About the service: St Margaret's Care Home is a care home which can provide nursing and personal care for up to 60 older people, some of whom are living with dementia. At the time of this inspection there were 50 people living at the service.

People’s experience of using this service: People told us they felt safe. They knew who to report any concerns to and were happy with the support they received from staff. Arrangements were in place to protect people from risks to their safety and welfare. Staff understood how to keep people safe and used information following incidents to reduce the likelihood of reoccurrence. Effective recruitment procedures were in place and staff received appropriate training.

Effective management systems were in place to monitor and audit the quality and safety of the service. Action was taken to address concerns identified by the provider through checks of the service. People and their relatives were involved in discussions about the service. Records were stored securely however some records were not up to date.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection: Requires Improvement (report published 22 May 2018).

At our last inspection we found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014. This related to safe care and treatment and good governance. This was because risks associated with people's care were not always identified and mitigated. The provider did not have effective quality assurance processes to monitor the quality and safety of the service provided to people. Care records did not always contain up to date and relevant information about people's care needs.

Why we inspected: This was a focused inspection. Since our last inspection we had received concerns identified by the provider in relation to the management of people’s personal allowances. We undertook a focused inspection to consider those concerns. We looked at our domains 'safe' and 'well led'. This report only covers our findings in relation to these concerns.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

This inspection took place on 26 March 2018 and was unannounced. A second day of inspection took place on 5 April 2018 and was announced.

St Margaret’s 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 Care Home provides personal care for up to 60 people. At the time of our inspection there were 48 people living at the home who received nursing and personal care, some of whom were living with a dementia. The service consists of three units or ‘communities’ as the provider called them: Cathedral, St Cuthbert’s and Prince Bishops.

A registered manager was in place at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission (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 2008 and associated Regulations about how the service is run.

We last inspected this service in February 2016 when it was rated ‘Good’ overall. During this inspection we found the service had deteriorated to ‘Requires Improvement.’

During this inspection we found breaches of Regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because risks associated with people's care were not always identified and mitigated. Pressure relieving mattresses were not always set correctly or checked regularly and people's positional changes were not always documented which increased people's risk of developing pressure damage. The provider did not have effective quality assurance processes to monitor the quality and safety of the service provided to ensure people received appropriate care and support. Care records did not always contain up to date and relevant information about people's care needs.

You can see what action we told the provider to take at the back of the full version of the report.

People and relatives spoke positively about the service. There were enough staff to meet people’s needs in a timely way.

Staff had received training in safeguarding and knew how to respond to any allegations of abuse. Safeguarding referrals had been made to the local authority appropriately. When new staff were appointed, thorough checks were carried out to make sure they were suitable to work with vulnerable adults.

Staff training in key areas was mostly up to date. Staff received regular supervisions and told us they felt well supported by the registered manager.

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.

Records relating to people’s fluid intake were incomplete. People were supported to attend appointments with healthcare professionals. Meal times were relaxed and a pleasant experience for people who lived at the service.

Each person who used the service was given information about how to make a complaint and how to access advocacy services. An advocate is someone who represents and acts on a person's behalf, and helps them make decisions.

People and relatives we spoke with knew how to make a complaint. They told us they could speak to a member of staff, the registered manager or raise issue through the residents’ committee if they had any issues.

There was a homely atmosphere at the service and the accommodation was clean and decorated to a good standard.

People, relatives and staff told us the registered manager was approachable.

This inspection took place on 15 and 17 February 2016 and was unannounced. This meant the staff and provider did not know we would be visiting.

St Margaret’s Care Home provides care and accommodation for up to 60 elderly people who require nursing or residential care. On the day of our inspection there were 50 people using the service.

The home had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (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 2008 and associated Regulations about how the service is run.

St Margaret’s Care Home was last inspected by CQC on 27 April 2014 and was compliant with the regulations in force at that time.

Accidents and incidents were appropriately recorded and investigated. Risk assessments were in place for people who used the service and staff and described potential risks and the safeguards in place. Staff had been trained in safeguarding vulnerable adults.

Appropriate arrangements were in place to ensure that medicines had been ordered, stored and administered appropriately.

The home was clean, spacious and suitable for the people who used the service and appropriate health and safety checks had been carried out.

There were sufficient numbers of staff on duty in order to meet the needs of people who used the service. The provider had an effective recruitment and selection procedure in place and carried out relevant checks when they employed staff. Staff were suitably trained and training sessions were planned for any due or overdue refresher training. Staff received regular supervisions and appraisals.

The provider was working within the principles of the Mental Capacity Act and was following the requirements in the Deprivation of Liberty Safeguards.

People were protected from the risk of poor nutrition and staff were aware of people’s nutritional needs. Care records contained evidence of visits to and from external health care specialists.

People who used the service, and family members, were complimentary about the standard of care at St Margaret’s Care Home. Staff treated people with dignity and respect and helped to maintain people’s independence by encouraging them to care for themselves where possible.

Care records showed that people’s needs were assessed before they moved into St Margaret’s Care Home and care plans were written in a person centred way. The provider sought alternative methods in supporting people with their care needs.

The home had a full programme of activities in place for people who used the service to help meet their social needs.

The provider had an effective complaints policy and procedure in place and people knew how to make a complaint.

The service had links with the local community and local organisations. The service had a positive culture that was person-centred, open and inclusive. The provider had a robust quality assurance system in place. People who used the service, family members and staff were regularly consulted about the quality of the service.

We spent time talking with people and observing care practice where people with nursing care needs lived. We saw people were treated with dignity and respect. For example, when staff talked with people they made sure they got down to their eye level. When people were supported to walk, they were not rushed but supported to move at a pace comfortable for them. We found people’s care and welfare needs were met. This was because important information in peoples care records had been kept up-to-date and were followed in practise.

Everyone we spoke with was complimentary about the care provided. People told us the staff were always smiling and treated them with respect. One person said “It’s marvellous here. I’ll give it ten out of ten.”

Overall we found significant improvements had been made since we last visited in October 2013.

People told us “They (the staff) are alright. They don’t bother you,” “Personally speaking I cannot grumble,” “I can go to bed when I want to,” “It’s lovely here,” “I feel well cared for” and “I find it absolutely marvellous here.”

However, despite these positive comments we found peoples’ care and welfare needs were not planned in a way which ensured their safety and welfare. This was because for some people had been assessed as at risk of developing a pressure ulcer but no risk management plans had been put in place to guide staff and to ensure people’s safety.

People who used the service were given appropriate information and some were involved in making decisions about their care and treatment. However, we found some people were not treated with dignity and respect. For example, when talking to people staff used phrases like “Don’t do that!” and “Leave the table alone”.

We found that there were sufficient staff to meet peoples’ needs. There was also an effective complaints procedure in place so people knew their views would be listened to.

St Margaret’s nursing home is situated near to the city of Durham. It is registered for the regulated activities ‘accommodation for persons requiring nursing or personal care, treatment of disease disorder and injury and diagnostic and screening procedures’. It can accommodate up to 60 people with nursing care needs.