This inspection took place on 29 March 2018 and was unannounced.

Margaret’s Rest Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service supports older people, including those living with dementia. Margaret’s Rest Home offers long-term residential care for up to 27 people including those living with dementia. At the time of our inspection, 27 people were using the service.

At the last comprehensive inspection on 14 and 15 March 2016, this service was rated as good. At this inspection, the service remained good overall but some areas of improvement were required under well-led.

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.

The provider regularly checked the quality of care at the service through quality audits, however we have identified some areas where further work was needed to ensure accurate records were maintained.

People told us they felt safe at the service because there were always staff on hand to support and care for them. Written risk assessments had been prepared to reduce the likelihood of injury or harm to people during the provision of their care. There were enough staff employed to meet people’s needs. Communal areas were well staffed and if people were in their bedrooms staff regularly checked on them. The staff recruitment procedures ensured that appropriate pre-employment checks were carried out to ensure only suitable staff worked at the service.

People received their medicines safely and as prescribed. There were systems in place to ensure the premises were kept clean and hygienic so that people were protected by the prevention and control of infection. There were arrangements in place for the service to make sure that action was taken and lessons learned when things went wrong, to improve safety across the service.

People’s care needs were assessed prior to them moving into the service. Staff received an induction process when they first commenced work at the service and in addition received on-going training to ensure they were able to provide care based on current practice when supporting people. People received enough to eat and drink, had a choice of meals and snacks and were supported by staff to access a variety of other services and social care professionals.

People were supported to access health appointments when required to make sure they received continuing healthcare to meet their needs. 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 (do not) support this practice.

People developed positive relationships with the staff who were caring and treated people with respect, kindness and courtesy. People were encouraged to make decisions about how their care was provided staff had a good understanding of people's needs and preferences.

Care plans were personalised and gave clear information to staff about each person's specific needs and how they liked to be supported. People were satisfied with how their personal care was provided. Records showed that people and their relatives were involved in the assessment process and the on-going reviews of their care. There was a complaints procedure in place to enable people to raise complaints about the service.

People, their relatives and staff had confidence in the leadership of the provider and registered manager. The culture was open and honest and focused on each person as an

This unannounced focused inspection took place on the 10 October 2016. Margaret's Rest Home provides accommodation for up to 27 people who require residential care for a range of personal care needs. There were 26 people in residence during this inspection. We carried out this inspection as we had received information of concern relating to staffing, the management of people with challenging behaviours and nutrition and hydration.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

The provider did not have suitable systems in place to monitor all aspects of the environment to maintain people’s safety. They did not always ensure that the access to the kitchen was secure.

The registered manager had not submitted the required notifications to the Care Quality Commission. The manager immediately provided the notifications and undertook to continue to provide the notifications as required by the regulations.

People who had behaviours that challenged others had risk assessments carried out and staff followed the plans designed to mitigate these identified risks. Staff were vigilant in providing close supervision for people during the times they displayed challenging behaviour. Staff took appropriate action to protect people from others who had episodes of behaviour that challenged. Staff referred people to appropriate healthcare professionals for assessment where people’s behaviours had become more frequent.

People’s risks were assessed and care plans that mitigated these risks were followed by staff. There were enough staff to provide for people’s needs.

People had enough to eat and drink to maintain their health and well-being.

This inspection was unannounced and took place on 14 and 15 March 2016.

Margaret’s Rest Home is a residential care home registered with The Care Quality Commission (CQC) to provide the regulated activity, accommodation for persons who require nursing or personal care. The service provides care for up to 27 older people, including people living with dementia and physical disabilities. On the day of our inspection 27 people were using the service.

The service had 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.

Each person had a mental capacity assessment (MCA) completed, although as set out in the Mental Capacity Act 2005 code of practice, 'specific decision' MCA assessments were not always considered.

People received their medication as prescribed and the systems to receive, store and administer medicines were appropriately maintained.

The provider notified the Care Quality Commission (CQC) of events, such as serious injuries, deaths and other events as required by law. They had also notified CQC of people placed under Deprivation of Liberty Safeguards (DoLS) authorisations also required by law.

Staff were aware of what constituted abuse and of their responsibilities to report abuse. Risks to people using the service and others were assessed, and control measures were in place to reduce any identified risks.

