We carried out a review of the data available to us about St Margarets on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about St Margarets, you can give feedback on this service.
St Margaret’s is a residential care home providing nursing and personal care to 43 people at the time of the inspection. The service can support up to 56 people, some of whom may be living with dementia. All facilities and accommodation are provided on the ground floor.
People’s experience of using this service and what we found
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. A more effective quality assurance system was in place and improvements had been made to the standard of care and consent records.
Systems were in place to investigate accidents and incidents, though records and staff practice did not always evidence what was learnt. We have made a recommendation about the safety of clinical equipment.
The environment was clean. Appropriate processes were mostly in place to prevent the spread of infections, though staff were not screening visitors and surplus decoration and soft furnishings could potentially compromise standards of hygiene. We have made a recommendation about following government guidance in relation to Covid-19.
There were systems in place to safeguard people from the risk of harm and abuse. People received their medicines as prescribed.
People told us they liked the food, and menus provided choices and alternatives. Any concerns regarding nutrition or other health needs were referred to health care professionals.
Staff had access to training, supervision and support. There were enough staff planned for each shift, but the management team struggled to cover some short notice absences. Staff were recruited safely and a recruitment programme was underway.
The home was friendly and welcoming. Works to provide a dedicated visiting room were in progress. The registered and deputy managers promoted a person-centred culture. Staff worked effectively as a team to meet people’s needs and preferences.
For more details, please see the full report which is on the Care Quality Commission website at www.cqc.org.uk
Rating at last inspection
The last rating for this service was requires improvement (report published 27 July 2019).
Why we inspected
We carried out an unannounced comprehensive inspection of this service on 10 and 13 June 2019. A breach of legal requirements was found. The provider completed an action plan after the last inspection to show what they would do and by when to improve the need to consent.
We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the key questions safe, effective and well-led.
We reviewed the information we held about the service. No areas of concern were identified in the other key questions. The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.
We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.
You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for St Margarets on our website at www.cqc.org.uk.
Follow up
We will continue to monitor information we receive about the service until we return to visit as per our reinspection programme. If we receive any concerning information we may inspect sooner.
St Margaret's Care Home is a residential care home providing personal and nursing care to 46 people at the time of the inspection. The service can support up to 56 people.
St Margaret's Care Home accommodates people across three separate units spread over one floor, each of which has separate adapted facilities. One of the units specialises in providing care to people living with dementia
People’s experience of using this service and what we found
People were not supported to have maximum choice and control of their lives. There was inconsistency regarding the application of the Mental capacity Act (2005) MCA. Where people had restrictions in place, information was not recorded in relation to capacity assessments and decisions made in their best interest.
Care plans had been updated but they were not always written in a person-centred way and people’s needs were not clearly identified. This meant that there was not always enough information for staff to meet people’s need’s effectively.
We have made a recommendation about care plans reflecting people’s current needs.
People were safely supported and protected from harm or abuse. Safeguarding systems in place supported this. Staffing levels were safe and new staff were recruited using robust procedures. Management of medicines were safe. Staff learnt lessons after dealing with problems.
Staff were trained to support people with mobility, nutrition and health care, as well as any diagnosed conditions. The premises were designed to meet the needs of the people that used the service.
Staff were kind and caring and knew all the people and their diverse needs. Staff understood their roles clearly and knew what was expected of them. People were treated with respect and dignity, they were also supported to maintain their independence.
Staff provided responsive care, adapting this as people’s needs changed. People and relatives felt their feedback was welcomed and were confident any concerns would be acted on appropriately.
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 requires improvement (published 13 June 2018). The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.
Why we inspected
This was a planned inspection based on the previous rating.
Enforcement.
We have identified a breach in relation to need for consent at this inspection.
Please see the action we have told the provider to take at the end of this report.
Follow up
We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
St Margaret’s 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. St Margaret’s, is a single storey building and accommodates 59 people across three units: Mews, Wybers and Royal. Royal Unit specialises in providing care to people living with dementia. There were also six self-contained bungalows on the site. At the time of our inspection there were 48 people using the service.
The service had a registered manager in post. A registered manager is a person who has registered with CQC 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.
Although staff had a good understanding of the need to gain consent from people prior to carrying out care tasks, we found there was inconsistency regarding the application of the Mental Capacity Act 2005 (MCA). The provider and registered manager had not always followed best practice regarding assessing people’s capacity and discussing and recording decisions made in their best interests, when restrictions were in place. You can see what action we told the provider to take at the back of the full version of the report.
People who used the service had an assessment of their needs, risk assessments and a care plan. There was inconsistency in the care files, with some people having good, informative person centred care plans for specific areas, whilst others contained minimal information to support people’s wishes and preferences for their care. We have made a recommendation about reviewing the care files to address shortfalls.
There was a quality monitoring system in place, which consisted of audits, checks, surveys and meetings. We found aspects of the audit programme were limited and had not been effective in identifying and addressing all the issues highlighted during our inspection. These included shortfalls in care records, including those to support consent and the renewal programme. We have made a recommendation about reviewing the audit programme.
