Archived: St Margarets Residential Care Home

Updated 18 November 2017

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014. This inspection was also carried out to check whether improvements had been made from the October 2016 inspection.

This inspection took place on 14 and 22 March 2017 and was unannounced. It was conducted by one inspector and an expert by experience in dementia. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Before the inspection, we reviewed the information we held about the service including previous inspection reports and notifications. A notification is information about important events which the service is required to send us by law.

We spoke with five people living at the home, a family member, a doctor who had regular contact with the home and a visiting care worker from another company who supported a person on a one-to-one basis. We spoke with the registered manager, two ‘managers’ who were in day to day charge of the service, the head of care and four care staff. Following the inspection we received feedback from a social care practitioner from the local safeguarding and quality team.

We looked at the care plans and related records of care provided for five people. We also looked at staff training records, staff recruitment files, duty rosters, records of complaints, accident and incident records, and quality assurance records.

We observed care and support being delivered in communal areas of the home. We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

Updated 18 November 2017

This inspection took place on 14 and 22 March 2017 and was unannounced. St Margarets Residential Care Home provides accommodation for up to 18 people, including people living with dementia care needs. There were 12 people living at the home when we visited. The home is based on two floors, connected by a stairway with a stair lift. Three bedrooms are shared double rooms and 12 bedrooms are for single occupancy.

The provider is registered as a partnership. However, following the death of one of the two partners, an application has been made to CQC to re-register the service as a new partnership. This process was still in progress at the time of this inspection.

The home 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.

At our previous inspection on 11 October 2016, we identified breaches of eight regulations. We issued warning notices requiring the provider to become compliant with regulations relating to consent to care and good governance by 10 January 2017. We also issued requirement notices requiring the provider to take action in relation to the registration of the service; person-centred care; safe care and treatment; staffing; openness and transparency; and the display of their performance rating.

At this inspection, we found some improvements had been made, but further improvement was required.

The provider had not met the requirements of the two warning notices we issued. They had not completed assessments of people’s capacity to make decisions or recorded decisions they had made on behalf of people. However, they had provided additional training to enable staff to do this.

The provider had not put an effective system in place to assess, monitor and improve the quality of the service overall. However, some individual issues highlighted in our warning notice relating to good governance had been addressed; for example, fire safety checks had been completed and action had been taken to meet the needs of people with diabetes.

Two issues we identified at the last inspection, relating to the security of medicines and the care of a person with a catheter (a device used to drain a person’s bladder through a flexible tube linked to an external bag) were only addressed during the inspection, after we raised them for a second time.

Individual risks to people were not always managed safely. Risk assessments had been completed for some, but not all the people who were potentially at risk of pressure injuries; and a person’s risk assessments was not reviewed when they experienced multiple falls. However, environmental risks were managed appropriately.

People told us they felt safe and staff knew how to identify, prevent and report incidents of abuse, although not all staff had attended refresher training in safeguarding, in accordance with the provider’s policy.

Medicines were not always managed safely. Checks of the competency and understanding of staff who administered medicines had not been completed.

There was no clear induction process in place to ensure that new staff were sufficiently competent to work alone. Experienced staff had completed additional training, although their training workbooks had not been marked to confirm that they had understood the training.

Managers had started to conduct appraisals with some staff, but staff did not have access to regular sessions of supervision. While most staff said they felt supported by their managers, some staff felt communication could be improved to ensure information about people’s well-being was shared effectively. They also felt the registered manager was not sufficiently visible around the home to provide the necessary guidance and direction.

People were satisfied with the quality of the food; although some people did not receive consistent support to make sure they ate and drank enough. Staff monitored people’s weight and took action if there was unplanned weight loss.

Some staff did not actively listen to people or treat them with consideration. However, most people told us staff were kind and caring and we observed some positive interactions between people and staff.

Activities were limited to an hour a day and were not run consistently, although the home was involved in an initiative with a school and people enjoyed interacting with pupils who visited.

There were enough staff to meet people’s essential care needs and recruitment processes helped ensure only suitable staff were employed.

Staff protected people’s privacy and dignity, including when they provided personal care, and confidential information was kept secure. People were encouraged to remain as independent as possible.

People were encouraged to make as many choices as possible about their day-to-day lives. They were supported to access healthcare services when needed and were involved in planning the care they received. The registered manager sought and acted on feedback from people.

Staff were more positive about the service than at our last inspection. They had been given enhanced roles and responsibilities, which the registered manager assured us would be “meaningful”.

We identified three breaches of regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have taken at the back of the full version of the report.

The overall rating for this service is ‘Requires improvement’. However, we are placing the service in 'special measures'. We do this when services have been rated as 'Inadequate' in any key question over two consecutive comprehensive inspections. The ‘Inadequate’ rating does not need to be in the same question at each of these inspections for us to place services in special measures.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.