St Margarets Care Home

We found the following examples of good practice.

Staff made sure that people were protected against the transmission of infection from visitors by scheduling visits, limiting areas that visitors could access and being available to escort visitors. Staff put appropriate actions into place to make sure people would be admitted safely into the service.

The provider had put measures in place to ensure staff cared for the same people to reduce the risk of transmission of infection. The home was clean and staff had increased cleaning of frequently touched surfaces to reduce the risk of transmission of infection.

Staff had enough personal protective equipment, such as masks, gloves and aprons, and had supported people so that they also understood the need for this. Regular COVID-19 testing was carried out to make sure staff could take the correct action to protect people.

The provider made sure staff and the manager received enough support during the pandemic and when additional staff were needed.

Additional risk assessments were completed for staff at increased risk of catching COVID-19 and actions put into place to reduce risks to them.

This unannounced inspection was carried out on 7 September 2017. At the last inspection on 28 October 2016, the service was rated as ‘requires improvement.’ At this inspection we found that the service had continued to make the necessary improvements.

There was a registered manager in post at the time of the inspection. A registered manager is a person who has registered with the Care Quality Commission (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.

Staff assisted people in a way that promoted their safety and people were looked after by staff in a kind and caring manner. Staff encouraged people to make their own choices. People’s privacy and dignity was promoted and maintained by staff.

Staff were knowledgeable of how to report incidents of harm and poor care. Staff were trained to provide effective and safe care. People were supported to take their medicines as prescribed and medicines were managed by staff whose competency had been assessed.

People and their relatives / advocates were involved in the setting up and agreement of their/their family members care plans. People’s care records took account of people’s wishes and any assistance they required. The majority of risks to people who lived at the service were identified and plans were put into place by staff to minimise and monitor these risks. However, not all risks to people had been formally assessed.

People were looked after by enough, suitably qualified staff to support them safely with their individual needs. There was a documented process to determine safe staffing levels in conjunction with people’s assessed dependency needs.

People were supported to eat and drink sufficient amounts of food and fluids. Staff monitored people’s health and well-being needs and acted upon issues identified. Staff supported people to access a range of external health care services where needed and people’s individual health needs were met.

Activities took place at the service; however, some people felt that the number and type of activities taking place could be increased/ improved to enhance social interactions.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Staff enjoyed their work and were supported by the registered and deputy managers. Staff understood their roles and responsibilities and were supported to maintain their skills by way of supervision and appraisal. Pre-employment checks were completed on new staff members before they were deemed to be suitable to look after people living at the service.

The service was responsive and flexible to people’s needs. People maintained contact with their relatives and friends and they were encouraged to visit the service and were made very welcome by staff.

There was an ‘open’ culture within the home. This was because there was a process in place so that people’s concerns and complaints could be listened to and acted upon. Wherever possible, complaints were resolved to the complainants’ satisfaction.

Arrangements were in place to ensure the quality of the service provided for people was regularly monitored. People who lived at the service, their relatives and staff were encouraged to share their views and feedback about the quality of the care and support provided. Actions were taken as a result to drive forward any improvements required.

This unannounced inspection took place on 28 October 2016.

At the last inspection on 17 August 2015 there was a breach of a legal requirement found. After the comprehensive inspection the provider wrote to us to say what they would do to meet the legal requirement in relation to improvements required. Improvements were needed to ensure that robust safety checks were undertaken on all new staff members prior to their employment. The provider sent us an action plan telling us how they would make the required improvements.

During this inspection we found that the provider had made the necessary improvement and all legal requirements were now being met.

The home had a registered manager; however, they were not in post. They had recently applied to voluntarily cancel their registration and were no longer working at the home. The owner of the home was in the process of completing their application to become the new registered manager and was overseeing the running of the home on a day-to-day basis. A registered manager is a person who has registered with the Care Quality Commission (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.

The provider’s recruitment process was followed and this meant that people using the service received care from suitable staff. However, the manager had not followed their CQC action plan in full to ensure that all areas of improvement actions identified at the last inspection had been completed. We found that gaps in a new staff member’s employment history were known but not formally documented.

Although we saw that there was a sufficient number of staff to meet the needs of people living in the home the manager could not provide robust written evidence that the decision making process to determine safe staffing levels, was undertaken in conjunction with people’s assessed dependency levels.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) and report on what we find. We found that there were formal systems in place to assess people’s capacity for decision making. Applications had been made to the authorising agencies for people who needed these safeguards. Staff had a basic understanding of the key legal requirements of the MCA and DoLS.

People who lived at the home were supported by staff in a kind and respectful way. People had individualised care and support plans in place which recorded their care and support needs. The information was up-to-date and correct. Individual risks to people were identified by staff. Plans were put into place to minimise these risks to enable people to live as independent and safe a life as possible. These documents prompted staff on any assistance a person may require. However, monitoring records for people deemed to be at risk of weight loss or dehydration were not always documented in detail by staff. This meant that although people’s risks were identified and minimised by the manager and staff. There was an increased risk that the monitoring kept did not present a complete record.

Arrangements were in place to ensure that people were supported and protected with the safe management of their prescribed medication. Detailed ‘step-by-step’ guidance for staff about ‘as required’ medication was not always kept.

There was an ‘open’ culture within the home. People, their relatives, and visitors were able to raise any suggestions or concerns that they might have with staff and manager and feel listened too.

People were supported to access a range of external health care professionals and were supported to maintain their health. People’s health and nutritional needs were met.

Staff were trained to provide effective care which met people’s individual support and care needs. Staff understood their role and responsibilities to report poor care and suspicions of harm. Staff were supported by the manager to develop their skills and knowledge through regular supervisions, observations and training.

The manager sought feedback about the quality of the service provided from people living at the home. They had in place quality monitoring checks to identify areas of improvement required. However, these checks were not always formally recorded with a robust action plan detailing what action needed to be taken; by whom and by when to evidence that the improvement had been completed.

Notifications are information on important events that happen in the home that the provider is required to notify us about by law. The manager was not aware of all of the important events they needed to notify the Care Quality Commission about.