Archived: The Margaret Centre

Updated 22 May 2015

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This was an unannounced inspection. The inspection team consisted of two inspectors, a pharmacy inspector, palliative care specialist, and estates and facilities specialist. We visited the service on 12 February 2015 and spoke with five relatives of people who used the service. We also spoke with six registered nurses, the nurse manager for the community team, the hospital matron, two medical consultants, clinical lead nurse for infection control and prevention, head of complimentary therapies, head of estates and facilities, deputy director of estates and facilities, head of health and safety management, the housekeeper and a kitchen assistant . We looked at three patient files, a range of audits, minutes for various meetings, accidents and incidents records, four staff recruitment files, health and safety folder, food menus, and policies and procedures for the service. We spent time observing interaction between patients who were staying at the service, relatives and staff. We looked at facilities and the building which included bedrooms, office accommodation, treatment areas, refreshment areas, communal lounge, and shared bathroom for the service.

Before our inspection, we reviewed the information we held about the service. This included the last inspection report for November 2013. Before the inspection the provider completed a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We also contacted the local authority safeguarding team and clinical commissioning group.

Updated 22 May 2015

The premises did not meet patient’s needs. The Margaret Centre was in need of refurbishment There were no suitable washing facilities for patients in the Margaret Centre. All the accommodation at the Margaret Centre was in single rooms which did not have en-suite toilet facilities. All patients used commodes due to the lack of toilet facilities rather than because of levels of independence or support needs. We also found concerns for the safety of patients due to the gas boiler room not meeting current fire regulations.

The service did not have effective systems to manage and monitor the prevention and control of infection. The service was not using clinical hand wash basins as required by a clinical setting. The service had no dedicated and compliant domestic cleaning facility which meant staff were storing hazardous substances in the gas boiler room putting patients at risk.

Record keeping and storage was not always safe. Clinical note files had a considerable volume of loose and ad hoc documents. We found on the day of the inspection it was not always easy to access information in a timely manner.

The majority of staff we spoke with told us they had not received a recent appraisal and did not have regular supervision meetings for the in-patient unit. The training information provided showed that most staff had not attended mandatory training in the last 12 months which included health and safety, medication, and Mental Capacity Act 2005 (MCA) & Deprivation of Liberty Safeguards (DoLS). Senior staff told us they could provide further documentation for supervision and appraisals however because of poor record keeping it could not be found.

We found staff morale was low. Staff told us they had no clear leadership for the service, high sickness levels, inappropriate acute admissions, and not enough investment in training needs for staff. Inadequate systems were in place to ensure the delivery of high quality care. During the inspection we identified failings in a number of areas. These included managing risks, infection control, record keeping, safety and suitability of premises, training and supporting staff.

Relatives told us they were happy with the care and support provided. We found that some systems were in place to help ensure people were safe. For example, staff had a good understanding of issues related to safeguarding vulnerable adults. People knew the procedures for reporting any concerns and had confidence senior staff would respond appropriately to any concerns raised. The service had a system to report and record accidents and incidents. Staff had a good understanding of the Mental Capacity Act 2005 (MCA) and DoLS. Medicines were stored and administered safely.

People in the community and patients of the service were able to access complimentary therapies. We found people and their relatives’ feedback was encouraged through questionnaires and regular listening events which provided opportunities to people and their relatives to address and discuss issues.

We found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.