St Margaret's is a care home which provides nursing care and support for up to 28 predominantly older people. At the time of the inspection there were 27 people living at the service. Some of these people were living with dementia. The service occupies a detached house over two floors with a passenger lift for access to the upper floors.

This unannounced comprehensive inspection took place on 15 November 2018. The last comprehensive inspection took place on the 5 December 2017 when the service was not meeting the legal requirements. We issued a warning notice against the service due to repeated breaches of the regulations. The service was rated overall as Requires Improvement at that time.

We carried out a focused inspection on the 8 February 2018 to review the actions taken by the service to meet the requirements of the warning notice. At that time, we inspected the service against two of the five questions we ask about services: is the service well led and is the service safe? No risks, concerns or significant improvement were identified in the remaining Key Questions through our ongoing monitoring or during our inspection activity so we did not inspect them. The service had taken action to address the concerns we had regarding fire door closures, oxygen signage and very hot water coming from the hot taps in sinks used by people living at the service. We had been concerned that there were not enough appropriately sized moving and handling slings to meet people’s needs. At the focused inspection we found the service had ensured each person had their own appropriately named sling. Infection control issues highlighted at the December 2017 inspection regarding overflowing bins without lids, and sluices which were unlocked had been addressed. Staff recruitment had been reviewed to ensure all staff had appropriate checks completed before commencing working at the service. Whilst the service had met the requirements of the warning notice we required a period of embedded and sustained improvement before the overall rating of the service was changed. We carried out this comprehensive inspection to review the service’s overall rating.

People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

We spent time in the communal areas of the service. Staff were kind and respectful in their approach. They knew people well and had an understanding of their needs and preferences. People were treated with kindness, compassion and respect.

People told us, "There is always enough staff. I can talk to any of the staff if I was worried and they listen and help you. One carer is one of the best, they know me and I know I don’t need to worry about anything whilst they are around,” “They (staff) do make sure I have my medication on time especially my Insulin. They always ask if I am in pain and if so they will give me something to ease the pain.”

The service was warm, comfortable and appeared clean with no odours. People’s bedrooms were personalised to reflect their individual tastes. The service had some pictorial signage to support people who were living with dementia, who may require additional support with recognising their surroundings. The premises were regularly checked and maintained by the provider. Equipment and services used at St Margaret's were regularly checked by competent people to ensure they were safe to use.

Care plans were well organised and contained accurate and up to date information. Care planning was reviewed regularly and people’s changing needs were recorded. Daily notes were completed by staff.

The service had identified the minimum numbers of staff required to meet people’s needs and these were being met. The service had no staff vacancies at the time of this inspection.

There were systems in place for the management and administration of medi

We undertook an unannounced focused inspection of St Margarets Nursing Home on 8 February 2018. This inspection was done to check that improvements to meet legal requirements planned by the provider after our December 2017 comprehensive inspection had been made. The team inspected the service against two of the five questions we ask about services: is the service well led and is the service safe? This is because the service was not meeting some legal requirements. No risks, concerns or significant improvement were identified in the remaining Key Questions through our ongoing monitoring or during our inspection activity so we did not inspect them. The ratings from the previous comprehensive inspection for these Key Questions were included in calculating the overall rating in this inspection.

The service was rated as Requires Improvement at the last inspection. Identified safety concerns included very hot water running from the taps in people's ensuite bathrooms and communally used toilets, posing a scalding risk to people using the hot water. One person's bedroom door closed shut very quickly and heavily posing a risk of injury to the person using this room. We also identified a number of fire doors to people's bedrooms that were propped open with door wedges. This placed people at risk in the event of a fire near to their bedroom. We advised the service to fit devices to the fire doors which allow the doors to be held open when needed but close when the fire alarm sounds. In December 2017 we identified infection control issues including overflowing bins and inappropriate storage of people’s slings, which were being routinely stored with staff coats. As a result of ongoing concerns enforcement action was taken.

Following the last inspection the service sent us an action plan stating what action it was taking to meet the requirements of the regulations. This inspection visit was planned to check on the action the service had taken to meet the requirements of the regulations.

