St. Margarets Residential Home

St. Margarets Residential Home, is a care home providing personal care and accommodation for up to 22 older people in one adapted building. At the time of our inspection there were 21 people using the service.

People’s experience of using this service and what we found

There were systems in place to understand and address the quality and safety issues within the service. The quality assurance system and processes covered aspects such as care plans and care records, medicines management, DoLS authorisations and renewals, night visits, call bells, incident and accidents, staff records, health and safety, and the premises. Regular staff, relatives and residents' meetings were held, and feedback was also sought from people about the service. Staff were complimentary about the manager, the registered manager and the home. The provider worked in partnership with health and social care professionals to ensure people's needs were planned and met. However, some aspects of the quality assurance system and process were not effective to mitigate risks in a timely way.

People and their relatives told us they felt safe. People were safeguarded from the risk of abuse. Staff had received safeguarding training and knew the actions to take to report abuse. Medicines were stored, administered, managed safely and accurate records were maintained. There were enough staff available to support people safely. People were protected from the risk of infection. The provider had a system to manage accidents and incidents.

Staff were supported through regular training and supervisions, so they were able to effectively carry out their roles. People's needs were assessed to ensure they could be met. 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 told us they asked for people's consent before offering support. People were supported to have enough to eat and drink and had access to healthcare professionals when required to maintain good health.

People and their relatives told us staff were caring, considerate and respected their privacy, dignity, and independence. They said staff involved them in making decisions about their daily care and support requirements.

People's care plans were reflective of their individual care needs and preferences and were reviewed on a regular basis. People and their relatives were aware of the home's complaints procedures and knew how to raise a complaint. People's cultural needs and religious beliefs were recorded, and they were supported to meet their individual needs. Where appropriate people had their end-of-life care wishes recorded in care plans.

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 good (published 22 July 2021).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

Enforcement and recommendations

We made 1 recommendation about improving quality assurance system and processes in good governance.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

St. Margaret’s Residential Home is a residential care home providing personal care to people aged 65 and over. The service can support up to 22 people. At the time of the inspection 19 people were using the service.

People’s experience of using this service and what we found

People told us they felt safe. There were safeguarding policies and procedures in place and staff had a clear understanding of these procedures. Appropriate recruitment checks took place before staff started work and there were enough staff available to meet people’s care and support needs. Risks to people were assessed and staff were aware of the action to take to minimise risks where they had been identified. Medicines were managed safely. The service had procedures in place to reduce the risk of infections and COVID 19.

There were effective systems in place to regularly assess and monitor the quality of service that people received. The provider took people’s views into account through satisfaction surveys and spot checks and feedback from these was used to improve the service. Staff said they received good support from the manager. The manager and staff worked well with health and social care providers to drive improvement and to deliver an effective service. Health and social care professionals commented positively about the leadership at the home.

Rating at last inspection. At the inspection (published 23 September 2020) the key question safe was rated as inadequate and well led was rated requires improvement. We served a Warning Notice in relation to Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We carried out an inspection (published 1 December 2020) to check whether the Warning Notice had been met. At that inspection we found enough improvement had been made in relation to parts of the warning notice. However not enough improvement had been made in relation to assessing risk, safety monitoring and management and the provider was still in breach of regulation 12.

At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

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 COVID-19 and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for St. Margaret’s Residential Home on our website at www.cqc.org.uk.

St. Margarets Residential Home is a residential care home providing personal care to 19 people aged 65 and over at the time of the inspection. The service can support up to 22 people.

People’s experience of using this service and what we found

Some risks relating to people’s care and support were not fully assessed. Risks in relation to fire, were safely managed.

People received their medicines as prescribed. The service was clean and on the whole staff adhered to government guidance on infection prevention and control. We have made a recommendation in relation to following government guidance on new admissions to care homes.

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 requires improvement (published 24 September 2020). At this inspection we found improvements had been made but the provider was still in breach of regulations.

