Archived: Margaret Allen House Residential Home

Updated 14 November 2017

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked 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 a comprehensive inspection which was unannounced on the first day and took place on 24 and 30 August 2017. We announced the second day so that key staff members were available to assist with the inspection. The inspection was completed by one adult social care inspector.

Before the inspection, we reviewed the information we held about the home and notifications we had received. By law, CQC must be notified of events in the home, such as accidents and issues that may affect the service. We received 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 spoke with nine people about their experiences living at Margaret Allen House. However, some other people were not able to comment specifically about their care experiences, so we used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people living with dementia.

We reviewed three people’s care files, two staff recruitment files, staff training records and a selection of records relating to the management of the service. We also spoke with four staff members about their roles and training, and a senior manager and a senior care staff member from another home.

Updated 14 November 2017

Margaret Allen House is a residential care home for 15 people, including people living with dementia. There are two floors accessed by a passenger lift and the lounge and dining room are based on the ground floor. An unannounced inspection took place on 24 and 30 August 2017. At the time of the inspection, 15 people were living at the home.

When we visited there was 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 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. However, during our inspection the registered manager was unavailable. The service was being overseen by a senior manager who was assisted by a team leader from another service. Since the inspection, the team leader has been promoted to manager.

After our inspection, we received information from the provider about a safeguarding alert, which was being investigated.

People living at the home were positive about living at the home and said they would recommend it to others. However, some people said they would like more to do to fill their time. People had good relationships with staff and they said staff were usually kind and caring. There had been some changes in the staff team but people mainly described the staff team as stable. Agency staff were being used to supplement the care team until newly recruited staff had completed their induction. People had not been provided with an opportunity to formally provide feedback on the service in the form of a survey. However, they felt informed about changes relating to the service.

The provider had created a Learning and Development Team that had set up an academy induction which starts staff on the Care Certificate. This ensured all newly recruited staff had received mandatory training before arriving on their first shift. This training took 6.5 days. The whole induction process takes six months once the staff member has completed further training on site in the care home. However, staff did not benefit from regular on-going support such as supervision, team meetings and observation of their practice. Staff morale was described by some team members as low, which they said negatively impacted on how the staff group worked as a team.

People were offered a choice of meals. They were supported with their health needs and had access to health professionals, when necessary. They told us staff respected their privacy and dignity. However, there were occasions when some staff practice undermined people’s privacy.

Staff knew how to recognise and respond to allegations of abuse. During the inspection, we shared feedback with the senior manager about concerns regarding staff practice, which a staff member said had not been managed appropriately. Subsequently the senior manager completed an investigation. Staff confirmed they had been spoken to about their practice but records were not found to corroborate this action. After our inspection, the senior manager completed an unannounced spot check visit to the home to monitor staff practice.

Staffing levels were based on a tool to assess the level of people’s care needs. Changes had been made to increase staffing availability at night in recognition of people’s increased needs. Following feedback during the inspection, the senior manager said the way the afternoon and evening shift was run would be reviewed. It had been identified that the staff rota had been poorly managed resulting in a risk of staff working excessive hours; this rota was now being overseen by senior staff to ensure there was an appropriate mix of staff skills and experience.

Quality assurance reports had highlighted improvements were needed in the running of the service. Care records and staff practice were not reviewed regularly to ensure they were meeting the needs of people. Risks to people were being reviewed and action was now taking place to ensure they were managed appropriately There had been delays in addressing the areas of concern highlighted by the quality assurance reports, including the security arrangements of the building. In response to these delays, a senior staff member from another service and a senior manager were now reviewing staff practice, care records and making environmental changes. They had begun work to deliver training to care staff in the completion of care records and risk assessments to make them effective and meaningful. As part of this review, improvements had been made to medicine practice at the home.

The Care Quality Commission (CQC) is required to monitor the operation of the Mental Capacity Act (2005) (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are put in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way, usually to protect themselves or others. At the time of the inspection two applications had been made to the local authority in relation to people who lived at the service. CQC had been notified about the outcome of one of these applications as it had been authorised, which they are legally required to do.

At the last inspection, the service was rated as Good. However, at this inspection the overall rating was Required Improvement. We judged there was one breach of regulation. You can see what action we told the provider to take at the back of the full version of the report.