We carried out a review of the data available to us about St Margaret's Care Home on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about St Margaret's Care Home, you can give feedback on this service.
St Margaret’s Care Home is a care home providing personal and nursing care to up to 60 people. The service provides personal and nursing support to older people including people who live with a dementia. At the time of our inspection there were 47 people using the service.
People’s experience of using this service and what we found
People’s nutritional well-being was becoming better-monitored to support improved nutritional health. The provider’s systems for monitoring potential risk had been improved where people were at risk of weight loss.
Records provided guidance to ensure people received safe, person-centred care and support from all staff members.
Staff contacted health professionals when people’s health needs changed. Staff followed good infection control practices and the home was clean and well maintained.
People and relatives were positive about the caring nature of staff and had good relationships with them. They trusted the staff who supported them. People said they felt safe with staff support.
There was a welcoming, cheerful and friendly atmosphere at the service. Staff spoke positively about working at the home and the people they cared for. They said communication was more effective to ensure they were kept up-to-date about any changes in people’s care and support needs.
People's diversity as unique individuals with their own needs was respected by staff. The staff team knew people well and provided support discreetly and with compassion.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
The last rating for this service was good (published 11 February 2020).
Why we inspected
The inspection was prompted in part due to concerns received about people's nutritional health. A decision was made for us to inspect and examine those risks.
The provider had taken effective action to mitigate the risk. We found no evidence during this inspection that people were at risk of harm from these concerns.
Please see the safe and effective sections of this report.
We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.
The overall rating for the service has not changed following this targeted inspection and remains good.
We use targeted inspections to follow up on Warning Notices or to check concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.
For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for St Margaret’s Care Home on our website at www.cqc.org.uk.
Follow up
We will continue to monitor information we receive about the service, which will help inform when we next inspect.
St Margaret’s is a residential care home providing accommodation, nursing and personal care to 55 older people at the time of the inspection. The service can support up to 60 people.
People’s experience of using this service and what we found
We received positive feedback from people, who told us they were happy living at St Margaret’s. They told us they felt safe with the level of staff available. People and their relatives were happy with the care, support and range of activities on offer.
People received person-centred support and staff knew people well. The care plans in place covered all aspects of people’s care and support preferences to ensure a personalised experience. People were supported to maintain important personal relationships with friends and relatives. There were systems in place for communicating with staff, people and their relatives to ensure they were well-informed about the service.
People were supported to have their say and to exercise their rights and access to advocacy was available if required. Information could be made available for people in the correct format. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.
Healthcare professionals the registered manager and staff team were all included in people’s care and support as and when needed. People who needed specialist diets were supported.
The environment was clean and maintained to a good standard with personalised bedrooms. Audits and monitoring systems were used effectively to manage the service and to make improvements as and when required. There were enough staff to support people and staff were always visible. Staff received support and a variety of appropriate training to meet people’s needs.
Medicines were managed well, safely administered and recorded accurately. Individualised risk assessments were in place. Staff were confident they would raise concerns to safeguard people. Robust recruitment and selection procedures ensured suitable staff were employed.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection and update
The last rating for this service was requires improvement (published 31 May 2019). There was also an inspection on 5 July 2019 however, the report following that inspection was withdrawn as there was an issue with some of the information that we gathered.
The last rating for this service was requires improvement (9 January 2019) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.
Why we inspected
This is a planned re-inspection because of the issue highlighted above.
Follow up
We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
People’s experience of using this service: People told us they felt safe. They knew who to report any concerns to and were happy with the support they received from staff. Arrangements were in place to protect people from risks to their safety and welfare. Staff understood how to keep people safe and used information following incidents to reduce the likelihood of reoccurrence. Effective recruitment procedures were in place and staff received appropriate training.
Effective management systems were in place to monitor and audit the quality and safety of the service. Action was taken to address concerns identified by the provider through checks of the service. People and their relatives were involved in discussions about the service. Records were stored securely however some records were not up to date.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection: Requires Improvement (report published 22 May 2018).
At our last inspection we found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014. This related to safe care and treatment and good governance. This was because risks associated with people's care were not always identified and mitigated. The provider did not have effective quality assurance processes to monitor the quality and safety of the service provided to people. Care records did not always contain up to date and relevant information about people's care needs.
Why we inspected: This was a focused inspection. Since our last inspection we had received concerns identified by the provider in relation to the management of people’s personal allowances. We undertook a focused inspection to consider those concerns. We looked at our domains 'safe' and 'well led'. This report only covers our findings in relation to these concerns.
Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.
St Margaret’s is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. St Margaret’s Care Home provides personal care for up to 60 people. At the time of our inspection there were 48 people living at the home who received nursing and personal care, some of whom were living with a dementia. The service consists of three units or ‘communities’ as the provider called them: Cathedral, St Cuthbert’s and Prince Bishops.
