Margaret Roper House

Updated 11 January 2024

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 Health and Social Care Act 2008.

Inspection team

The inspection was carried out by 1 inspector and 2 medicines inspectors.

Service and service type

Margaret Roper House is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Margaret Roper House is a care home with nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was not a registered manager in post.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and other professionals who work with the service. The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke with the interim manager, the director of quality, a clinical nurse, as well as other members of the staff team including a domestic, chef and the administrator. We also spoke with 5 people who used the service about their experience of the care provided.

We reviewed a range of records. This included 5 people's care records and a range of people’s medication records. We looked at 3 staff files in relation to safe recruitment. A variety of records relating to the management of the service, including audits, were also reviewed.

After the inspection

We continued to seek clarification from the provider to validate evidence found. We looked at staff training and quality assurance records. We spoke with the nominated individual (the nominated individual is responsible for supervising the management of the service on behalf of the provider) over the telephone who shared their action plan to address the concerns found at our inspection. We also spoke with 3 members of care staff on the telephone.

Updated 11 January 2024

About the service

Margaret Roper House is a residential care home providing personal and nursing care to up to 23 people. The service provides support to younger and older adults living with mental health conditions. At the time of our inspection there were 22 people using the service.

The service was purpose built and accommodation was over 2 floors. People had access to a communal lounge and kitchenette on each floor, in addition to a dining room and conservatory located on the ground floor.

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

People living at Margaret Roper House did not always benefit from a service that was safe, effective and well-led. At this inspection we found the safety, effectiveness and oversight of the service required improvement.

Practices at the service placed people at risk of harm. Systems in place to monitor, assess and improve the safety and quality of the service were not robust.

Risks to people were not always managed safely, as care plans did not always assess risks consistently or provide adequate information on how risks should be minimised and mitigated.

Although accidents were recorded, there was no evidence that risks had been analysed or that safety related themes and trends had been considered, meaning there were missed opportunities to identify and mitigate risks.

People’s care plans lacked detail, provided inconsistent information and did not always reflect people’s current needs, meaning people were at risk of receiving inappropriate care. There was a lack of management oversight to ensure records were maintained accurately.

Management of medicines was not always safe. The service did not always follow best practice guidance to ensure medicines were managed safely. Policies and procedures relating to medicines lacked sufficient information to help guide staff. Not all staff had an up-to-date competency assessment to ensure they were safe to administer people’s medicines.

The environment posed risks to people as it was not safely maintained. For instance, some internal doors were not fire safety compliant. Infection prevention and control procedures were not always effective as some communal toilets were visibly dirty. Some of the communal baths were damaged, which compromised effective cleaning.

The principles of the Mental Capacity Act were not always adhered to when seeking and recording people’s consent to their care and treatment, therefore people were not supported to have maximum choice and control of their lives.

We were not assured people’s nutrition and hydration needs were met adequately. Advice from professionals regarding people’s intake was not always evidenced as provided. Any support from staff regarding these needs, was not properly documented within care plans. We have made a recommendation for people who require support with their dietary needs, that their care plans are updated to include proper guidance for staff to follow.

Although staff were competent in their roles, some refresher courses for core training, such as first aid and moving and handling, were overdue. However, people told us they thought staff were trained and competent in their roles. We have made a recommendation that the provider ensures training for staff is provided in line with best practice guidance.

We received positive feedback from people regarding their treatment from staff. People told us they were treated and supported well and enjoyed living at the home. People appeared calm and at ease in their surroundings.

Both the provider and quality compliance team responded in a positive and proactive way to the findings at our inspection and began to work to action and address the shortfalls immediately, demonstrating their dedication to improve standards in the safety and quality of care being delivered to people living at Margaret Roper House.

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 21 December 2017).

Why we inspected

The inspection was prompted in part due to concerns received about medicines, staffing and governance. A decision was made for us to inspect and examine those risks. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

We have found evidence the provider needs to make improvements. Please see the safe, effective and well-led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

Enforcement and Recommendations

We have identified breaches in relation to the management of risk, medicines, safety of premises, consent and governance systems at this inspection. We also made 2 recommendations regarding updating care plans for people with specific dietary requirements and that systems in place to train and support staff are improved.

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