St. Margaret’s Residential Home is a care home. 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. The care home is registered to accommodate up to 20 people in one adapted building which has facilities including dining rooms and sitting areas. There were 18 people living at the home when we visited.

This unannounced inspection took place on 27 March 2018. At our last inspection of 10 February 2017, there was a breach of regulation relating to staff recruitment. The recruitment practices were not robust and safe. The provider sent us an action plan on how they would improve. At this inspection we found that the service had made the required improvement in this area. Recruitment practices were safe. Appropriate checks took place to ensure only suitable and staff deemed fit were recruited to work with people. However, we found two breaches of regulations of the Health and Social Care Act 2008. People’s care and support was not person - centred and planned in a way that catered for their individual needs and requirements. The systems in place for assessing and monitoring the service were not robust and failed to identify the issues we found during this inspection. Information about people was not always clearly documented. The service obtained the views of people and their relatives but did not develop plans to make improvements following feedback received.

The service had a registered manager who had worked at the service for several years. 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’s medicines were managed and stored in line with safe medicine administration and management guidelines. Medicines were administered as prescribed. Medicines records were completed as required.

Risks to people were assessed and management plans were available for staff on how to keep people safe from danger and to reduce risks to them. People and their relatives were involved in their care. Care plans were reviewed and updated as required. People’s nutritional needs and dietary requirements were met

Staff were trained on safeguarding adults from abuse. They understood signs of abuse and how to report it in order to protect people. There were sufficient staff available and deployed properly to meet people’s needs. Staff received training, support and supervision in their roles. People had access to healthcare services they needed to maintain good health. The service ensured people received consistent care when they moved between services.

The provider maintained health and safety systems, and carried out regular checks to ensure the environment continued to be safe. Staff were trained in infection control and knew the procedures to reduce risks of infection. Records of incidents and accidents were maintained, and actions were put in place to reduce chances of incidents from happening again. People had equipment and adaptations such as grab rails they needed.

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. People gave consent to the care and support they received. The service assessed people’s capacity as required by the Mental Capacity Act 2005 (MCA) and obtained the Deprivation of Liberty Safeguards (DoLS) authorisation to ensure people were not unlawfully restricted. Relatives and healthcare professionals were involved in making decisions for people in their best interests where this was appropriate.

Staff were kind an

This inspection took place on 10 February 2017 and was unannounced. At the last inspection of the service on 9 and 10 February 2016 we found a breach of regulation of the Health and Social Care Act 2008 in that the provider failed to ensure the proper and safe management of medicines and procedures and systems in place to evaluate and monitor the quality of the service provided in particular the management of medicines were not always effective in ensuring the quality of care people received. We carried out this inspection to check the outstanding breach had been met and also to provide a review of the rating for the service.

St Margaret's residential home provides accommodation and personal care support for up to twenty two older people, some of which are living with dementia. The home is situated in a residential area of Sidcup Kent and is spread out over two floors. At the time of our inspection there were 19 people using the service. There was a registered manager in post at the time of our inspection. 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 this inspection we found the provider had made the required improvements and systems in place to ensure the proper and safe management of medicines were robust. However at this inspection we found a new breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the provider to take at the back of the full version of the report.

The provider failed to ensure there were safe staff recruitment practices in place. Some systems to monitor the quality of service delivery were not always conducted in line with the providers schedule and did not always identify issues that required attention.

Risks to the health and safety of people were assessed and reviewed in line with the provider's policy. Medicines were managed, administered and stored safely. There were arrangements in place to deal with foreseeable emergencies and there were safeguarding adult’s policies and procedures in place. Accidents and incidents were recorded and acted on appropriately. There were appropriate numbers of staff to meet people’s needs.

Staff new to the home were inducted into the service appropriately and staff received training, supervision and appraisals. There were systems in place which ensured the service complied with the Mental Capacity Act 2005 (MCA 2005). This provides protection for people who do not have capacity to make decisions for themselves. People’s nutritional needs and preferences were met and people had access to health and social care professionals when required.

People were treated with kindness and respect and their support needs and risks were identified, assessed and documented within their care plan. People were provided with information on how to make a complaint. People using the service and their relatives were asked for their views about the service.

