Archived: Margaret Riley House

Margaret Riley provides respite care and support for a maximum of three people who live with learning disabilities. At the time of our inspection there was one person staying at the home. Margaret Riley is situated in a residential area of Blackpool close to local amenities. All bedrooms are situated on the first floor, which can be accessed by a stair lift. Two lounges and a dining area are available so people can choose where to relax.

A registered manager was in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

At the last inspection on 11 September 2014, we found the provider was meeting the requirements of the regulations.

During this inspection, we found concerns related to the monitoring and auditing of people’s care and safety. The registered manager failed to assess and establish systems to maintain their welfare. They had not always prevented the potential for risks through service audits and there were no localised policies to guide staff. This is a breach of Regulation 17 of Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 Good Governance.

You can see what action we told the provider to take at the back of the full version of the report.

Staff completed risk assessments to protect people from potential harm. They demonstrated a good understanding of how to safeguarding individuals from abuse or poor practice. People told us they felt safe and comfortable whilst receiving respite care. A relative added, “I can go away, relax and re-energise. Then I can come back ready to take [my relative] home and care for them again.”

We observed staff completed medication processes safely. They received training and competency checks to underpin their knowledge. Medicines were stored in a safe and clean environment. A relative told us, “The staff are good with the medication and do it safely.”

We found staffing levels were sufficient in meeting people’s needs in a timely manner. Staff told us their training provision assisted them in their roles and responsibilities. Although no new staff had been recruited for four years, staff files evidenced the registered manager employed suitable staff.

We observed staff supported people with a respectful approach. They were kind and had a good understanding of maintaining their dignity and privacy. A relative told us, “[My relative] says he would be much happier at the home than staying with me. That tells me he’s well-cared for.”

Mealtime options were flexible because staff discussed with people what they wanted on a daily basis. Care records held detailed information about food likes and dislikes as well as risk assessments to protect individuals against the risks of malnutrition.

Staff demonstrated a good understanding and practice of the Mental Capacity Act (MCA) and associated Deprivation of Liberty Safeguards (DoLS). Staff further demonstrated an awareness of the principles of consent. One staff member said, “We work at a slower pace and use pictures to check for consent and their understanding.”

Staff built care records around the requirements of the individual, including their preferences and wishes. They involved people and their relatives in the regular review of care planning to ensure this responded to their changing needs.

The registered manager led the home in a transparent way and involved staff and people in the running of the home. People were supported to comment about their experiences of respite care. A relative told us, “If I go in with a suggestion I know [the registered manager] would listen and change things straight away.”

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well-led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records.

Is the service safe?

People were comfortable and relaxed during our inspection. A relative told us, 'I know my daughter's safe when she's at the home, which is very reassuring to me'.

Our discussions with staff demonstrated they understood the needs of people they supported. Care plans we reviewed showed people's needs were identified, risk assessed and reviewed. This meant the provider had protected people from unsafe care by ensuring care planning and risk assessment was appropriate.

We found Margaret Riley House to be hygienic and well-maintained to enhance the well-being of people who received support. A relative told us, 'The house is always very clean and the d'cor is beautiful. My daughter loves staying there'. Although some staff required refresher training and there were no cleaning schedules, the manager assured us this would be addressed.

Staff, a service user who received support and their relative told us staffing levels were safe. A relative said, 'The staff are very experienced and have ample time to spend giving a quality service to my daughter'. This meant staffing levels deployed by the service were adequate to ensure the safety of people in their care.

Is the service effective?

People told us the home was efficient in meeting their needs. One person explained, 'The best thing is having the same staff every time I come to stay. I know and trust them and they know me and what help I need'.

Documents we reviewed showed support plans and risk assessments were individualised and updated. Support planning matched people's assessed needs. This meant people were protected against ineffective care provision because people's needs were adequately assessed.

We observed Margaret Riley House worked effectively with other providers. Staff amended care plans and support provided to people where changes occurred. Staff had a good understanding of how to co-operate with other providers in an emergency. A relative told us, 'They check with me if there have been any changes in my daughter's care between stays. The GP changed her medication recently and the staff have managed this well'.

Is the service caring?

The service user and relative we spoke with told us they found staff to be caring and compassionate. One person told us, "The staff are great. I get a bit sad sometimes and they sit and chat with me. I always feel better after that". A relative said, "I wouldn't want my daughter to go anywhere else. They're very caring".

Our discussions with staff showed they had respect and compassion for the people they supported. One staff member told us, "I absolutely love my job. It's what I've always wanted to do. I love supporting people'.

Is the service responsive?

Care records we reviewed evidenced where people's needs changed, care plans were amended to incorporate these changes. A relative told us, 'They check with me if there have been any changes in my daughter's care between stays'. This demonstrated the service had minimised the risks of unsafe care because the service had responded to people's changing needs.

The service worked well with other providers. One staff member told us, 'We plan ahead before the service user comes in for respite. This helps us to prepare and understand if people's needs have changed since their last stay'. This meant Margaret Riley House protected people from unsafe care because the manager had responded to their changing needs.

Is the service well-led?

There were some quality audits in place to monitor service delivery. The manager assured us further recorded audits would be put in place. Appropriate policies and other regular processes underpinned this, such as satisfaction surveys, staff meetings and staff supervision. This meant people were protected against inappropriate support because the manager had systems to check the quality of care.

Care planning was personalised and updated. Care delivery was well-led and there were clear lines of responsibility. A staff member told us, 'The manager is brilliant. She is an inspiration and I aspire to be like her. She's a great leader'. This meant care delivery was appropriate and safe because Margaret Riley House was well-led.

The home monitored and managed people's changing health needs by working closely with the individual's social worker. Staff described appropriate management of emergencies and working with other providers where this became necessary. This demonstrated the home managed people's changing needs or where emergency treatment was required.

During our inspection we looked at care and maintenance records and undertook a tour of the building. We also observed breakfast being served and spoke to the young person staying at the home and a relative of another person who had stayed at the home. We did this to confirm the young person was having their care needs met.

The young person told us she was receiving safe and appropriate care which was meeting her needs. She told us the staff were polite, caring and she liked them. The young person said, "I have stayed here many times. The staff are great with me'. We also spoke with the relative of another person who stays at the home. They told us their relative had been staying at the home for over four years and she was very happy with the service provided. The person said, 'My daughter loves staying here. She has a good relationship with the staff and has made lots of friends. She attends plenty of activities and enjoys her meals. They have lots of choices made available to them'.

During our inspection we contacted the Blackpool contracts monitoring team. They told us they currently had no concerns with the service being provided by the home.

The people currently staying at this home had been supported by the provider on a number of occasions. They told us they could express their views and were involved in decision making about their care. They said they were treated with dignity and respect and encouraged to take part in activities during their stay. They told us they were liked staying at the home and they felt safe and comfortable. They told us they were involved in decision making about their care and their views were always respected.

A relative we spoke with told us, 'You are always made welcome as the atmosphere is so friendly and warm.' And, 'I couldn't fault the home.'

Staff members we spoke with told us that they liked working at the home. They told us that the place has a homely feel. One person told us, 'It's like home from home.'