People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. St Margarets is a care home which offers care and support for up to 28 predominantly older people. At the time of the inspection there were 26 people living at the service. Some of these people were living with dementia. The service uses a detached house over two floors with a passenger lift for people to access the upper floor.

At this inspection we found maintenance work had been carried out to ensure the hot water system was safe to use and did not exceed recommended temperatures for a domestic hot water supply. We checked all hot water supplies and found these were not excessively hot. Daily temperature checks were carried out to ensure the system was consistent. There was also a monthly audit of maintenance check of the hot water system. People told us they had not experienced any recent issues with the temperature of water at the service.

The service had taken actions regarding concerns about the maintenance and use of fire doors. A fire door previously identified as having a faulty closure device had been fixed. We saw the door was now held open by a device connected to the fire alarm system which automatically closed in the event of a fire. All other fire doors were working effectively and none were being wedged open by furniture as had been previously identified. Appropriate signage and safety procedures were in place for a person who used oxygen in their room. The premises, equipment and services were regularly checked and maintained by a maintenance person or other competent people.

At the last inspection in December 2017 staff told us there were insufficient numbers of appropriate sized moving and handling slings for all the people who needed them at St Margarets. No-one was sharing slings at this inspection as the se

This unannounced comprehensive inspection took place on 5 December 2017. The last two inspections, which took place on 17 May 2016 and 20 October 2016 found the service to be in breach of the legal requirements. The service was rated as Requires Improvement at the last inspection. At both inspections we identified very hot water running from the taps in people’s ensuite bathrooms and communally used toilets, posing a scalding risk to people using the hot water. In May 2016 one person’s bedroom door closed shut very quickly and heavily posing a risk of injury to the person using this room. In May and October 2016 we identified there were a number of fire doors to people's bedrooms that were propped open with door wedges. This placed people at risk in the event of a fire near to their bedroom. We advised the service to fit devices to the fire doors which allow the doors to be held open when needed but close when the fire alarm sounds. In October 2016 we identified that staff were not supported with regular supervision, appraisal, staff meetings and regular training updates in mandatory subjects such as infection control and health and safety.

Following the last inspection the service sent us an action plan stating what action it was taking to meet the requirements of the regulations. This inspection visit was planned to check on the action the service had taken to meet the requirements of the regulations.

People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. St Margarets is a care home which offers care and support for up to 28 predominantly older people. At the time of the inspection there were 26 people living at the service. Some of these people were living with dementia. The service uses a detached house over two floors with a passenger lift for people to access the upper floor.

At this inspection we again found very hot water coming from the taps in the ensuite bathrooms of two people who used the hot water in their rooms independently. We also found very hot water coming from the taps in a communally used bathroom. Signs throughout the service stated the water was very hot and in a shower the sign stated the hot water posed a scald risk.

At this inspection we identified a person’s bedroom door was slamming shut quickly and heavily. The door closure device was faulty. This was the same bedroom door identified as a concern at the May 2016 inspection. This door was not being held open by the device which was connected to the fire alarm system, which closed in the event of a fire, but by an ornament which would not allow the door to close in an emergency. This put the disabled person in this bedroom at risk.

At this inspection we found people’s bedroom doors continued to be held open by items other than fire system devices. One person, whose door was wedged open by furniture, was using oxygen in their room, there was no door guard on the door and no sign on their door to alert people to the use and storage of oxygen in their room. This meant the person was at considerable risk in the event of a fire.

Staff told us there were not sufficient numbers of appropriate sized moving and handling slings for all the people who needed them at St Margarets. Nine people were sharing slings. Some people required large sized slings which were not available to them. This meant people were at risk of not being moved safely and appropriately. Sharing slings does not protect people’s dignity and is a cross infection risk.

Slings were hung together on hooks in the corridor. Staff hung their outside coats, scarves and jumpers on these same hooks. This increased the risk of cross infection. Open bins, without lids, were used for food waste in the dining room. Staff also used this bin for their soiled gloves and aprons. Open bins without lids were also found in toil

This unannounced comprehensive inspection took place on 20 and 21 October 2016. The last inspection took place on 17 May 2016. At this inspection we identified breaches of the legal requirements. Following the inspection we asked the provider to send the Care Quality Commission an action plan outlining how they would address the identified breach. We did not receive any action plan from St Margaret's Nursing Home. This inspection was carried out to review the actions taken by the provider to address the concerns found at the last inspection.

