St Margarets Care Home is registered to provide accommodation and personal care to 16 people. At the time of our inspection 15 older people some of whom are living with dementia were living in the home. The home is situated over three floors with stairs and a stair lift to access upper floors. Two bedrooms are shared double occupancy rooms, and six bedrooms have an en suite with a basin and a toilet. There are communal bathroom and toilet facilities for people who do not have an en suite within their room. There are a number of communal areas within the home, including two lounges and a dining area and an outside area for people and their visitors to use.This unannounced inspection took place on 28 October 2016.
At the last inspection on 17 August 2015 there was a breach of a legal requirement found. After the comprehensive inspection the provider wrote to us to say what they would do to meet the legal requirement in relation to improvements required. Improvements were needed to ensure that robust safety checks were undertaken on all new staff members prior to their employment. The provider sent us an action plan telling us how they would make the required improvements.
During this inspection we found that the provider had made the necessary improvement and all legal requirements were now being met.
The home had a registered manager; however, they were not in post. They had recently applied to voluntarily cancel their registration and were no longer working at the home. The owner of the home was in the process of completing their application to become the new registered manager and was overseeing the running of the home on a day-to-day basis. 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.
The provider’s recruitment process was followed and this meant that people using the service received care from suitable staff. However, the manager had not followed their CQC action plan in full to ensure that all areas of improvement actions identified at the last inspection had been completed. We found that gaps in a new staff member’s employment history were known but not formally documented.
Although we saw that there was a sufficient number of staff to meet the needs of people living in the home the manager could not provide robust written evidence that the decision making process to determine safe staffing levels, was undertaken in conjunction with people’s assessed dependency levels.
The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) and report on what we find. We found that there were formal systems in place to assess people’s capacity for decision making. Applications had been made to the authorising agencies for people who needed these safeguards. Staff had a basic understanding of the key legal requirements of the MCA and DoLS.
People who lived at the home were supported by staff in a kind and respectful way. People had individualised care and support plans in place which recorded their care and support needs. The information was up-to-date and correct. Individual risks to people were identified by staff. Plans were put into place to minimise these risks to enable people to live as independent and safe a life as possible. These documents prompted staff on any assistance a person may require. However, monitoring records for people deemed to be at risk of weight loss or dehydration were not always documented in detail by staff. This meant that although people’s risks were identified and minimised by the manager and staff. There was an increased risk that the monitoring kept did not present a complete record.
Arrangements were in place to ensure that people were supported and protected with the safe management of their prescribed medication. Detailed ‘step-by-step’ guidance for staff about ‘as required’ medication was not always kept.
There was an ‘open’ culture within the home. People, their relatives, and visitors were able to raise any suggestions or concerns that they might have with staff and manager and feel listened too.
People were supported to access a range of external health care professionals and were supported to maintain their health. People’s health and nutritional needs were met.
Staff were trained to provide effective care which met people’s individual support and care needs. Staff understood their role and responsibilities to report poor care and suspicions of harm. Staff were supported by the manager to develop their skills and knowledge through regular supervisions, observations and training.
The manager sought feedback about the quality of the service provided from people living at the home. They had in place quality monitoring checks to identify areas of improvement required. However, these checks were not always formally recorded with a robust action plan detailing what action needed to be taken; by whom and by when to evidence that the improvement had been completed.
Notifications are information on important events that happen in the home that the provider is required to notify us about by law. The manager was not aware of all of the important events they needed to notify the Care Quality Commission about.