Margaret House Care Home Ltd

Updated 3 November 2022

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection, we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

Two inspectors undertook the inspection on the first day and 1 inspector visited the service on the second day.

Service and service type

Margaret House Care Home Ltd is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Margaret House Care Home Ltd is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered manager

This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

At the time of our inspection there was not a registered manager in post.

Notice of inspection

This inspection was unannounced on the first day.

What we did before the inspection

We reviewed information we had received about the service, such as notifications. These are events that happen in the service that the provider is required to tell us about. We also sought feedback from the local authority.

The provider completed a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We observed how staff provided support for people to help us better understand their experiences of the care they received. We spoke with 8 people living in the home, 2 members of staff, the deputy manager and the nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider. We also spoke with a visiting healthcare professional.

We had a tour of the building with the deputy manager and reviewed a range of records. This included 4 people’s care documentation, 2 staff files and a sample of people’s medication records. We also reviewed a range of records relating to the management of the service.

After the inspection

The provider sent us an action plan in response to the findings of the inspection, the fire risk assessment and an action plan in relation to the fire arrangements. They also sent us documentation relating to new governance systems.

Updated 3 November 2022

About the service

Margaret House Care Home Ltd is a residential care home providing personal care for up to a maximum of 11 people in one adapted building. The service specialises in providing care and support for people with mental health conditions. There were 9 people accommodated in the home at the time of the inspection.

People’s experience of using this service and what we found

People were satisfied with the service and told us the staff were helpful and pleasant. Staff understood how to protect people from harm or discrimination and had access to safeguarding adults’ procedures. There were shortfalls in some people’s care plans and records and risks to people’s health safety and well-being had not always been assessed and managed. The home had a satisfactory standard of cleanliness. There were sufficient staff on duty and staff were attentive in responding to people’s needs. There were minor shortfalls in the recruitment records of new staff. The deputy manager assured us these issues would be addressed. Medicines were not always managed safely. Whilst a pre-planned fire risk assessment was carried out during the inspection, we were concerned about the fire arrangements and asked the local authority’s Fire and Rescue Service to carry out an audit. The nominated individual took immediate action to address issues highlighted during the fire assessment.

People were satisfied with the meals provided. However, dietary records were not consistently completed. 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. However, there were no supporting care plans in relation to Deprivation of Liberty applications. Staff received appropriate training and an annual appraisal of their work performance. We were told the manager was due to arrange supervision meetings with staff. People’s healthcare needs were recorded in their care plan. However, staff were provided with inconsistent advice about monitoring 2 people’s blood sugars, and were not maintaining a consistent record. Some areas of the home looked worn and damaged and would benefit from redecoration and refurbishment.

People’s rights to privacy and dignity were not always promoted and upheld. We noted people’s bedrooms were not always well presented and apart from 1 bedroom there were no curtains at windows. Whilst there were blinds, these were not in a good condition. We also noted there was no privacy glass on a bathroom window. People were satisfied with the care provided and we observed caring interactions throughout the inspection.

The provider had arrangements for planning care, however, one person did not have a care plan accessible to staff and other people’s care plans had not always been reviewed and updated. We noted the manager was in the process of developing new care plans which were stored on the computer. We made a recommendation about ensuring up to date care plans were readily accessible to staff. We saw limited evidence to demonstrate people were involved in the development and review of their care plan. People had few opportunities to participate in activities. Although there were arrangements for monthly discussions with people, records indicated these had not always taken place. The deputy manager assured us the discussions would be reinstated.

Whilst the management team had carried out a series of audits as part of the governance systems, we found a number of shortfalls during the inspection in respect to the management of risks and medicines and the maintenance of records. We also found people were given limited opportunities to express their views. There was evidence of only one residents’ meeting during 2022. Whilst the nominated individual explained satisfaction surveys had recently been distributed, we saw no evidence of previous surveys.

The manager was away on annual leave at the time of the inspection. Following our visit, the nominated individual sent us an action plan setting out their response to the inspection findings.

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

Rating at the last inspection

The last rating for this service was good (published 22/11/2019).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We have found evidence that the provider needs to make improvements. You can see what action we have asked the provider to take at the end of this full report.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Margaret House Care Home Ltd on our website at www.cqc.org.uk.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to the management of risks and medicines and the governance and record keeping systems. We also made a recommendation about making sure up to date care plan information to readily accessible to staff. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.