Archived: Queen Margaret's Care

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.

People told us that staff were considerate. One visitor told us "The staff understand the advice given by the community psychiatric nurse and work well with (my relative) to make sure they are as settled as they can be.'

We found that people were consulted about their care and that people and their families were involved in decisions about care.

We saw that the home assessed people's care needs and developed care plans which were reviewed with risk assessments in place. The home consulted with specialists where necessary to ensure people had the benefit of expert advice.

There had been a number of safeguarding referrals to the local authority since the last inspection. We saw that the management had responded to the results of investigations and that improvements to safety had been made.

We saw that the home was working with the social care community pharmacy team to make improvements to the way medication was handled. Improvements had been made which meant people's medication was appropriately managed.

People were living in a safe and secure environment.

The home monitored the quality of its service through surveys and internal systems so that improvements could be identified and put in place.

We found that some people were consulted about their care on a daily basis and some peoples' views were difficult to obtain so that staff were not always able to include them in their care. We found that although people had their basic needs met, staff could not always assure peoples' optimum comfort and occupation, because of the difficulty obtaining views. We found that in some areas of the nursing home bedrooms were cold, carpets were worn and there were unpleasant odours. We found other bedrooms to be warm, well maintained and fresh. We found other areas of the nursing home to have satisfactory carpets.

We found that while people had been safeguarded from harm because of the provider's action and having a safeguarding procedure in place, the provider had not appropriately followed the procedure on one occasion. We found that although there were sufficient numbers of care and cleaning staffing employed and there were sufficient care and cleaning hours allocated, people were not given the attention and support they needed and the home was not as clean as it could be.

We found that complaints were handled appropriately but that complaint records had not been well maintained. Some records in case files that related to people that used the service were incomplete.