This inspection took place on 9 and 10 February 2016 and was unannounced. At our previous inspection in May 2014, we found the provider was meeting the regulations in relation to the outcomes we inspected.

St Margaret's residential home provides accommodation and personal care support for up to twenty two older people, some of which are living with dementia. The home is situated in a residential area of Sidcup Kent and is spread out over two floors.

At this inspection 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.

The provider failed to ensure the proper and safe management of medicines. Procedures and systems in place to evaluate and monitor the quality of the service provided were not always effective in ensuring the quality of care people received.

There were safeguarding adult’s policies and procedures in place to protect people from harm and incidents and accidents were recorded and acted on appropriately. Assessments were conducted to assess levels of risk to people’s physical and mental health and care plans contained guidance for staff to ensure people were kept safe by minimising assessed risks.

There were safe recruitment practices in place and appropriate recruitment checks were conducted before staff started work. There were appropriate levels of staff on duty and deployed throughout the home to meet people’s needs.

There were arrangements in place to deal with foreseeable emergencies and there were systems in place to monitor the safety of the premises and equipment used within the home. People were supported by staff that had appropriate skills and knowledge to meet their needs and staff received supervision and annual appraisal of their performance.

Staff demonstrated good knowledge and understanding of the MCA and the Deprivation of Liberty Safeguards (DoLS) including people’s right to make informed decisions independently but where necessary to act in someone’s best interests.

People were supported to eat and drink suitable healthy foods and received sufficient amounts to meet their needs and ensure well-being. People had access to health and social care professionals when required.

Interactions between staff and people using the service were positive and staff had developed good relationships with people. Care plans demonstrated people’s involvement in their care.

Staff were knowledgeable about people's needs with regards to their disability, race, religion, sexual orientation and gender and supported people appropriately to meet their identified needs and wishes.

People received care and treatment in accordance with their identified needs and wishes. Detailed assessments of people’s needs were completed and reviewed in line with the provider’s policy. People were supported to engage in a range of activities that met their needs and reflected their interests.

People and their relatives told us they knew who to speak with if they had any concerns. There was a complaints policy and procedure in place and complaints were managed appropriately.

The manager was knowledgeable about the requirements of being a registered manager and their responsibilities with regard to the Health and Social Care Act 2014. The provider took account of the views of people using the service and their relatives through annual residents and relative’s surveys.

We considered our inspection findings to answer questions we always ask providers when we visit to inspect a service; is the service caring, responsive, safe, effective and well led.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with staff and from examining records. If you want to see the detailed evidence supporting our summary please read the full report.

At the time of our inspection there were 19 people residing at St Margaret's residential home. We used different methods to help us understand the experiences of people who use the service as not everyone who lived at the home was able to communicate verbally with us in a significant way. We used our Short Observational Framework for Inspection (SOFI) tool. SOFI is a specific way of observing care provided which helps us to understand the experiences of people who could not talk with us.

Is the service caring?

We observed that people using the service were free to access all areas of the home, for example some people were sitting in the garden enjoying the good weather, some people were sitting in the smaller quiet lounge reading and others were participating in group activities. People we spoke with told us they were happy with the care and support received. One person told us “I like living here, it’s my home and I can do as I want. Staff are very supportive and will help me to venture outside”.

During lunchtime we undertook a SOFI (Short Observational Framework for Inspection) in the main dining room of the home. We used our SOFI tool which helps us to see what people’s experiences at mealtimes were. We found that overall people had positive experiences. Staff members supporting people with their lunch knew what support they needed. We saw that people were assisted to the dining room and supported with their choice of meal and drink. We observed that people were spoken to respectfully.

Is the service responsive?

People expressed their views and were involved in making decisions about their care and treatment. People who use the service were given appropriate information about the home and understood the care and support choices available to them. People using the service who we spoke with told us they were very much a part of the planning of their care and daily activities. One person told us “All the staff are great. I have a keyworker and they know me well. They know what I like and what I don’t like and how to support me”.