Why we inspected

We undertook this targeted inspection to check whether the Warning Notice we previously served in relation to Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. The overall rating for the service has not changed following this targeted inspection and remains requires improvement.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

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 Residential Home on our website at www.cqc.org.uk.

Enforcement

We have identified a breach in relation to risk management.

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 COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. 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.

People’s experience of using this service and what we found

The service was not always safe and there was a lack of understanding regarding safe infection control procedures. Staff and the manager were not following government guidance issued as part of the COVID-19 pandemic, regarding social distancing, or wearing appropriate protective equipment such as masks.

Risks relating to people’s care and support were not fully assessed and there was a lack of guidance for staff regarding key areas of people’s healthcare needs such as epilepsy, diabetes and stoma care. Medicines were not always managed safely and were not always administered in line with the prescriber’s instructions.

The environment was not always safe, as key risks in relation to fire were not fully mitigated. A fire door was unable to close as a stair gate was in the doorway and hallways were not kept free of combustible materials.

Staff were not always recruited safely. Full work histories had not always been gathered and references were not always verified. Some staff had criminal records checks, and these had not been risk assessed for possible risks to people safety.

There appeared to be enough staff to keep people safe, however, we have made recommendation regarding how to formally assess the number of staff needed at the service.

The long standing registered manager at the service had recently left and the new deputy manager was acting as manager at our inspection. Whilst they were receptive to our feedback and acted quickly to make changes neither they nor the provider had identified the serious concerns we found during this inspection.

Safeguarding procedures were adhered to and we saw positive feedback from a relative following a recent request for feedback. Notifications had been submitted to CQC when required.

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 good (published 19 July 2018.)

Why we inspected

This was planned as a targeted inspection looking at the infection control and prevention measures the provider has in place. As part of CQC’s response to the coronavirus pandemic we are conducting a thematic review of infection control and prevention measures in care homes. This inspection took place on 21 August 2020 and was announced. The service was invited to take part in this thematic review which is seeking to identify examples of good practice in infection prevention and control.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

We inspected and found there was a concern with infection control so we widened the scope of the inspection to become a focused inspection which included the key questions of safe and well-led.

The ratings from the previous comprehensive inspection for the key questions effective, caring and responsive were not looked at on this occasion so were used in calculating the overall rating at this inspection. The overall rating for the service has now changed from good to requires Improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for St. Margarets Residential Home on our website at www.cqc.org.uk.

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 COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and 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 breaches in relation to risk management, infection control, medicines, recruitment and good governance.

Please see the action we have told the provider to take at the end of this report.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. 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.

People’s experience of using this service

Risks to people were managed to reduce harm to them and to promote their health and safety. People were safeguarded from the risk of abuse. Incidents and accidents were reviewed, and actions taken to reduce the risk of them happening again. People’s medicines were administered and managed safely. There were enough staff available to support people. Staff were trained in infection control and followed procedures to reduce risks of infection.

People’s needs were assessed in line with best practice guidance. People had nutritious food and were supported to eat and drink enough to maintain good health. Staff received training, support and supervision to deliver their roles. People had access to healthcare services they needed to maintain good health; and staff liaised effectively with other services.

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. People’s consent was sought for the care and support they received.

The service complied with the requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). Relatives and healthcare professionals were involved in making decisions for people in their best interests where this was appropriate.

Staff were kind and compassionate to people. People were involved in their care delivery. People were treated with respect and dignity, and their independence promoted. People received care and support tailored to their individual needs and preferences. People’s end-of-life wishes were documented in their care plans. People were supported and encouraged to participate in activities they enjoyed.

People and their relatives told us the service was well run. People and their relatives knew how to raise concerns about the service. The registered manager addressed any complaints they received appropriately. The provider worked in partnership with other organisations and services to develop and improve the service. The service had effective systems to monitor the quality and safety of the service.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for St. Margaret’s Residential Home on our website at www.cqc.org.uk.