Staffing levels were adequate to meet people’s current needs. The staff recruitment procedures ensured that appropriate pre-employment checks were carried out to ensure only suitable staff worked at the service. Staff induction training and on-going training was provided to ensure they had the skills, knowledge and support they needed to perform their roles.

Consent was gained from people before any care was provided. People had a choice of meals, nutritional assessments were carried out and special diets catered for, and people were supported to see healthcare professionals as and when they needed to.

Staff treated people with kindness, dignity and respect and spent time getting to know them and their specific needs and wishes. The views of people living at the service and their representatives were sought and areas identified for improvement were acted upon to make positive changes.

People and their families were fully involved and in control of their care. Care was based upon people’s individual needs and wishes. The care plans were reviewed and updated, to ensure they reflected the most recent and up-to-date information regarding people’s care.

Social, leisure and recreational activities were provided for people to participate in if they wished.

The service had a complaints procedure in place, to ensure that people and their families were able to provide feedback about their care and to help the service make improvements where required.

Regular management audits were carried out to assess and monitor the quality of the service. The vision and values of the service were person-centred and made sure people were at the heart of the service.

During our inspection of Margaret’s Rest Home we set out to answer our five questions;

Is the service safe?

Is the service caring?

Is the service responsive?

Is the service effective?

Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with people using the service, their relatives, the staff supporting them and looking at records.

If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

Equipment at the home had been well maintained and serviced regularly therefore not putting people at unnecessary risk. The provider also had systems in place in case of an emergency. The systems included a call bell system to enable people who chose to remain in their rooms to call for staff assistance.

Is the service caring?

We saw that staff interacted with people in a kind and supportive way. We saw people enjoying some activities and laughing with staff that were supporting them. People were happy with the care that had been delivered, one person said “the staff are lovely and are very friendly; they know exactly what I like”.

Is the service responsive?

People received care that met a range of individual needs and these included supporting people’s nutritional, continence, mobility and skin care needs. We found that referrals were made promptly to health care professionals when required.

Is the service effective?

Specialist dietary, mobility and equipment needs had been identified in care plans where required to meet people’s needs. It was clear from our observations and from speaking with staff that they had a good understanding of the care and support requirements of people that used the service.

Is the service well led?

We saw that the registered manager had used a system of audits to continuously monitor the quality of service at the home. We found that records were regularly updated so that people’s requirements were accurate. We also found that staffing rotas were arranged in advance by the registered manager which ensured that staffing levels met people’s needs. We found the service to be well led.

We spoke with one person who used the service; they told us “all the staff are very kind”. They told us that they liked living at Margaret’s Rest Home.

We spoke with two members of staff who told us that there were enough staff on duty to meet people’s needs.

We found that people received care that was planned to meet their individual needs. There were safeguarding measures in place to protect people from harm. We found that staff had been employed who had relevant experience and there were enough staff on duty to meet people’s needs. The records at the service were organised and well maintained.

People were being monitored to maintain adequate hydration. Staff were using appropriate moving and handling techniques when assisting people to move.

We spoke with four people who use the service; they told us the staff were kind and nice.

We spoke with relatives of people who use the service who said that they were kept well informed, and made to feel welcome.

Some of the people using the service had dementia and were not able to tell us what they thought about their care. As part of our inspection we used our SOFI (Short Observational Framework for Inspection) tool. This is a way of observing interactions with people who find it difficult to communicate verbally, and gives us some insight into their experience of care.

We spent time watching the support four people using the service received, and used the SOFI tool to record their experiences. We found their experiences were positive; the staff were attentive and responsive to people's individual needs and involved people in conversation, activities and decisions about aspects of their daily lives.

As most of the people in the home have dementia, with associated communication problems, we only spoke with three people. We also spoke with three relatives about their views of the care provided.

People and their relatives we spoke with praised the service: '’Staff are always friendly.’’ ‘’I have never needed to complain about anything here.’’ ‘‘All the care I need is supplied. I have never had any problems with any staff.’’

There were a small number of suggestions that we received :

As staff were very busy in the morning, there needed to be another staff member on duty for that time.

More one-to-one time was needed with people to give them more interest and purpose.

One person said it would be nice to have a cat in the home. The manager said there had been a cat in the past and she would look into this.

The manager said she would look into and follow up these comments.

We inspected the service by using a method called the Short Observational Framework Inspection (SOFI). In effect this meant we observed three people for an hour to see how they lived their lives and how staff provided care and related to them.