Arrangements were in place to provide people with opportunities to engage in social and leisure activities in and out of the home’s environment. We met with the activities co-ordinator for the home. We saw that they had introduced a range of meaningful activities that people could participate in. The current activities programme we looked at included a range of activities such as arts and crafts, hair and beauty treatments, stretch and move exercise classes, quizzes and one to one time with a member of staff venturing outside of the home to participate in activities such as shopping or attending a local club. We spoke with the activities co-ordinator who told us that people using the service each had an activities profile. This recoded people’s preferences for their pastimes including how these needs could be met and risks identified in doing so.

Is the service safe?

People who used the service told us they felt safe and well supported. One person said, "The staff are very helpful. If I need them, I press my buzzer and staff will come”. Another person told us "They always check on us during the night to make sure we are alright”. Relatives of people using the service told us they were happy with the care and support provided and felt assured that their loved ones were safe. One person told us “I am aware of who to speak with or how to complain, however I have never needed to. I am very happy with the service”.

Is the service effective?

We saw people's wishes and choices being respected by staff in a kind and caring manner. Staff addressed people respectfully when talking with them and used people’s preferred names. We saw that staff offered people a choice of how they wanted to spend their time, for example, if they wanted to watch television, listen to music or read and what people’s choices were in relation to the homes daily food and drinks menu.

We examined the homes training matrix and training plan they had developed and put in place to address the gaps in staff training. There was recorded evidence that staff training was taking place and training sourced by the provider was detailed and appropriate in content. In addition we saw that there were reference documents on display around the home on various health and social care key topics. This enabled staff to refresh their memories. We looked at a sample of staffing records and saw certificated evidence of training undertaken by the staffing team. We saw that members of staff had been provided with frequent supervision which was well documented and had an annual appraisal.

Is the service well-led?

People who use the service were asked for their views about the care and treatment provided and they were acted on. We found that there were robust systems in place to monitor the quality and safety of the service provided. These included seeking the opinion of people using the service and their relatives and gaining feedback from visiting professionals. The opinions of people using the service were gathered through a survey that took place on an annual basis. In between these times, people living in the home were able to attend residents meetings that took place every few months.

People we spoke with were aware of the home’s complaints procedure and said they knew they could speak with a member of staff or the manager if they had any concerns. One person told us “I have no complaints at all, however if I did I know who to speak with”. The service had a clear procedure for dealing with complaints and a whistle blowing policy that all staff were aware of.

People told us that they were very happy and they enjoyed living at the home. People told us that the amount of activities had increased as there was a new activity coordinator in post. One person said “the summer fete was very enjoyable; we all had a lovely time”. People said that staff were trying to get people involved in different activities and that helped the time pass. People told us that they felt staff responded to their requests for assistance in a timely manner and that they were not often kept waiting for assistance.

People's needs were assessed and care was planned and regularly reviewed, and the majority of care plans reflected people’s needs and the care provided. The provider had made sufficient improvements to staff training to ensure staff were appropriately trained to deliver the care people required safely and the provider had completed a satisfaction survey since our last inspection. The remedial work from the fire risk assessment had been completed.

People told us that staff were very good and they enjoyed living at the home and the care was good. People told us that the food was very good and one person said “there’s always enough to eat and the cook always makes a cake for afternoon tea”. took time to ask how they liked things like personal care to be done and encouraged them to do as much independently as possible. People said that they enjoyed using the computer but staff were not always available to help them and there wasn’t always enough to do. People told us that they felt staff responded in a timely manner to call bells and that they did not have to waited for assistance. Some people we spoke with were aware that the provider carried out reviews of their care.

People's needs were assessed and care was planned and regularly reviewed, however sometimes care plans did not reflect the care provided. People's medication arrangements matched their care plan and we found staff administered medicines safely and in a timely polite manner. However, the provider had not made sufficient improvements to staff training to ensure staff were appropriately trained to deliver the care people required safely and some quality assurance processess such as satisfaction surveys could not be evidenced. Some fire risk assessment actions remained outstanding from April 2012.

People we spoke with told us that they had been involved in decisions about their care and felt able to discuss their needs with the staff.

People told us that staff took time to ask how they liked things like personal care to be done and encouraged them to do as much independently as possible.

People said that they enjoyed using the computer but staff were not always available to help them.

People told us that they felt staff responded in a timely manner to call bells at night and rarely waited for assistance.