Rating at last inspection and follow up:

The last rating for this service was requires improvement (published 11 May 2018) and there were two breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations. At this inspection the service was now rated Good overall.

Why we inspected: This was a planned inspection based on the previous rating of the service.

This unannounced inspection took place on 27 March 2018. At our last inspection of 10 February 2017, there was a breach of regulation relating to staff recruitment. The recruitment practices were not robust and safe. The provider sent us an action plan on how they would improve. At this inspection we found that the service had made the required improvement in this area. Recruitment practices were safe. Appropriate checks took place to ensure only suitable and staff deemed fit were recruited to work with people. However, we found two breaches of regulations of the Health and Social Care Act 2008. People’s care and support was not person - centred and planned in a way that catered for their individual needs and requirements. The systems in place for assessing and monitoring the service were not robust and failed to identify the issues we found during this inspection. Information about people was not always clearly documented. The service obtained the views of people and their relatives but did not develop plans to make improvements following feedback received.

The service had a registered manager who had worked at the service for several years. 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’s medicines were managed and stored in line with safe medicine administration and management guidelines. Medicines were administered as prescribed. Medicines records were completed as required.

Risks to people were assessed and management plans were available for staff on how to keep people safe from danger and to reduce risks to them. People and their relatives were involved in their care. Care plans were reviewed and updated as required. People’s nutritional needs and dietary requirements were met

Staff were trained on safeguarding adults from abuse. They understood signs of abuse and how to report it in order to protect people. There were sufficient staff available and deployed properly to meet people’s needs. Staff received training, support and supervision in their roles. People had access to healthcare services they needed to maintain good health. The service ensured people received consistent care when they moved between services.

The provider maintained health and safety systems, and carried out regular checks to ensure the environment continued to be safe. Staff were trained in infection control and knew the procedures to reduce risks of infection. Records of incidents and accidents were maintained, and actions were put in place to reduce chances of incidents from happening again. People had equipment and adaptations such as grab rails they needed.

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. People gave consent to the care and support they received. The service assessed people’s capacity as required by the Mental Capacity Act 2005 (MCA) and obtained the Deprivation of Liberty Safeguards (DoLS) authorisation to ensure people were not unlawfully restricted. Relatives and healthcare professionals were involved in making decisions for people in their best interests where this was appropriate.

Staff were kind and compassionate to people. They provided people with reassurance and comfort when needed, and treated them respectfully, maintaining their independence and dignity. Staff were trained in end-of-life care. People’s end-of-life wishes were documented in their care plans, to ensure these were implemented appropriately. People were also encouraged to participate in activities they enjoyed. Staff had received equality and diversity training and respected people’s differences and individuality.

The provider had procedures in place for managing complaints, and people and relatives knew how to raise concerns. The registered manager and provider worked in partnership with other organisations and services to develop and improve the service.

St Margaret's residential home provides accommodation and personal care support for up to twenty two older people, some of which are living with dementia. The home is situated in a residential area of Sidcup Kent and is spread out over two floors. At the time of our inspection there were 19 people using the service. There was a registered manager in post at the time of our inspection. 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 this inspection we found the provider had made the required improvements and systems in place to ensure the proper and safe management of medicines were robust. However at this inspection we found a new breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the provider to take at the back of the full version of the report.

The provider failed to ensure there were safe staff recruitment practices in place. Some systems to monitor the quality of service delivery were not always conducted in line with the providers schedule and did not always identify issues that required attention.

Risks to the health and safety of people were assessed and reviewed in line with the provider's policy. Medicines were managed, administered and stored safely. There were arrangements in place to deal with foreseeable emergencies and there were safeguarding adult’s policies and procedures in place. Accidents and incidents were recorded and acted on appropriately. There were appropriate numbers of staff to meet people’s needs.