St Margaret's Nursing home offers nursing care and support for up to 28 predominantly older people. At the time of the inspection there were 27 people living at the service. Some of these people were living with dementia. The building is a detached house over two floors. There is a passenger lift that provides access for people to the upper floor.

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.

At the last inspection we identified very hot water running from the taps in people’s ensuite bathrooms and the basin in a separate toilet in the upstairs corridor. There were signs above each sink stating, “Caution very hot water.” This posed a scald risk to vulnerable people using the sinks. At this inspection we found that the maintenance man had taken action to help to reduce the temperature of the water in the hot taps by reducing the temperature of the boiler. He also carried out regular checks of the temperature of water in people’s rooms and toilets. We checked the temperature of hot water in two sinks on the first day of our inspection, it was over 45 degrees centigrade. We were told staff had turned on the electric immersion to override the boiler and this made the water hotter than it should be. On the second day of our inspection, the hot water was at a slightly lower temperature when checked.

At the last inspection we identified doors to people's bedrooms slammed shut very quickly and loudly. This posed a risk of injury to people using these doors. At this inspection we found the doors closed slower as they had been adjusted.

At the last inspection we identified staff training, supervision and appraisal was not being provided in accordance with the policy held by the service. Some staff had not attended mandatory updates such as health and safety and moving and handling. At this inspection we found regular supervision for most staff was being provided and annual appraisals had taken place for most staff. However, although some training had been provided to some staff since the last inspection, some mandatory training was still required by some staff. The registered manager told us they had been required to work more nursing shifts recently to cover for staff taking leave, and this had hindered their progress with this training provision. We saw staff had been provided with paper based training packages which they were working on at the time of this inspection.We have recommended that the registered manager addresses this concern immediately

At the last inspection we identified there were a number of fire doors to people's bedrooms that were propped open with door wedges. Some people, whose bedroom doors were wedged open, were cared for in bed due to their healthcare needs. We saw that people had signed disclaimers, saying they were happy to have their doors wedged open. However, this practice was not safe and meant that people would not be protected in the event of a fire near to their bedroom. We advised the service to fit devices to the fire doors which allow the doors to be held open when needed but close when the fire alarm sounds. At this inspectio

This unannounced comprehensive inspection took place on 17 May 2016. The last inspection took place on 14 August 2015. At that inspection we identified breaches of the legal requirements and told the provider to take action to address the breaches of the regulations. Following the inspection in August 2015 the provider sent the Care Quality Commission an action plan outlining how they would address the identified breaches. We carried out this comprehensive inspection to check on the actions taken by the service to meet the requirements of the regulations.

St Margaret's Nursing home is a care home which offers nursing care and support for up to 28 predominantly older people. At the time of the inspection there were 28 people living at the service. Some of these people were living with dementia. The building is a detached house over two floors. There is a passenger lift that provides access for people to the upper floor.

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 current registered manager had only been formally in post since January 2016 and had started a programme of improvements to the service. There was evidence of improvement at the service which is detailed in the main section of this report.

During this inspection we identified very hot water running from the taps in people’s ensuite bathrooms and a separate toilet in the upstairs corridor. There were signs above each sink stating, “Caution very hot water.” Whilst it was not possible to accurately record the temperature of this hot water we asked the registered manager to accompany us to several sinks and experience the hot water coming from the taps. The registered manager agreed it presented a potential scalding risk to people. Some people used their ensuite bathrooms independently and were experiencing a varying degree of physical and mental impairment. This meant they were at an increased risk from being scaled by very hot water.

We identified doors to people’s bedrooms slammed shut very quickly and loudly. This posed a risk of injury to people using these doors.

