The inspection was carried out on 20 March 2018, and was an unannounced inspection.

St Margaret's Nursing 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. St Margaret's Nursing Home provides nursing care and accommodation for up to 25 older people, who were living with a range of care needs; including some of whom were also living with dementia. Some people needed support with all of their personal care and some with eating, drinking and their mobility needs. Other people were more independent, needing less support from staff. The service is a detached building set in the centre of Hythe alongside the Royal Military Canal. Accommodation is provided on two floors, the upper floor is accessed by stairs and a passenger lift. Eighteen people were living at the service.

At the last Care Quality Commission (CQC) inspection on 17 and 18 November 2016, the service was rated Required Improvement in Safe, Effective, Responsive and Well Led domains. Rated Good in Caring domain with an overall Required Improvement rating. We found breaches of Regulations 9, 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We found that the provider had not ensured care and treatment was person centred to meet with people's needs and reflect their preferences. The provider had not ensured medicines were properly managed; arrangements were not fully implemented to safeguard against the risks of Legionella and practices did not always follow planned care and treatment pathways to mitigate risk. The provider had not ensured systems or processes were operated effectively to assess and improve the quality and safety of the services provided; or operated effectively to ensure complete, contemporaneous records were kept for each service user; including a record of care and treatment provided. We also recommended that the provider adopted a best practice ethos to ensure health care plans are individually fully completed for each person in relation to their particular condition to meet published guidelines as set out by organisations such as Diabetes UK and the National Institute for Health and Care Excellence (NICE).

We asked the provider to take action to meet the regulations. We received action plans on 10 February 2017, which stated that the provider will be meeting the regulations by 31 March 2017.

At this inspection, we found the service Required Improvement.

There was a registered manager at the service. 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 and associated Regulations about how the service is run.

Risk assessments were in place. However they were not always individualised to the person. We made a recommendation about this.

People were supported to eat and drink enough to meet their needs. However, people did not always received food and drink at an appropriate time and temperature. We have made a recommendation about this.

Records relating to people’s care were not always well organised and adequately maintained. We have made a recommendation about this.

People gave us positive feedback about the service they received. People told us they felt safe and well looked after. Relatives who we spoke with during our visit were satisfied with the service.

People continued to be safe at St Margaret's Nursing Home. Staff knew what their responsibilities were in relation to keeping people safe from the risk of abuse but these were not always followed.

Medicines were managed safely. Medicines were recorded, stored or monitored effectively.

Staff encouraged people to actively partic

The inspection took place on 17 and 18 November 2016 and was unannounced.

St Margaret's Nursing Home provides nursing care and accommodation for up to 25 older people, who were living with a range of care needs; including some of whom were also living with dementia. Some people needed support with all of their personal care and some with eating, drinking and their mobility needs. Other people were more independent, needing less support from staff. The service is a detached building set in the centre of Hythe alongside the Royal Military Canal. Accommodation is provided on two floors, the upper floor is accessed by stairs and a passenger lift. There were 23 people living in the service at the time of the inspection.

A registered manager was 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.

St Margaret's Nursing Home was last inspected on 30 January 2014 and no concerns were identified at that time. However, this inspection highlighted some shortfalls where the regulations were not met. We also identified areas where improvement was required and made a recommendation the service should adopt.

Medicine quantities were not always recorded, this meant it was not possible to back track to ensure medicines were administered correctly because the starting quantity was unknown. Further guidance and records were required for the application of skin creams to ensure they were administered.

Most checks took place to reduce the risk of Legionella, a water borne bacteria, however, these checks did not meet the requirements of the service’s water management policy because they were incomplete.

Staff had not recognised an out of date Percutaneous Endoscopic Gastrostomy (PEG) feeding plan was being used. Mouth care was, in one case, ineffective and there were no records to support mouth care given.

Elements of some care plans were not tailored to individual preferences and clear links were not always made between some conditions and other associated care needs. This did not provide the service with the best and earliest opportunity to be responsive to changes in people’s needs.

Quality audits carried out by the registered manager and the provider were not fully effective because they had not provided continuous oversight of all aspects of the service.

Services and equipment including the electrical installation, gas safety certificate, portable electrical appliances, fire alarm and firefighting equipment were checked when needed to help keep people safe. The service was well maintained and comfortable.

The registered manager and deputy manager had a good understanding of the Mental Capacity Act 2005, and Deprivation of Liberty safeguards. They understood in what circumstances a person may need to be referred, and when there was a need for best interest meetings to take place. We found the service was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS) and that people’s rights were respected and upheld.

There were enough staff to meet people’s needs. Staff understood how to protect people from the risk of abuse and the action they needed to take to alert managers or other stakeholders if they suspected abuse to ensure people were safe.

New staff underwent an induction programme and shadowed experienced staff, until they were competent to work on their own. There was a continuous staff training programme, which included courses relevant to the needs of people supported by the service.

There were low levels of incidents and accidents and these were managed appropriately with action or intervention as needed to keep people safe. Risks were identified and strategies implemented to minimise the level of risk.

Care plans we

At the time of our inspection, there were 23 people who lived in the home. We spoke with seven people who lived there, two visitors, four staff and the manager.

People we spoke with who lived in the home told us that they were happy with the care and support they received. Comments included “they look after me well; everything is nice” and “I’m fine; they’re very kind to me” and “very good in here; couldn’t get the care anywhere else”.

People told us that they were supported to make their own day-to-day decisions and were involved in how their care and support was provided.

We found that care plans contained details about people's daily routines, their care needs and the support they required from staff. Risk assessments were in place to identify and minimise risks as far as possible for people who lived in the home.

We found that the home was clean and had effective systems in place to help protect people from the risks of cross-infection. There was guidance and training for staff to help ensure they understood the importance of infection control.

We found that there were enough suitably trained and qualified staff to support people’s needs. One person we spoke with who lived in the home told us “there’s enough staff; oh yes”. A visitor commented “I think this home is well staffed”.

In this report, the name of one registered manager appears who was not in post and not managing the regulatory activities at the home at the time of our inspection. Their name appears because they were still registered with us at the time of our inspection.

People were supported to make their own decisions and choices in their daily life. They told us “You always get a choice of fresh food”. Each person had a written care plan, which gave staff guidance about how people preferred to receive support. People’s health care needs were met and their welfare promoted by social activities. One visitor said “When [my relative] moved in, they had just come out of hospital and were very frail. Now they are much better, which is down to good care and good food”.

People lived in an adequately decorated environment, which was warm throughout. The quality of the environment had been and was in the process of being improved. People were cared for by suitably trained staff who were supported in their roles by supervision. People told us “Staff are very kind indeed and most helpful, they are a nice lot of people”. The manager knew about how to work with the authorities about any concerns or allegations of abuse. People who used the service, their representatives and staff were asked for their views about the service provided. These were acted on to make improvements. One person told us “I have no complaints and am not unhappy about anything, if I was, it would be sorted out quickly”.

In this report, the name of one registered manager appears who was not in post and not managing the regulatory activities at the home at the time of our inspection. Their name appears because they were still registered with us at the time of our inspection.