Staff new to the home were inducted into the service appropriately and staff received training, supervision and appraisals. There were systems in place which ensured the service complied with the Mental Capacity Act 2005 (MCA 2005). This provides protection for people who do not have capacity to make decisions for themselves. People’s nutritional needs and preferences were met and people had access to health and social care professionals when required.

People were treated with kindness and respect and their support needs and risks were identified, assessed and documented within their care plan. People were provided with information on how to make a complaint. People using the service and their relatives were asked for their views about the service.

St Margaret's residential home provides accommodation and personal care support for up to twenty two older people, some of which are living with dementia. The home is situated in a residential area of Sidcup Kent and is spread out over two floors.

At this inspection we found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

The provider failed to ensure the proper and safe management of medicines. Procedures and systems in place to evaluate and monitor the quality of the service provided were not always effective in ensuring the quality of care people received.

There were safeguarding adult’s policies and procedures in place to protect people from harm and incidents and accidents were recorded and acted on appropriately. Assessments were conducted to assess levels of risk to people’s physical and mental health and care plans contained guidance for staff to ensure people were kept safe by minimising assessed risks.

There were safe recruitment practices in place and appropriate recruitment checks were conducted before staff started work. There were appropriate levels of staff on duty and deployed throughout the home to meet people’s needs.

There were arrangements in place to deal with foreseeable emergencies and there were systems in place to monitor the safety of the premises and equipment used within the home. People were supported by staff that had appropriate skills and knowledge to meet their needs and staff received supervision and annual appraisal of their performance.

Staff demonstrated good knowledge and understanding of the MCA and the Deprivation of Liberty Safeguards (DoLS) including people’s right to make informed decisions independently but where necessary to act in someone’s best interests.

People were supported to eat and drink suitable healthy foods and received sufficient amounts to meet their needs and ensure well-being. People had access to health and social care professionals when required.

Interactions between staff and people using the service were positive and staff had developed good relationships with people. Care plans demonstrated people’s involvement in their care.

Staff were knowledgeable about people's needs with regards to their disability, race, religion, sexual orientation and gender and supported people appropriately to meet their identified needs and wishes.

People received care and treatment in accordance with their identified needs and wishes. Detailed assessments of people’s needs were completed and reviewed in line with the provider’s policy. People were supported to engage in a range of activities that met their needs and reflected their interests.

People and their relatives told us they knew who to speak with if they had any concerns. There was a complaints policy and procedure in place and complaints were managed appropriately.

The manager was knowledgeable about the requirements of being a registered manager and their responsibilities with regard to the Health and Social Care Act 2014. The provider took account of the views of people using the service and their relatives through annual residents and relative’s surveys.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with staff and from examining records. If you want to see the detailed evidence supporting our summary please read the full report.

At the time of our inspection there were 19 people residing at St Margaret's residential home. We used different methods to help us understand the experiences of people who use the service as not everyone who lived at the home was able to communicate verbally with us in a significant way. We used our Short Observational Framework for Inspection (SOFI) tool. SOFI is a specific way of observing care provided which helps us to understand the experiences of people who could not talk with us.

Is the service caring?

We observed that people using the service were free to access all areas of the home, for example some people were sitting in the garden enjoying the good weather, some people were sitting in the smaller quiet lounge reading and others were participating in group activities. People we spoke with told us they were happy with the care and support received. One person told us 'I like living here, it's my home and I can do as I want. Staff are very supportive and will help me to venture outside'.

During lunchtime we undertook a SOFI (Short Observational Framework for Inspection) in the main dining room of the home. We used our SOFI tool which helps us to see what people's experiences at mealtimes were. We found that overall people had positive experiences. Staff members supporting people with their lunch knew what support they needed. We saw that people were assisted to the dining room and supported with their choice of meal and drink. We observed that people were spoken to respectfully.

Is the service responsive?