At the August 2015 inspection we found that staff had not always received necessary training updates. Supervision and appraisals were not provided for all staff in accordance with the policy held by the service, which stated all staff should have supervision every six months and appraisals annually. The staff records relating to training, supervision and appraisal were not monitored and not always accurate. Some staff had not attended mandatory updates such as health and safety and moving and handling. At this inspection we found that the newly registered manager had focused on the care staff support. Training updates, supervision and appraisals for all the care staff were being provided. However, the nursing staff still needed training updates. Only the registered manager and the clinical lead had received supervision in the last six months. We were told some members of the nursing staff team had showed some resistance to attending training updates and having regular supervision. This was being addressed by the new registered manager, who was using the revalidation process being undertaken by the nurses during 2016 to ensure all nurses had attended recent training.

At the August 2015 inspection we found items in the medicine trolley that had been prescribed for people no longer at the service. At this inspection we found the medicine trolley only contained items that had been prescribed for people living at the service. We looked at how medicines were managed and administered. We found it was always possible to establish if people had received their medicine as

This inspection took place on 14 August 2015 and was an unannounced comprehensive inspection. The last inspection took place on 29 July 2014. The service was meeting the requirements of the regulations at that time.

St Margaret's is a care home which offers nursing care and support for up to 28 predominantly older people. At the time of the inspection there were 28 people living at the service. Many of these people were living with dementia.

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 registered manager was not present at this inspection as they are also registered manager for another home in the organisation and were busy at that service on the day of this inspection.

We looked at how medicines were managed and administered. We found people had received their medicine as prescribed. Regular medicines audits were consistently identifying if errors occurred. However, we did find items in the medicines trolley that had been prescribed for people no longer at the service.

The service had identified the minimum numbers of staff required to meet people’s needs and these were being met.

The recruitment process was not always robustly followed. One new member of staff had not had two references requested from past employers prior to commencing work at the service. Staff were not always supported with their training requirements and supervision was not being provided according to the policy held at the service. Appraisals were provided for most staff and staff were supported by an induction programme when they began working at the service.

Risks to people were identified and assessed, however, advice and guidance for staff was not always clear for staff to follow. There were no emergency plans in place for individuals to advise staff of their specific requirements in the event of an evacuation.

Staff meetings had been held. These allowed staff to air any concerns or suggestions they had regarding the running of the service.

Meals were appetising and people were offered a choice in line with their dietary requirements and preferences. Where necessary staff monitored what people ate to help ensure they stayed healthy.

Care plans were well organised and contained accurate and up to date information. Care planning was reviewed regularly and people’s changing needs recorded. Where appropriate, relatives were included in the reviews.

Activities were provided although the activity coordinator was due to leave shortly after this inspection.

The registered manager covered two care homes in the organisation. The nurses ran the shifts and managed the care staff on a day to day basis. Although there was some administration time allocated to their shifts this was to update care plans and risk assessments. There was no one monitoring the training and supervision of staff at the service. The maintenance records and other documents held by the service were not accessible to us at this inspection as staff were not aware of where they were stored.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014. You can see what action we told the provider to take at the back of the full version of the report.

We spent time observing people in various areas of the home and lounge areas. We toured the building and saw people’s bedrooms (with their permission), bathrooms, the laundry room and communal areas. We also spent time looking at records, which included people’s care records, and records relating to the management of the home. One inspector carried out this inspection.

Before our inspection we reviewed all the information we held about the home. On the day we visited we spoke with five people who were living at St Margaret’s. We also spoke with three relatives, three members of the care staff, two nurses and the acting manager.

We considered our inspection findings to answer our five questions; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well-led?

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

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

Is the service safe?

We judged the service to be safe on the day of our inspection.

People were treated with dignity and respect by staff.

Care plans were individualised and contained information that directed and informed staff to provide appropriate care and support.

There were enough staff to meet people’s needs and a member of the management was available on call in case of emergencies.

Staff personnel records contained all the information required by the Health and Social Care Act. This meant the provider could demonstrate that the staff employed to work at the home were suitable and had the skills and experience needed to support the people living in the home.

