Margaret House provides care and support to people living in specialist 'extra care' housing. Extra care housing is purpose-built or adapted single household accommodation in a shared site or building.

The accommodation is rented or partially owned, and is the occupant's own home. People's care and housing are provided under separate contractual agreements. The Care Quality Commission (CQC) does not regulate premises used for extra care housing; this inspection looked at people's personal care and support service. The building is owned by Saxon Weald and has a restaurant on site that provides a midday meal to everyone living at Margaret House under their service agreement. Communal areas are available on site where activities are provided.

Not everyone living at Margaret House receives the regulated activity. CQC only inspects the service being received by people provided with 'personal care'; help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided. At the time of the inspection, there were 21 people receiving the regulated activity.

This was the first inspection of the service since their registration with the CQC in March 2018, following a change in provider. Staff and the care manager (branch manager) were based in an office within the ‘extra care’ housing.

This inspection took place on 14 and 18 of September 2018. It was an announced visit, which meant the service was given 48 hours’ notice, to ensure staff were available to facilitate the inspection.

The service had an acting manager who was a registered manager at another service within the same organisation, and who had applied for registration as Manager of Margaret House with the CQC. 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.

Feedback that we received from people about staff and the service provided was very positive. However, the provider had not ensured all aspects of the service were safe or that the quality of the service was monitored. Systems and records did not support the safe management of medicines. Accidents and incidents were not recorded in a consistent way and did not demonstrate that they had been used effectively to reduce risks. They had not been reviewed or evaluated. Staff had not been trained on fire safety. Management systems had not been fully established to ensure suitable, accurate records were maintained in all areas. This included records relating to, accidents, medicines and ‘best interest’ meetings. We also found that the service had not notified CQC of all significant events which had occurred in line with their legal obligations in a timely way.

People were supported by staff they liked and who knew them well. Staff understood people’s needs and preferences. People were visited at times they wanted and staff stayed the correct amount of time to meet their individual needs.

There were enough staff working with the right skills to respond to emergency calls and people’s assessed needs. Staff had a good understanding of the procedures to follow to safeguard people from the risk of abuse and to protect people’s individual rights. People’s choices were assessed and staff delivered care in a person-centred way that reflected people’s wishes.

Staff recognised when people’s needs changed and staff ensured health and social care professionals were involved in regular reviews. Packages of care were updated as required and staff worked flexibly to respond to people’s needs.

People were supported by staff who were caring and kind and took account of people’s privacy and dignity. Where required, staff supported people to have enough to eat and drink and maintain a healthy diet.

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