People expressed their views and were involved in making decisions about their care and treatment. People who use the service were given appropriate information about the home and understood the care and support choices available to them. People using the service who we spoke with told us they were very much a part of the planning of their care and daily activities. One person told us 'All the staff are great. I have a keyworker and they know me well. They know what I like and what I don't like and how to support me'.

Arrangements were in place to provide people with opportunities to engage in social and leisure activities in and out of the home's environment. We met with the activities co-ordinator for the home. We saw that they had introduced a range of meaningful activities that people could participate in. The current activities programme we looked at included a range of activities such as arts and crafts, hair and beauty treatments, stretch and move exercise classes, quizzes and one to one time with a member of staff venturing outside of the home to participate in activities such as shopping or attending a local club. We spoke with the activities co-ordinator who told us that people using the service each had an activities profile. This recoded people's preferences for their pastimes including how these needs could be met and risks identified in doing so.

Is the service safe?

People who used the service told us they felt safe and well supported. One person said, "The staff are very helpful. If I need them, I press my buzzer and staff will come'. Another person told us "They always check on us during the night to make sure we are alright'. Relatives of people using the service told us they were happy with the care and support provided and felt assured that their loved ones were safe. One person told us 'I am aware of who to speak with or how to complain, however I have never needed to. I am very happy with the service'.

Is the service effective?

We saw people's wishes and choices being respected by staff in a kind and caring manner. Staff addressed people respectfully when talking with them and used people's preferred names. We saw that staff offered people a choice of how they wanted to spend their time, for example, if they wanted to watch television, listen to music or read and what people's choices were in relation to the homes daily food and drinks menu.

We examined the homes training matrix and training plan they had developed and put in place to address the gaps in staff training. There was recorded evidence that staff training was taking place and training sourced by the provider was detailed and appropriate in content. In addition we saw that there were reference documents on display around the home on various health and social care key topics. This enabled staff to refresh their memories. We looked at a sample of staffing records and saw certificated evidence of training undertaken by the staffing team. We saw that members of staff had been provided with frequent supervision which was well documented and had an annual appraisal.

Is the service well-led?

People who use the service were asked for their views about the care and treatment provided and they were acted on. We found that there were robust systems in place to monitor the quality and safety of the service provided. These included seeking the opinion of people using the service and their relatives and gaining feedback from visiting professionals. The opinions of people using the service were gathered through a survey that took place on an annual basis. In between these times, people living in the home were able to attend residents meetings that took place every few months.

People we spoke with were aware of the home's complaints procedure and said they knew they could speak with a member of staff or the manager if they had any concerns. One person told us 'I have no complaints at all, however if I did I know who to speak with'. The service had a clear procedure for dealing with complaints and a whistle blowing policy that all staff were aware of.

People's needs were assessed and care was planned and regularly reviewed, and the majority of care plans reflected people's needs and the care provided. The provider had made sufficient improvements to staff training to ensure staff were appropriately trained to deliver the care people required safely and the provider had completed a satisfaction survey since our last inspection. The remedial work from the fire risk assessment had been completed.

People told us that staff were very good and they enjoyed living at the home and the care was good. People told us that the food was very good and one person said 'there's always enough to eat and the cook always makes a cake for afternoon tea'. took time to ask how they liked things like personal care to be done and encouraged them to do as much independently as possible. People said that they enjoyed using the computer but staff were not always available to help them and there wasn't always enough to do. People told us that they felt staff responded in a timely manner to call bells and that they did not have to waited for assistance. Some people we spoke with were aware that the provider carried out reviews of their care.

People's needs were assessed and care was planned and regularly reviewed, however sometimes care plans did not reflect the care provided. People's medication arrangements matched their care plan and we found staff administered medicines safely and in a timely polite manner. However, the provider had not made sufficient improvements to staff training to ensure staff were appropriately trained to deliver the care people required safely and some quality assurance processess such as satisfaction surveys could not be evidenced. Some fire risk assessment actions remained outstanding from April 2012.