Archived: Margaret House

Margaret House is a purpose-built residential care home providing personal care to 50 people at the time of the inspection. The service can support up to 51 people. The home has five units which are referred to as bungalows.

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

People were happy with the care and support they received. Staff were kind, friendly and attentive to people’s needs. People gave mixed views about if there were enough staff to meet their needs. Staff also felt more staff were needed to give people more attention. Staff were trained and felt supported.

People felt safe and staff were aware of how to promote people’s safety. Regular checks were in place to ensure staff worked in accordance with training and health and safety guidance was adhered to. However, some areas needed clarity and better communication, for example, to ensure all staff were aware of people’s recorded risks relating to choking and how to transfer a person safely in a wheelchair. This was completed on the day of inspection.

There were governance systems in place and these were used effectively in most cases. However, these had not identified all issues in relation to medicines at care team level. Feedback about the registered manager, and management team was positive. There was an open culture in the home and an expectation that people were supported in a person-centred way. Staff were clear about their roles and the management team positively engaged with the team and other agencies.

The environment was being developed to make it more homely with dementia care in mind, some areas had been completed. This included signage and items to stimulate people's minds and interests. There was plenty of communal space for people to enjoy, and people could walk through the whole house freely. People enjoyed the activities that were provided, however staff told us that they would like more time to support people in their rooms or those who don’t come off of their individual bungalows with activities.

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 knew people well and worked in a way that promoted people’s preferences and wishes.

People were involved in planning their care and they, along with their relatives. The management team were working on ways to better capture people’s involvement. People had end of life care plans which were going to be further developed. Complaints were responded to appropriately and people felt confident to make a complaint if needed. Feedback was sought through meetings and the registered manager speaking with people and relatives.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

The last rating for this service was Requires Improvement (published 28 November 2018). At this inspection the service has improved to Good.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Margaret House provides care and support to up to 51 people some of who live with dementia. At the time of our inspection 49 people were living at the service. The home is split across five self-contained bungalows, each with its own communal areas and kitchenette.

At our last inspection on 05 November 2015 we rated the service good. At this unannounced inspection we found evidence that demonstrated concerns. These were in relation to management of risks to people’s safety, staff deployment, inaccurate completion of care records and governance of the service. The overall rating for the service has changed to requires improvement.

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.

People felt safe at the service, staff had received relevant training on how to safeguard people and understood their responsibilities to report any concerns. However, risks to people’s safety and well-being were identified but not always managed to keep them safe from harm. People were not always supported by sufficient numbers of staff on one specific unit. Relevant pre-employment checks had been completed for all staff and safe recruitment practices followed. Medicines were stored appropriately, and administered to people as the prescriber intended, managed safely and audits completed. People lived in a clean and hygienic environment and were cared for by staff who followed robust infection control procedures.

People felt staff were well trained. Staff had attended relevant training to undertake their role and spoke positively about the training they were provided. Staff felt supported and attended regular supervisions and appraisals. The registered manager was in the process of reviewing people’s consent. However, staff were aware of how to support those people who may not be able to provide their consent. People’s nutritional needs were met and responded to when people were at risk of weight loss. The environment of the home was in need of redecoration and a plan was in place to address this.

People told us that staff were friendly and respected their privacy. Staff knew people well and were knowledgeable about people’s individual needs. People felt staff knew what was important to them and knew how people chose to spend their day. People's privacy and dignity was promoted.

People’s received care that responded to their individual choices and promoted their independence. People and their relatives were involved in planning how their, their family members support would be delivered. Staff were aware of people's choices and preferences and delivered care accordingly. Care records were in the process of being reviewed, however staff were aware of people’s current needs. People were able to have visitors without restriction and able to see them in privacy. People were encouraged to provide feedback on the service they received and knew how to make a complaint.

Although being reviewed, we found people’s care records were not always updated in a timely manner when people’s needs changed. Audits completed by the registered manager and provider did not identify the issues with people’s care records and consent documentation. The registered manager had not delivered the improvements they told us about in their annual improvement plan. People were aware of who the registered manager was and felt they were visible and approachable. Staff were encouraged to attend team meetings which were held regularly. People’s feedback was used to improve the quality of care they received. Notifications required to be sent to us were made in a timely manner.

People told us that there had been a number of managers in the past year and that this had been unsettling and that they were glad that there was a new manager. All of the people we spoke with were happy with the new manager. The staff said that they felt appreciated and that she was a good manager who lead by skill and experience. They told us that she was easy to talk to and that she knew all the residents although she had only been in post for two weeks.

Visitors said that the new manager was easy to talk to and that they were happy with how their relative was cared for. They said that they had confidence in the home and that they were informed if there was a problem.

We visited the home in August 2012 and found that the outcomes in relation to Care and Welfare of People, Nutrition, Medication, Staffing, and Quality Assurance were not met. On this visit we found that progress had been made on all outcomes, with the exception of Quality Assurance. We found that the home did not have effective leadership.

We found that the staff knew the people well and were able to meet their needs. We observed staff deliver care in a manner that was kind and compassionate. People's nutritional needs were recognised and met. Medication was administered and stored appropriately. There were sufficient numbers of staff on duty but they were not deployed in the best interests of the people. We saw that this meant that some people were waiting an unnecessary amount of time for their breakfast.