We carried out an inspection of Margaret House Care Home Ltd on 23 and 24 May 2017. The first day was unannounced.

Margaret House Care Home Ltd provides accommodation and personal care for up to 11 people, including people living with dementia or a mental illness. There were 11 people accommodated in the home at the time of the inspection.

Margaret House Care Home Ltd is an older type extended property providing facilities on two floors which could be accessed by a stair lift. There is a lounge and dining room and nine of the single bedrooms had en-suite facilities. The home is located on a main bus route on the outskirts of the town of Burnley, Lancashire. Shops, pubs, churches and other amenities, including a park, are within walking distance. There are surrounding gardens and patio areas.

The service was managed by a registered manager. The registered manager had been in post since February 2015. 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.

During our last inspection visit on 17 and 18 May 2016 we found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to medicines management, providing a clean and well maintained environment, recording and managing the risks to people's health, safety and welfare and ineffective quality assurance systems. Following the last inspection the infection control lead nurse visited the service and advice and support was provided. We asked the provider to take action to make improvements and to send us an action plan. During this inspection we found the necessary improvements had been made.

People told us they felt safe and staff were kind and caring. Safeguarding adults' procedures were in place and staff understood how to safeguard people from abuse. The registered manager and staff were observed to have positive relationships with people living in the home. People were relaxed in the company of staff and there were no restrictions placed on visiting times for friends and relatives.

We found staff were respectful to people, attentive to their needs and treated people with kindness and respect. The atmosphere in the home was comfortable and relaxed. From our observations it was clear staff knew people well and were knowledgeable about their individual needs, preferences and personalities.

Appropriate Deprivation of Liberty Safeguard (DOLS) applications had been made to the local authority and people's mental capacity to make their own decisions had been assessed and recorded in line the requirements of the Mental Capacity Act 2005. People were supported to have 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.

Each person had a care plan that was sufficiently detailed to ensure they were at the centre of their care. People’s care and support was kept under review and, where appropriate, they were involved in decisions about their care. Risks to people’s health and safety had been identified, assessed and managed safely. Relevant health and social care professionals provided advice and support when people’s needs changed.

There were enough staff to support people in a timely and unhurried way. The registered manager followed a safe recruitment procedure to ensure new staff were suitable to care for vulnerable people and arrangements were in place to make sure staff were trained, supported and supervised.

Medicines were managed safely and people had their medicines when they needed them. Staff administering medicines had been trained and supervised to do this safely.

Appropriate aids and adaptations had been provided to help maintai

We carried out an unannounced inspection of Margaret House Care Home Ltd on the 17 & 18 May 2016. The first day was unannounced.

Margaret House provides accommodation and personal care for up to 11 people, including people living with dementia or a mental illness. There were 11 people accommodated in the home at the time of the inspection.

This was the first inspection of the service following a change of ownership in January 2015.

During this inspection visit we found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to medicines management, providing a clean and well maintained environment, recording and managing the risks to people’s health, safety and welfare and ineffective quality assurance systems. You can see what action we told the registered provider to take at the back of the full version of the report. We also made recommendations about assessing staffing levels.

The service was managed by a registered manager. 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 and relatives told us they did not have any concerns about the way they or their relatives were cared for. They were happy with the care and support provided and they felt safe. Staff were aware of the action they would take if they witnessed or suspected any abusive or neglectful practice and had received training on the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards.

People told us they were given their medicines when they needed them. However, we found areas where improvements were needed to ensure people’s medicines were always managed safely.

We found that not all risks to people’s health, safety and welfare had been recognised or recorded. This meant staff may not respond quickly to any increased risks or changes to people’s health.

We found some areas of the home were not clean and hygienic. We noted some improvements had been undertaken but other areas were in need of maintenance and redecoration. People told us they were happy with the facilities available in the home. They had arranged their bedrooms as they wished and had brought personal possessions with them.

The number of shortfalls we found indicated quality assurance and auditing processes had not been effective as matters needing attention had not always been recognised or addressed. This meant the provider had not identified risks to make sure the service ran smoothly.

The service had recruitment and selection policies and procedures although they needed to be reviewed to reflect current guidance. Staff had been recruited safely and received training and support to help them look after people properly. However, they had not received specialised training such as mental health awareness and dementia training.

People were happy with the staff team and told us there were sufficient numbers of staff to meet their needs in a safe way. Staff told us they had a stable team and they worked well with each other. Staffing levels were not formally assessed although staff were confident additional staff would be made available if people’s needs changed.

People told us they enjoyed the meals. We noted the atmosphere was relaxed with chatter throughout the meal. Staff were aware of people’s dietary preferences and professional advice and support had been sought when needed.

People were involved in the running of the home and were kept up to date. They told us they had no complaints and were aware of how to raise their concerns if they needed to.

Everyone had a care plan, which had been kept up to date about their needs and preferences. People told us they were kept up to date and involved in decisions about care and support.

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