Systems were in place to make sure that managers and staff learnt from events such as accidents and incidents, complaints and concerns. This reduced the risks to people and helped to continually improve the service. St Margaret’s alerted the local authority and the Care Quality Commission when notifiable events occurred or they had any concerns regarding people who used the service. St Margaret’s held policies and procedures in relation to the Mental Capacity Act 2005 (MCA) and the associated Deprivation of Liberty Safeguards (DoLS). We saw that they were using these protections appropriately.

CQC monitors the operation of the Deprivation of Liberty Safeguarding which applies in care homes. While no applications have needed to be submitted, appropriate policies and procedures were in place. Relevant staff had been trained to understand when an application should be made, and how to submit one.

We reviewed the medication administration records (MAR). We did not see any gaps in these records. There was a medication policy and procedure for St Margaret’s, which was in use. This helped to ensure people received their prescribed medication at the appropriate time.

Is the service effective?

We judged the service to be effective on the day of our inspection

During our inspection we observed staff caring for people. It was clear from our observations and from speaking with staff, and relatives of people who used the service, that staff had a good understanding of people’s needs.

People who lived at the service told us they sometimes had to wait to be taken to the toilet from the lounge areas. Staff confirmed this was an issue due to only having one toilet accessible with a hoist on the ground floor. The acting manager and lead nurse were aware of this concern and were working with the provider to address the issue.

Newly appointed staff received an induction prior to starting work, which included a period of shadowing more experienced staff.

Mandatory training was up to date and staff received further training specific to the needs of the people they supported.

We did not see any evidence of people being involved in their own care plan reviews. The acting manager told me they were about to starting using a document shared by the sister home, Trewiston Lodge, which would encourage the involvement of people and/or their representatives in their care plans and then ask them to sign in agreement with the contents.

Risk assessments were carried out to ensure people were protected from the risk of harm and guided staff on any action needed to minimise risk.

Is the service caring?

We judged the service to be caring on the day of our inspection.

Our observations of the care provided, discussions with staff and records we looked at enabled us to conclude that individual wishes regarding people’s care and support were taken into account and respected.

From discussion with the staff, it was clear they understood the people’s needs well. We were told the acting manager did their best to ensure the people were well cared for, and promoted people to have suitable opportunities and choices.

People’s preferences, interests, aspirations and different needs had been recorded and care and support had been provided in accordance with people’s wishes.

We saw visitors were welcomed throughout the day and encouraged to ‘feel at home’ during their visits, helping themselves to hot drinks from the kitchen. One visitor told us “it feels like a real family here”.

Is the service responsive?

We judged the service was responsive on the day of our inspection.

From discussion with the staff and from inspection of records we judged there were suitable links with local health services. Records showed there was appropriate contact with medical professionals.

Recent residents meetings had led to the service changing its provision in accordance with people’s wishes, for example, meal choices and activities available. We were told by one person that they greatly enjoyed the trips out in the community; we were shown a picture of a number of people who lived at St Margaret’s enjoying a trip out to the zoo.

We saw people who lived at the home were supported to make choices, such as where they wanted to spend time and what they would like to eat. We saw catering staff asking people during the morning of our inspection what they would like to choose for their lunch that day.

We saw records of best interest meetings to decide individuals end of life care plans.

Is the service well led?

We judged the service to be well-led on the day of our inspection.

The staff told us that regular staff meetings were held. This showed the management consulted with staff regularly to gain their views and experiences and improve support for people who lived at the service.

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and the quality assurance processes that were in place. They told us they felt able to approach the acting manager at any time and they were confident they would be listened to. This helped to ensure that people received a good quality service at all times.

Staff told us they were offered relevant and useful training on a regular basis.

The people we spoke with who lived at the service told us they found the acting manager was “easy to talk to” and “always there if you need anything”.

Regular audits were carried out to ensure the home was operating effectively and safely. Where these identified need for action this was followed up.

We carried out this inspection having recieved information of concern from a member of the public. We were told the service was not warm enough and cold at night, and that people who lived at St Margarets Nursing Home were waiting a long time for staff to respond to them when they needed assistance.

We spoke with the manager, the registered manager, a nurse, two carers and six people who lived at St Margarets Nursing Home. Overall people who used the service were positive about the home. Their comments included "I have no complaints" and "staff come when I need them".