Staff had been recruited safely. There were sufficient numbers of staff on duty at all times and with an appropriate skill mix, to meet people’s assessed needs. Staff had access to induction, training, supervision and support, which enabled them to feel skilled when supporting people who used the service. Staff said they received good support from the management team who were always available to give advice and guidance. A new staff rewards scheme had been introduced.
Risks to people in relation to their needs had been assessed. Staff were confident about how to protect people from harm and what they would do if they had any safeguarding concerns. The registered manager maintained records of accidents and incidents, which gave them an overview of any trends. The safety of the premises and equipment was maintained. The home was clean and tidy during the inspection and staff were seen to follow infection control procedures.
People’s health care needs were met and they had access to community health care professionals when required. The registered manager and staff team had developed good working relationships with health colleagues to support the provision of joined-up care. Arrangements were in place to support people at the end of their life.
People received their medicines safely from trained staff. People who were being cared for in bed were regularly seen by staff to make sure they remained comfortable.
People were treated with kindness, respect and compassion and they were given emotional support when needed. Staff understood the importance of respecting people's human rights, offering choice and promoting independence. The staff we spoke with demonstrated caring values.
People’s nutritional needs were met. However, the full range of snack options wasn’t offered to people during the inspection, which the registered manager confirmed they would follow up. Menus provided people with choices and alternatives. Staff contacted dieticians and speech and language therapists in a timely way when they had concerns.
Feedback from people who used the service and relatives was very positive about the activity programme, which included one-to-one sessions, group activities, entertainers and community trips.
There were systems in place through meetings and surveys to enable people to share their opinion of the service provided and the general facilities at the home. The provider had a complaints policy and procedure and staff knew how to manage complaints. Relatives told us they felt able to raise concerns if required. All nine relatives spoken with described an open culture and accessible management. They were happy with the service their family member received.
St Margret’s provides nursing and residential care for up to 56 people. The service provides support for adults over the age of 18 including older people, people living with dementia and people with a physical disability. At the time of our inspection the service was supporting 46 people, 30 of which required nursing care and 16 required residential support. The service offers various communal lounges, a large open plan dining area, an activity area, kitchen and an enclosed outdoor space which is wheelchair accessible and offers outdoor seating and flower beds. The building is fully accessible to people with mobility difficulties and there is a car parking available on site.
The inspection was unannounced and took place on 29 September and 2 October 2015. The last inspection was completed on 28 August 2013 and the service was compliant in all areas assessed.
The service had 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.
We found that staff understood how to identify sign of possible abuse and knew how to report suspected abuse to the relevant bodies. Staff were recruited safely and appropriate checks were
completed prior to them working with vulnerable people. Staff had good knowledge and understanding of the needs of the people who used the service. People who used the service told us they felt safe.
There were sufficient numbers of staff to safely support people. Staff received supervision, observations of practice and annual appraisals to support their practice. We found people received their medicines as prescribed and staff were appropriately trained with the skills to carry out their role effectively.
People were offered choices of food and drinks and individual dietary needs were catered for and monitored in line with their care plan. People had access to health services when required and the service responded quickly when advice or guidance was needed from other professionals.
People were treated with respect and staff were kind and patient in their approach to people. A range of in house and community based activities were offered by the activities co-ordinators and people were encouraged to participate and get involved.
The service had a complaints policy and welcomed feedback from people living at the service, relatives and staff in order to make improvements and develop.
People who used the service had personalised care plans in place and individual’s likes and dislikes were clearly documented. Risk assessments were in place along with life history, medical conditions and professional contact records. Family and friends were welcome to visit and people living at the service were encouraged to maintain family contact.
A relative we spoke with said, 'They always let me know when there are any changes in him' and went on to say, 'It's a fantastic place, I hope I can come here when the time comes.' A person who used the service said, 'I get the care I need.'
We took a tour of the building and found it to be clean and free form unwanted odours. Some of the bedrooms we saw had stained carpets, we discussed with the manager who said, 'As rooms get redecorated we will be putting down a washable floor covering.'
Appropriate arrangements were in place for the safe ordering, dispensing and disposal of medication. The home had a range of medication policies in place that outlined how to manage medicines effectively.
Staff received appropriate professional development. We saw that care staff had completed training pertinent to their role such as moving and handling, infection control and safeguarding. Further specialised training including PEG fitting, vene puncture and blood glucose monitoring had been completed by members of the registered nursing team.
We observed that people were supported to make choices through their day and that interactions with staff were respectful.
We saw that people were supported to have their needs met through a care planning process and that these documents were regularly reviewed to ensure that staff were aware of the latest needs of the person. One visitor we spoke with told us that the home was 'Excellent' and that the staff were 'Phenomenal'. With another visitor confirming 'Yes X's needs are met, it's not bad at all here.'
Everyone we spoke with felt safe living in the home and staff had undertaken training on the safeguarding of vulnerable people.
We saw that there was a set amount of staff on duty each day and that the manager had a system in place to cover for any staff sickness or holidays.
There was a complaints system in the home and people told us they would raise concerns with the manager.
We saw that the manager completed audits within the home and spoke to people who lived in the home to ensure the home were aware of their views.
The provider sent us information relating to the outcomes of quality surveys completed in January 2011 by people living in the home and/or their representative. This showed that there were high levels of satisfaction with the service provided and with the management of the home.