A registered manager was in place at the time of our inspection. 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.
We last inspected this service in February 2016 when it was rated ‘Good’ overall. During this inspection we found the service had deteriorated to ‘Requires Improvement.’
During this inspection we found breaches of Regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because risks associated with people's care were not always identified and mitigated. Pressure relieving mattresses were not always set correctly or checked regularly and people's positional changes were not always documented which increased people's risk of developing pressure damage. The provider did not have effective quality assurance processes to monitor the quality and safety of the service provided to ensure people received appropriate care and support. Care records did not always contain up to date and relevant information about people's care needs.
You can see what action we told the provider to take at the back of the full version of the report.
People and relatives spoke positively about the service. There were enough staff to meet people’s needs in a timely way.
Staff had received training in safeguarding and knew how to respond to any allegations of abuse. Safeguarding referrals had been made to the local authority appropriately. When new staff were appointed, thorough checks were carried out to make sure they were suitable to work with vulnerable adults.
Staff training in key areas was mostly up to date. Staff received regular supervisions and told us they felt well supported by the registered manager.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.
Records relating to people’s fluid intake were incomplete. People were supported to attend appointments with healthcare professionals. Meal times were relaxed and a pleasant experience for people who lived at the service.
Each person who used the service was given information about how to make a complaint and how to access advocacy services. An advocate is someone who represents and acts on a person's behalf, and helps them make decisions.
People and relatives we spoke with knew how to make a complaint. They told us they could speak to a member of staff, the registered manager or raise issue through the residents’ committee if they had any issues.
There was a homely atmosphere at the service and the accommodation was clean and decorated to a good standard.
People, relatives and staff told us the registered manager was approachable.
St Margaret’s Care Home provides care and accommodation for up to 60 elderly people who require nursing or residential care. On the day of our inspection there were 50 people using the service.
The home had a registered manager 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.
St Margaret’s Care Home was last inspected by CQC on 27 April 2014 and was compliant with the regulations in force at that time.
Accidents and incidents were appropriately recorded and investigated. Risk assessments were in place for people who used the service and staff and described potential risks and the safeguards in place. Staff had been trained in safeguarding vulnerable adults.
Appropriate arrangements were in place to ensure that medicines had been ordered, stored and administered appropriately.
The home was clean, spacious and suitable for the people who used the service and appropriate health and safety checks had been carried out.
There were sufficient numbers of staff on duty in order to meet the needs of people who used the service. The provider had an effective recruitment and selection procedure in place and carried out relevant checks when they employed staff. Staff were suitably trained and training sessions were planned for any due or overdue refresher training. Staff received regular supervisions and appraisals.
The provider was working within the principles of the Mental Capacity Act and was following the requirements in the Deprivation of Liberty Safeguards.
People were protected from the risk of poor nutrition and staff were aware of people’s nutritional needs. Care records contained evidence of visits to and from external health care specialists.
People who used the service, and family members, were complimentary about the standard of care at St Margaret’s Care Home. Staff treated people with dignity and respect and helped to maintain people’s independence by encouraging them to care for themselves where possible.
Care records showed that people’s needs were assessed before they moved into St Margaret’s Care Home and care plans were written in a person centred way. The provider sought alternative methods in supporting people with their care needs.
The home had a full programme of activities in place for people who used the service to help meet their social needs.
The provider had an effective complaints policy and procedure in place and people knew how to make a complaint.
The service had links with the local community and local organisations. The service had a positive culture that was person-centred, open and inclusive. The provider had a robust quality assurance system in place. People who used the service, family members and staff were regularly consulted about the quality of the service.
Everyone we spoke with was complimentary about the care provided. People told us the staff were always smiling and treated them with respect. One person said 'It's marvellous here. I'll give it ten out of ten.'
Overall we found significant improvements had been made since we last visited in October 2013.
People told us 'They (the staff) are alright. They don't bother you,' 'Personally speaking I cannot grumble,' 'I can go to bed when I want to,' 'It's lovely here,' 'I feel well cared for' and 'I find it absolutely marvellous here.'
However, despite these positive comments we found peoples' care and welfare needs were not planned in a way which ensured their safety and welfare. This was because for some people had been assessed as at risk of developing a pressure ulcer but no risk management plans had been put in place to guide staff and to ensure people's safety.
People who used the service were given appropriate information and some were involved in making decisions about their care and treatment. However, we found some people were not treated with dignity and respect. For example, when talking to people staff used phrases like 'Don't do that!' and 'Leave the table alone'.
We found that there were sufficient staff to meet peoples' needs. There was also an effective complaints procedure in place so people knew their views would be listened to.