Archived: Margaret House

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well-led?

During this inspection we spoke with four people using the service and two visitors. We spoke with two care staff and the owner of the home. We viewed records which included, three care plans and daily care records, policies and procedures, maintenance records and quality assurance information.

We considered the evidence we had gathered under the outcomes. This is a summary of what we found:

Is the service safe?

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We were told no applications had needed to be submitted. Brief training around the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS) had been provided for some staff. The owner had an awareness of the procedures however policies and procedures were not yet available for staff to refer to if needed.

Staff had attended Mental Health Awareness and dementia training. This should help staff to understand and meet people's complex mental health needs.

People had access to a range of appropriate, well maintained equipment to safely meet their needs and to promote their independence and comfort. Staff were competent to use the equipment safely and properly.

Is the service effective?

Regular reviews were carried out to respond to any changes in people's needs and to ensure the level of care was appropriate. People told us they were offered choices and had been involved in agreeing and reviewing their support plan. We observed staff seeking people's opinions and offering advice and support as needed. One person said, 'I do more or less what I want but staff are here to give me help and advice'.

From looking at records we found the service had good links with health care professionals to make sure people received prompt, co-ordinated and effective care. We spoke with a district nurse. We were told staff notified them of any issues relating to their 'patient's' health and well-being and that any instructions they gave were followed. The nurse told us, 'People are happy enough. They (the staff) are very good with them'.

Is the service caring?

People told us they were happy with the care and support they received at Margaret House. Comments from people living in the home included, 'It is very good here', 'I am well looked after' and 'I can come and go as I please but I know the staff are here to help me when I need'. Visitors told us, 'It is a superb place; they are treated as individuals', 'They have the freedom they need' and 'Staff are great, very friendly'.

We observed staff interacting with people in a pleasant and friendly manner and being respectful of people's choices and opinions and we observed staff responding kindly and patiently to a person who presented with behaviour that challenges.

Is the service responsive?

We found people's needs were assessed by suitably experienced staff, prior to admission to Margaret House, to determine whether they could be looked after properly. The care plans contained information about people's preferred routines, likes and dislikes which would help staff to look after them properly and help ensure people received the care and support they needed and wanted.

People's health and well-being was considered and appropriate advice and support had been sought in response to changes in their condition. One person said, "I have seen the doctor and they make sure I get all my medicines'. Visitors told us, 'It is good care; he has improved physically'. However, risks relating to nutrition, falls, moving and handling or skin integrity were not always assessed. This meant the risks to people's health may not be recognised in a timely way.

There were opportunities for involvement in a range of suitable activities both inside and outside the home. People were active in the local community and maintained contact with friends and family. Holidays were planned for small groups of people with similar interests and people were free to plan their day with staff responding flexibly to their wishes. Activities were tailored to people's individual needs and preferences.

People told us they had no complaints about the service but were confident they could raise their concerns with any of the staff. Comments included, 'I would tell the staff right away if I was unhappy' and, 'They ask me if I am happy or not'.

Is the service well-led?

The owner was responsible for the day to day management of the service and was registered with the Care Quality Commission (CQC).

People were encouraged to express their views and opinions of the service through regular 'chat' meetings and reviews, during day to day discussions with staff and management and by completing customer satisfaction surveys. People were kept up to date and involved with any decisions about how the service was run.

There were systems in place to monitor the quality of the service with evidence these systems identified any shortfalls. Improvements had been made which should help to protect people from poor care standards and identify any areas of non-compliance.

Any incidents and/or safeguarding concerns had been reported to the appropriate agencies. Staff were aware of the procedures for reporting any concerns about poor practice.

We looked at the care files for three people who used the service. The manager told us that following the last inspection they had introduced new documentation. We saw records that included personal details and a personal record sheet. This identified where people who used the service had undertaken activities or had visits for example, from the GP. All had been dated and signed by staff.

We spoke with three people who used the service. We received complementary feedback about the manager, owner and staff and care they received. Some examples of comments received were, 'The home is brilliant, it feels like home, the best I have ever seen. I have been through my care file and I agree with my care'. Another told us, 'The staff go through my care file with me regularly. I have signed and agree with my care' and, 'I am happy with my care the staff have gone through my records with me'.

We spoke with six people living in the home who told us they were happy with the care and support they received. Comments included, "It's a lovely place" and "I'm very well looked after; the staff are really good to us".

People told us they enjoyed the food served at the home. Comments included, "The food is very good " and "We get well fed here".

We looked at how people's medicines were managed and found that staff managed people's medicines safely. However we noted that medicines that required refrigeration required separate storage from the home's kitchen refrigerator.

Most of the care staff had achieved a recognised qualification in care, which would help them to look after people properly. We observed staff interacting with people in a pleasant and friendly manner and being respectful of people's choices and opinions.

People spoken with told us there were sufficient staff to look after them. People made positive comments about the staff team such as, 'There are always enough staff here' and 'They take us out and are kind to us'.

We found that risk assessments required to be kept to protect the safety and wellbeing of people who used the service were not always accurate or up to date and there was a potential for risk of harm to people who used the service.