This inspection took place on 21 and 22 March 2018 and was unannounced on the first day. At the last inspection in September 2015, the provider was compliant with regulations in all areas we assessed.

St Margaret’s 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. St Margaret’s, is a single storey building and accommodates 59 people across three units: Mews, Wybers and Royal. Royal Unit specialises in providing care to people living with dementia. There were also six self-contained bungalows on the site. At the time of our inspection there were 48 people using the service.

The service had a registered manager in post. A registered manager is a person who has registered with 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.

Although staff had a good understanding of the need to gain consent from people prior to carrying out care tasks, we found there was inconsistency regarding the application of the Mental Capacity Act 2005 (MCA). The provider and registered manager had not always followed best practice regarding assessing people’s capacity and discussing and recording decisions made in their best interests, when restrictions were in place. You can see what action we told the provider to take at the back of the full version of the report.

People who used the service had an assessment of their needs, risk assessments and a care plan. There was inconsistency in the care files, with some people having good, informative person centred care plans for specific areas, whilst others contained minimal information to support people’s wishes and preferences for their care. We have made a recommendation about reviewing the care files to address shortfalls.

There was a quality monitoring system in place, which consisted of audits, checks, surveys and meetings. We found aspects of the audit programme were limited and had not been effective in identifying and addressing all the issues highlighted during our inspection. These included shortfalls in care records, including those to support consent and the renewal programme. We have made a recommendation about reviewing the audit programme.

Staff had been recruited safely. There were sufficient numbers of staff on duty at all times and with an appropriate skill mix, to meet people’s assessed needs. Staff had access to induction, training, supervision and support, which enabled them to feel skilled when supporting people who used the service. Staff said they received good support from the management team who were always available to give advice and guidance. A new staff rewards scheme had been introduced.

Risks to people in relation to their needs had been assessed. Staff were confident about how to protect people from harm and what they would do if they had any safeguarding concerns. The registered manager maintained records of accidents and incidents, which gave them an overview of any trends. The safety of the premises and equipment was maintained. The home was clean and tidy during the inspection and staff were seen to follow infection control procedures.

People’s health care needs were met and they had access to community health care professionals when required. The registered manager and staff team had developed good working relationships with health colleagues to support the provision of joined-up care. Arrangements were in place to support people at the end of their life.

People received their medicines safely from trained staff. People who were being cared for in bed were regularly seen by staff to make sure they remained comfortable.

People were treated with kindness, respect an

Where people did not have the capacity to give their consent, the provider acted in accordance with legal requirements. We saw evidence that best interest meetings had been arranged when people who used the service lacked the capacity to make a decision in relation to their care and treatment.

A relative we spoke with said, “They always let me know when there are any changes in him” and went on to say, “It’s a fantastic place, I hope I can come here when the time comes.” A person who used the service said, “I get the care I need.”

We took a tour of the building and found it to be clean and free form unwanted odours. Some of the bedrooms we saw had stained carpets, we discussed with the manager who said, “As rooms get redecorated we will be putting down a washable floor covering.”

Appropriate arrangements were in place for the safe ordering, dispensing and disposal of medication. The home had a range of medication policies in place that outlined how to manage medicines effectively.

Staff received appropriate professional development. We saw that care staff had completed training pertinent to their role such as moving and handling, infection control and safeguarding. Further specialised training including PEG fitting, vene puncture and blood glucose monitoring had been completed by members of the registered nursing team.

People told us that staff were polite and treated them with respect. They said, ““Yes, the staff look after us they do pretty good” and “They look after me”.

We observed that people were supported to make choices through their day and that interactions with staff were respectful.

We saw that people were supported to have their needs met through a care planning process and that these documents were regularly reviewed to ensure that staff were aware of the latest needs of the person. One visitor we spoke with told us that the home was “Excellent” and that the staff were “Phenomenal”. With another visitor confirming “Yes X’s needs are met, it’s not bad at all here.”

Everyone we spoke with felt safe living in the home and staff had undertaken training on the safeguarding of vulnerable people.

We saw that there was a set amount of staff on duty each day and that the manager had a system in place to cover for any staff sickness or holidays.

There was a complaints system in the home and people told us they would raise concerns with the manager.

We saw that the manager completed audits within the home and spoke to people who lived in the home to ensure the home were aware of their views.

St Margret’s provides nursing and residential care for up to 56 people. The service provides support for adults over the age of 18 including older people, people living with dementia and people with a physical disability. At the time of our inspection the service was supporting 46 people, 30 of which required nursing care and 16 required residential support. The service offers various communal lounges, a large open plan dining area, an activity area, kitchen and an enclosed outdoor space which is wheelchair accessible and offers outdoor seating and flower beds. The building is fully accessible to people with mobility difficulties and there is a car parking available on site.

The inspection was unannounced and took place on 29 September and 2 October 2015. The last inspection was completed on 28 August 2013 and the service was compliant in all areas assessed.

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.

We found that staff understood how to identify sign of possible abuse and knew how to report suspected abuse to the relevant bodies. Staff were recruited safely and appropriate checks were

completed prior to them working with vulnerable people. Staff had good knowledge and understanding of the needs of the people who used the service. People who used the service told us they felt safe.

There were sufficient numbers of staff to safely support people. Staff received supervision, observations of practice and annual appraisals to support their practice.

We found people received their medicines as prescribed and staff were appropriately trained with the skills to carry out their role effectively.

People were offered choices of food and drinks and individual dietary needs were catered for and monitored in line with their care plan. People had access to health services when required and the service responded quickly when advice or guidance was needed from other professionals. 

People were treated with respect and staff were kind and patient in their approach to people. A range of in house and community based activities were offered by the activities co-ordinators and people were encouraged to participate and get involved.

The service had a complaints policy and welcomed feedback from people living at the service, relatives and staff in order to make improvements and develop.

People who used the service had personalised care plans in place and individual’s likes and dislikes were clearly documented. Risk assessments were in place along with life history, medical conditions and professional contact records. Family and friends were welcome to visit and people living at the service were encouraged to maintain family contact.