Margaret House 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.

Margaret House provides care and support to up to 51 people some of who live with dementia. At the time of our inspection 49 people were living at the service. The home is split across five self-contained bungalows, each with its own communal areas and kitchenette.

At our last inspection on 05 November 2015 we rated the service good. At this unannounced inspection we found evidence that demonstrated concerns. These were in relation to management of risks to people’s safety, staff deployment, inaccurate completion of care records and governance of the service. The overall rating for the service has changed to requires improvement.

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.

People felt safe at the service, staff had received relevant training on how to safeguard people and understood their responsibilities to report any concerns. However, risks to people’s safety and well-being were identified but not always managed to keep them safe from harm. People were not always supported by sufficient numbers of staff on one specific unit. Relevant pre-employment checks had been completed for all staff and safe recruitment practices followed. Medicines were stored appropriately, and administered to people as the prescriber intended, managed safely and audits completed. People lived in a clean and hygienic environment and were cared for by staff who followed robust infection control procedures.

People felt staff were well trained. Staff had attended relevant training to undertake their role and spoke positively about the training they were provided. Staff felt supported and attended regular supervisions and appraisals. The registered manager was in the process of reviewing people’s consent. However, staff were aware of how to support those people who may not be able to provide their consent. People’s nutritional needs were met and responded to when people were at risk of weight loss. The environment of the home was in need of redecoration and a plan was in place to address this.

People told us that staff were friendly and respected their privacy. Staff knew people well and were knowledgeable about people’s individual needs. People felt staff knew what was important to them and knew how people chose to spend their day. People's privacy and dignity was promoted.

People’s received care that responded to their individual choices and promoted their independence. People and their relatives were involved in planning how their, their family members support would be delivered. Staff were aware of people's choices and preferences and delivered care accordingly. Care records were in the process of being reviewed, however staff were aware of people’s current needs. People were able to have visitors without restriction and able to see them in privacy. People were encouraged to provide feedback on the service they received and knew how to make a complaint.

Although being reviewed, we found people’s care records were not always updated in a timely manner when people’s needs changed. Audits completed by the registered manager and provider did not identify the issues with people’s care records and consent documentation. The registered manager had not delivered the improvements they told us about in their annual improvement plan. People were aware of who the registered manager was and felt they were visible and approachable. Staff were encouraged to attend team

The inspection took place 05 November 2015 and was unannounced. At our last inspection on 15 October 2013, the service was found to be meeting the required standards in the areas we looked at. Margaret House provides accommodation and personal care for up to 51 people. At the time of our inspection 45 people lived at the home.

There was a manager in post who had registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the 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 and associated Regulations about how the service is run.

The CQC is required to monitor the operation of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are put in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way, usually to protect themselves or others At the time of the inspection we found that where people lacked capacity to make their own decisions, consent had been obtained in line with the MCA 2005. The manager had submitted DoLS applications to the local authority for people who needed these safeguards.

People told us that they felt safe, happy and well looked after at the home. Staff had received training in how to safeguard people from abuse and knew how to report concerns, both internally and externally. Safe and effective recruitment practices were followed to ensure that all staff were suitably qualified and experienced. Arrangements were in place to ensure there were sufficient numbers of suitable staff available at all times to meet people’s individual needs.

The environment and equipment used were regularly checked and well maintained to keep people safe. Trained staff helped people to take their medicines safely and at the right time.

Relatives and healthcare professionals were positive about the skills, experience and abilities of staff who worked at the home. They received training and refresher updates relevant to their roles and had regular supervision meetings to discuss and review their development and performance.

People were supported to maintain good health and had access to health and social care professionals when necessary. They were provided with a healthy balanced diet that met their individual needs.

Staff obtained people’s wishes and consent before providing personal care and support, which they did in a kind and compassionate way. Information about local advocacy services was available to help people and their family’s access independent advice or guidance.

Staff had developed positive and caring relationships with the people they cared for and clearly knew them very well. People were involved in the planning, delivery and reviews of the care and support provided. The confidentiality of information held about their medical and personal histories was securely maintained throughout the home.

Care was provided in a way that promoted people’s dignity and respected their privacy. People received personalised care and support that met their needs and took account of their preferences. Staff were knowledgeable about people’s background histories, preferences, routines and personal circumstances.

People were supported to take part in meaningful activities relevant to their needs. They felt that staff listened to them and responded to any concerns they had in a positive way. Complaints were recorded and investigated thoroughly with learning outcomes used to make improvements where necessary.

Relatives, staff and professional stakeholders very were complimentary about the manager, deputy manager and how the home was run and operated. Appropriate steps were taken to monitor the quality of services provided, reduce potential risks and drive improvement.

The people who lived in the home told us that they were happy there and that the staff were kind and caring. One person told us that the staff who had been in the home for a while were their friend and that they cared for them like family members.

People told us that there had been a number of managers in the past year and that this had been unsettling and that they were glad that there was a new manager. All of the people we spoke with were happy with the new manager. The staff said that they felt appreciated and that she was a good manager who lead by skill and experience. They told us that she was easy to talk to and that she knew all the residents although she had only been in post for two weeks.

Visitors said that the new manager was easy to talk to and that they were happy with how their relative was cared for. They said that they had confidence in the home and that they were informed if there was a problem.

The people who used the service and their relatives told us that they were happy with the care provided. They said that the staff were kind and caring. One visitor told us that they left the home without any worries about how their relative was being cared for.

We visited the home in August 2012 and found that the outcomes in relation to Care and Welfare of People, Nutrition, Medication, Staffing, and Quality Assurance were not met. On this visit we found that progress had been made on all outcomes, with the exception of Quality Assurance. We found that the home did not have effective leadership.

We found that the staff knew the people well and were able to meet their needs. We observed staff deliver care in a manner that was kind and compassionate. People’s nutritional needs were recognised and met. Medication was administered and stored appropriately. There were sufficient numbers of staff on duty but they were not deployed in the best interests of the people. We saw that this meant that some people were waiting an unnecessary amount of time for their breakfast.

During our visit to Margaret House, people that we spoke with told us that they received good care and did not have to complain about any specific issues. In the majority they told us that they were happy living there. One person who had recently moved into the house told us that the staff had had difficulties in updating her medication as prescribed by their doctor. They told us that they expected the home should have been able to manage the changes.