meetings. Our conversations with the registered manager and care staff demonstrated they were caring and committed to their role to provide good quality care.

Is the service responsive?

We looked at people's care plans and we saw the management team generally contacted health and social professionals appropriately when people's needs changed. However, there were delays to address areas of improvement identified by the provider as resources were not always provided to make the improvements occur in a timely manner.

Is the service well-led?

We could see steps had been taken to address performance issues for some staff to help them develop their skills. There were quality assurance processes in place to monitor the quality of the service for people living at the home.

Inspection carried out on 7 October 2013

During a routine inspection

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time. There was a new manager in post who was not yet registered with the Commission.

There were 15 people living at the home on the day of our visit.

We spent time with all of the people living in the home and spoke more meaningfully with ten of the people. We spoke with five members of staff.

The home had a homely, friendly and respectful atmosphere. People told us "we are looked after properly" and "I can't fault anything".

Staff knew all the people's needs at the home well. Each person had a care file which contained all the information needed to meet their care needs fully.

People received nutritious, appealing and home cooked meals and were very complimentary of the food. Comments included "love the food", "cooking is good" and "it's (the food) very nice".

Staff demonstrated that they understood the signs of abuse and how to report any concerns. The home was aware of the process to follow in cases of suspected abuse.

People at the home told us that they did not have any complaints but that if they did they would speak to the manager.

We looked at the handling of medicines in the home and saw that these were not always being recorded accurately or safely.

Inspection carried out on 12 March 2013

During a routine inspection

One person who used the service told us: "They always knock on my door and they respect my privacy. They would always say is that alright before they did anything. I'm fully aware of the care they give me and have signed consent forms".

Staff we spoke with were able to show a good understanding of the importance of determining if a person had the capacity to give consent to their care and treatment. We observed people being treated compassionately with their individual needs considered.

There was a relaxed atmosphere where people looked well cared for and were seen to be comfortable and at home in the environment. One person told us: "I'm very contented here, the staff are excellent". Another person who used the service told us: "I think it is really, really good here, the food is excellent and the staff are wonderful".

We were shown around the home by staff, decoration and carpets in some rooms appeared tired and stained. Hallways were clean without obstructions. Furniture was clean and functional.

We were also told: "I really enjoy working here and feel very supported by the senior carers". Each staff member told us they enjoyed their work and this was evident from the observations we made.

We were shown a comments book and a complaints book kept in the reception area, which any relative or visitor could document any complaints or concerns. No complaints had been recorded.

Inspection carried out on 25 April 2012

During a routine inspection

We made an unannounced visit to Margaret Allen House on 21 February 2012. On the day we visited 14 people were living at the service. All were female and older people. We �pathway tracked� four of the people who were living at the home. This means that we spent time talking with them about their experiences of living at Margaret Allen House and we looked at records the staff had completed about them and we spoke with duty staff who were supporting them with their care needs.

The people we spoke with were positive about their experiences of living at the home. They told us they were treated well by kind staff. They also said they could raise concerns to any of the staff team in the knowledge that their concerns would be treated seriously and acted upon. They told us that the environment was kept clean and although food choices were, at times, limited, the kitchen staff endeavoured to make individual meals for them that they liked.

We found the provider was currently making improvements to the environment, working to strengthen the permanent staffing team and acting to improve record keeping. These processes are not yet complete. However, we are satisfied that progress against self-imposed targets for improvements was being monitored by the provider�s senior management team.

We have asked for improvements to be made with regard to care records and weekend staffing levels. This is to ensure that people receive individual care based on detailed assessment of and monitoring of needs and that the care workers have time to spend supporting people with social or recreational needs at weekends.

Reports under our old system of regulation (including those from before CQC was created)