Background to this inspection
Updated
16 October 2021
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014. We undertook this inspection as part of a random selection of services rated Good and Outstanding to test the reliability of our new monitoring approach.
Inspection team
The inspection was carried out by one inspector who visited Margaret Court on the 21 September 2021.
Service and service type
This service provides care and support to people living in specialist 'extra care' housing. Extra care housing is purpose-built or adapted single household accommodation in a shared site or building. The accommodation is bought and is the occupant's own home. People's care and housing are provided under separate contractual agreements. CQC does not regulate premises used for extra care housing; this inspection looked at the personal care provided.
The service had a registered manager. This means the registered manager and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection
This inspection was unannounced. Prior to entering the building, we spoke with the registered manager because of the risks associated with COVID-19. This meant we could discuss how to ensure everyone remained safe during the inspection.
What we did before inspection
We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority who work with the service. The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report. We checked for feedback on the Healthwatch website. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England. We used all this information to plan our inspection.
During the inspection
We spoke with two people who received a service to get their experiences about the quality of service. We spoke with one member of care staff and two duty managers. In the report unless specified, we refer to them as staff. We also spoke with the registered manager and a business development manager. We reviewed a range of records. This included examples of three people's care records and examples of medication records. We also looked at two staff recruitment files and records that related to the management and quality assurance of the service, especially around managing risk and care call timings.
After the inspection
We continued to seek clarification from the provider to validate evidence found.
Updated
16 October 2021
About the service
Margaret Court is registered to provide personal care to older people. Care and support was provided to people at prearranged times in a specialist ‘independent living’ service. Margaret Court consists of 44 apartments and six bungalows. People living at Margaret Court own their own home and share on site communal facilities such as a passenger lift, lounges, dining room and the use of an onsite restaurant.
This provider is based at Margaret Court and provides emergency support to everyone living there. Planned day to day personal care can be provided by staff based at this site or from other agencies who provide personal care and support packages. Not everyone living at Margaret Court receives regulated personal care. At the time of this inspection visit, Margaret Court staff supported four people, so we only looked at the care and support for those four people receiving personal care from this provider.
People's experience of using this service and what we found
Systems to learn lessons when things went wrong continued to need improvements.
Audits or checks we would expect to be completed for this type of service, such as medicines, care call logs, daily record checks were not always completed or completed regularly. The systems were not effective and in addition, there was no oversight when checks were delegated to others. There was no evidence the provider undertook any quality assurance checks. The provider had not shared important learnt lessons from other inspections where shortfalls had been identified. At this inspection, similar issues around a lack of effective systems remained as found at the last two inspections.
People’s plans of care guided staff to provide safe care. Staff’s knowledge of how to support people was consistent with what people told us. However, people’s risk assessments required more information to help staff provide consistent support to manage those identified risks. The registered manager assured us this would be addressed. Conversations with staff showed they knew how to manage risk. In some examples, intervention by a GP or occupational therapist had been sought to help keep people safe.
People were complimentary about the service they received. Staff and the provider knew how to keep people safe and protected from abusive practice.
People said staff were kind, caring, gentle and in the majority of cases, always willing to do what was needed. People were cared for by staff who attended training relevant to their roles.
Staff followed infection control procedures in line with national guidance for reducing the spread of COVID-19 when supporting people with personal care.
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; the policies and systems in the service supported this practice.
Staff training was completed and staff said the training they had, helped them to support people.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection and update
The last rating for this service was Good (published 13 September 2019)
Why we inspected
We undertook this inspection as part of a random selection of services rated Good and Outstanding to test the reliability of our new monitoring approach.
Enforcement
We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection.
We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.
We have identified a breach in relation to good governance.
Please see the action we have told the provider to take at the end of this report.
Follow up
We will work alongside the provider and 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.