Archived: Queen Margaret's Care

Updated 4 October 2016

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 and to look at the overall quality of the service under the Care Act 2014.

We undertook an unannounced focused inspection of Queen Margaret’s Care on 11 and 12 August 2016. This inspection was done to check that improvements to meet legal requirements planned by the provider after our 13 and 17 November 2015 inspection had been made.

The team inspected the service against two of the five questions we ask about services: is the service safe and well led. This is because the service was not meeting some legal requirements in these areas at the last inspection. The inspection was undertaken by two adult social care inspectors and a specialist nurse advisor.

Prior to our inspection we reviewed all of the information we held about the service. We considered information which had been shared with us by the local authority and by family and friends who were important to those people currently living at the service. We also considered information shared with us by the Coroner and by North Yorkshire Police regarding concerns raised following the death of a service user at the home prior to our inspection in November 2015.

We received a Provider Information Return (PIR) from the service. This is a form that asks the registered provider to give some key information about the service, what the service does well and improvements they plan to make. We used the information on the completed PIR to support our judgements and also gathered information we required during the inspection visit. We examined notifications sent to CQC as part of the service’s statutory duty to inform CQC of certain events and incidents.

During our inspection we spoke with eleven people who lived at the service, four visitors and eleven members of staff across the two days of inspection. The staff we spoke with included two nurses, the Registered Manager, and eight care staff. After the inspection we spoke with two health care professionals and a social care professional.

We looked at selected areas of the home, including some people’s bedrooms. We looked at shower rooms, toilets and all communal areas. We looked at eleven care records and associated documentation such as clinical monitoring charts. We also looked at records relating to the management of the service; for example, staff duty rotas.

We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people when we are unable to speak with them. We observed the lunchtime experience and interactions between staff and people living at the home.

Updated 4 October 2016

We carried out an unannounced comprehensive inspection of this service on 13 and 17 November 2015. Breaches of legal requirements were found as follows:

Regulation 12 HSCA (RA) Regulations 2014, safe care and treatment. The provider had not ensured that risk was sufficiently assessed and acted upon to care for people safely.

Regulation 17 HSCA (RA) Regulations 2014, good governance. Records relating to the care and treatment of each person using the service were not always well kept or fit for purpose.

Regulation 18 HSCA (RA) Regulations 2014, staffing. There were insufficient numbers of well deployed, suitably qualified, competent, skilled and experienced persons to care for people safely.

After the comprehensive inspection, the provider wrote to us, and provided us with an action plan, saying what they would do to meet legal requirements in relation to the above breaches.

We undertook this unannounced focused inspection on 11 and 12 August 2016 to check that the provider had followed their action plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Queen Margaret’s Care on our website at www.cqc.org.uk”

Queen Margaret’s Care is a service which provides care and support for up to 44 older people with nursing care needs. Some of the people cared for may be living with dementia, have a learning disability and/or have a sensory impairment.

There is a passenger lift to assist people to the upper floors and the service is located close to local shops with an accessible area to the front and side of the property. On the days of inspection there were 32 permanent residents and two people who were staying at the service for a short stay. A previous suspension on admissions from the local authority had been relaxed to allow four admissions a month. This was because the local authority commissioners had decided that the quality and safety of care at the service had improved. The service was also accepting privately funded admissions.

The home had a registered manager. A registered manager is a person who has registered with the Care Quality Commission 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. A new manager had registered with CQC since the last comprehensive inspection.

People were cared for safely in line with their plans of care and associated risk management plans. People’s care was consistently monitored to ensure that they were protected from harm, while not being unduly restricted.

Staff understood the risks associated with people’s care and carried out care in a way which minimised those risks. For example staff moved people in a way which protected them from harm. The people who lived at the service, their visitors, health professionals, social care professionals told us that people were cared for safely. This meant that the registered provider was no longer in breach of regulation 12 HSCA (RA) Regulations 2014, safe care and treatment.

Staffing ratios had improved to ensure people were cared for safely. Staffing was planned in line with a recognised dependency tool to ensure there were sufficient staff at all times to meet the needs of each person who lived at the home. We saw that care was unhurried and that staff had time for people. People who lived at the service, health professionals and social care professionals told us they had noticed that staffing ratios were improved. We observed that the care offered to people was well paced and attentive. This meant that the registered provider was no longer in breach of regulation 18 HSCA (RA) Regulations 2014, staffing.

Record keeping had improved across a range of records including risk management plans, care plans, daily observation notes, clinical monitoring charts and audits of such areas as infection control and medicine handling. The registered manager had implemented a range of checks and guidelines to ensure that records were completed consistently and that they contained information which was relevant to monitoring the safety and quality of care. This meant that the registered provider was no longer in breach of regulation 17 HSCA (RA) Regulations 2014, good governance.