We saw there was appropriate care planning documentation used in respect of people who lived at the home. People’s care needs were assessed, care and treatment was planned and delivered in line with their individual care plan.

We found the home was warm and people told us, and we saw the bedrooms were in good decorative order and personalised with people's possessions.

At our last inspection in August 2013 we had concerns regarding the managers ability to assess, monitor and review the service which was being provided due to a lack of systems and processes in place. We issued a compliance action in this regard.

We spoke to the registered manager, one member of staff, four people who used the service and two visitors to St Margarets Nursing Home. People told us "I have no compliants" and "they (staff) are all pretty good". People told us they felt able to approach the manager and staff if they had any concerns.

We found St Margarets nursing home had effective systems and processes in place to assist the management and staff in monitoring and reviewing the service that was provided.

We spoke with five people who lived at St Margarets, the registered manager, the deputy manager, two nurses, care staff and two visitors to the home.

Overall people were positive about the home and the staff, and told us the staff were “very good” and “lovely”. There were other comments including “it can take a while for staff to take me to the toilet when I call”, and “Some of my clothes have not come back from the laundry”.

We found peoples’ views and experiences had been taken into account in the way the service was provided and delivered in relation to their care.

Peoples’ privacy and dignity was respected and people experienced care, treatment and support that met their needs and protected their rights.

People were protected from the risks of inadequate nutrition and dehydration.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

There were enough qualified, skilled and experienced staff to meet people’s needs.

The provider did not have an effective system in place to identify, assess and manage risks to health, safety and welfare of people who used the service.

Records were stored securely in order to protect peoples’ confidentiality.

We spoke with five people who lived at St Margaret’s, the manager, deputy manager, a mental health nurse, care staff, housekeeping staff, a kitchen assistant and a relative.

Overall people were complementary about the staff, and told us they were “kind”. However, other comments included, “sometimes go a whole day without speaking to a sole”, “lack of social activity”, and “don’t always get enough to drink”.

We found, people’s privacy, dignity and independence were not respected and people’s views and experiences were not taken into account in the way the service was provided and delivered in relation to their care.

People did not experience care, treatment and support that met their needs and protected their rights. Care and treatment was not planned and delivered in a way that was intended to ensure peoples safety and welfare.

People were not protected from the risks of inadequate nutrition and dehydration.

People were not protected against the risks associated with medicines because the provider did not have appropriate arrangements in place to manage medicines.

There were not enough qualified, skilled and experienced staff to meet people’s needs.

The provider did not have an effective system in place to identify, assess and manage risks to the health, safety and welfare of people who used the service and others.

Records were not kept securely.

We asked 12 people using the service about life at St Margaret’s care home. They said they were very comfortable and happy living in the home, They said that the home was well maintained and kept very clean They told us they chose what they did each day, for example:, they go to bed and get up when they like, what clothes they like to wear, there was a good choice of food at mealtimes and there were activities they could join in if they wished. We saw, during our visit, people joined in group activities, socialised in the lounges, watched TV or listened to music and received visitors.

People told us they could raise concerns to staff or the manager if the need ever arose. We spoke to relatives who echoed this and said that they felt welcomed to the home.

Our observations concluded people appeared happy with the service and the staff that supported them. We observed that people’s privacy and dignity was respected during our visit. Staff were observed talking to people and asking them what they would like to do. We saw that people’s wishes were respected. We observed people moving around the home with no restrictions

The people who we were able to speak with said they were happy living in the home. People said that staff were hardworking and caring. People said the food was good and there was enough to eat and drink. Everyone said they were happy with their accommodation.

We spoke with some people who were able to talk to us about the service and about how they make choices in the care they receive. They told us that they sometimes have the opportunity to express preferences and make choices. There is a stable team of care workers that work hard to meet the needs of the people that live there. Comments received from people that live at St Margarets confirm their confidence in the care workers. People said they were satisfied with the care provided and the kindness and politeness of the care workers. We also spoke to staff who said they had confidence in the registered manager, one saying that she “is the best manager I have worked for”.

A representative from the Department of Adult Care and Support (DACS) told us that “there are no current concerns about this service”.