St Margarets Care Home provides accommodation and personal care for up to 16 adults, some of whom may be living with dementia. The home is situated over three floors with stairs and a stair lift to access upper floors. Two bedrooms were shared; single sex, double occupancy rooms and six bedrooms have an en suite with a basin and toilet. There were communal bathroom and toilet facilities for people who do not have an en suite within their room. There are a number of communal areas within the home and an enclosed garden for people and their visitors to use. At the time of our inspection there were 15 people living at the service.

This unannounced inspection was carried out on 7 September 2017. At the last inspection on 28 October 2016, the service was rated as ‘requires improvement.’ At this inspection we found that the service had continued to make the necessary improvements.

There was a registered manager in post at the time of the inspection. 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.

Staff assisted people in a way that promoted their safety and people were looked after by staff in a kind and caring manner. Staff encouraged people to make their own choices. People’s privacy and dignity was promoted and maintained by staff.

Staff were knowledgeable of how to report incidents of harm and poor care. Staff were trained to provide effective and safe care. People were supported to take their medicines as prescribed and medicines were managed by staff whose competency had been assessed.

People and their relatives / advocates were involved in the setting up and agreement of their/their family members care plans. People’s care records took account of people’s wishes and any assistance they required. The majority of risks to people who lived at the service were identified and plans were put into place by staff to minimise and monitor these risks. However, not all risks to people had been formally assessed.

People were looked after by enough, suitably qualified staff to support them safely with their individual needs. There was a documented process to determine safe staffing levels in conjunction with people’s assessed dependency needs.

People were supported to eat and drink sufficient amounts of food and fluids. Staff monitored people’s health and well-being needs and acted upon issues identified. Staff supported people to access a range of external health care services where needed and people’s individual health needs were met.

Activities took place at the service; however, some people felt that the number and type of activities taking place could be increased/ improved to enhance social interactions.

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 enjoyed their work and were supported by the registered and deputy managers. Staff understood their roles and responsibilities and were supported to maintain their skills by way of supervision and appraisal. Pre-employment checks were completed on new staff members before they were deemed to be suitable to look after people living at the service.

The service was responsive and flexible to people’s needs. People maintained contact with their relatives and friends and they were encouraged to visit the service and were made very welcome by staff.

There was an ‘open’ culture within the home. This was because there was a process in place so that people’s concerns and complaints could be listened to and acted upon. Wherever possible, complaints were resolved to the complainants’ satisfaction.

Arrangements were in place to ensu

St Margarets Care Home is registered to provide accommodation and personal care to 16 people. At the time of our inspection 15 older people some of whom are living with dementia were living in the home. The home is situated over three floors with stairs and a stair lift to access upper floors. Two bedrooms are shared double occupancy rooms, and six bedrooms have an en suite with a basin and a toilet. There are communal bathroom and toilet facilities for people who do not have an en suite within their room. There are a number of communal areas within the home, including two lounges and a dining area and an outside area for people and their visitors to use.

This unannounced inspection took place on 28 October 2016.

At the last inspection on 17 August 2015 there was a breach of a legal requirement found. After the comprehensive inspection the provider wrote to us to say what they would do to meet the legal requirement in relation to improvements required. Improvements were needed to ensure that robust safety checks were undertaken on all new staff members prior to their employment. The provider sent us an action plan telling us how they would make the required improvements.

During this inspection we found that the provider had made the necessary improvement and all legal requirements were now being met.

The home had a registered manager; however, they were not in post. They had recently applied to voluntarily cancel their registration and were no longer working at the home. The owner of the home was in the process of completing their application to become the new registered manager and was overseeing the running of the home on a day-to-day basis. 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’s recruitment process was followed and this meant that people using the service received care from suitable staff. However, the manager had not followed their CQC action plan in full to ensure that all areas of improvement actions identified at the last inspection had been completed. We found that gaps in a new staff member’s employment history were known but not formally documented.

Although we saw that there was a sufficient number of staff to meet the needs of people living in the home the manager could not provide robust written evidence that the decision making process to determine safe staffing levels, was undertaken in conjunction with people’s assessed dependency levels.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) and report on what we find. We found that there were formal systems in place to assess people’s capacity for decision making. Applications had been made to the authorising agencies for people who needed these safeguards. Staff had a basic understanding of the key legal requirements of the MCA and DoLS.

People who lived at the home were supported by staff in a kind and respectful way. People had individualised care and support plans in place which recorded their care and support needs. The information was up-to-date and correct. Individual risks to people were identified by staff. Plans were put into place to minimise these risks to enable people to live as independent and safe a life as possible. These documents prompted staff on any assistance a person may require. However, monitoring records for people deemed to be at risk of weight loss or dehydration were not always documented in detail by staff. This meant that although people’s risks were identified and minimised by the manager and staff. There was an increased risk that the monitoring kept did not present a complete record.

Arrangeme

This inspection was carried out on 17 August 2015 and was unannounced. This was the first inspection of this service since Fins Care Limited had been registered with the Care Quality Commission as the provider. This change of registration occurred on 20 March 2015

St Margarets Care Home is registered to provide accommodation and personal care for 16 older people some of whom are living with dementia. There were 15 people living at the home during this inspection. The home is situated over three floors with stairs and a stair lift to access upper floors. Two bedrooms are shared double occupancy rooms, and six bedrooms have an ensuite with a basin and a toilet. There are communal bathroom and toilet facilities for people who do not have an ensuite within their room. There are a number of communal areas within the home, including two lounges and a dining area and a garden for people and their visitors to use.

There was a registered manager in place. 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 Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) and report on what we find. We found that there were formal systems in place to assess people’s capacity for decision making and applications had been made to the authorising agencies for people who needed these safeguards. Whilst staff respected people choices we found that some staff were not always aware of the key legal requirements of the MCA and DoLS.

People who used the service were supported by staff in a kind and respectful way. People had individualised care and support plans in place which recorded their care and support needs. Individual risks to people were identified by staff. Plans were put into place to minimise these risks to enable people to live as independent and safe a life as possible. These documents prompted staff on any assistance a person may require. Arrangements were in place to ensure that people were supported and protected with the safe management of medication.

There was an ‘open’ culture within the home. People, their relatives, and visitors were able to raise any suggestions or concerns that they might have with staff and registered manager and feel listened too. People were supported to access a range of external health care professionals and were supported to maintain their health. People’s health and nutritional needs were met.

There were a sufficient number of staff on duty. The decision making process to determine safe staffing levels decided by people’s dependency and support needs was not formally recorded by the registered manager.

Effective recruitment checks were not always in place. Staff were trained to provide effective care which met people’s individual support and care needs. Staff understood their role and responsibilities to report poor care. Staff were supported by the registered manager to develop their skills and knowledge through regular supervision and training.

The registered manager sought feedback about the quality of the service provided from people who used the service and staff by sending out surveys. They had in place a quality monitoring process to identify areas of improvement required within the home. However, these checks were not always formally recorded with an action plan.

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.