Care at Home Services (South East) Limited – Margaret House

Margaret House provides care and support to people living in specialist 'extra care' housing. Extra care housing is purpose-built or adapted single household accommodation in a shared site or building. The accommodation is rented or owned and is the occupant's own home.

There are 39 one and two-bedroom apartments at Margaret House. Not everyone who lived at Margaret House received personal care. CQC only inspects where people receive personal care; this is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided. There were 33 people receiving care and support at the time of this inspection.

People’s experience of using this service and what we found People told us they felt safe with staff who supported them. Risks to people had been identified and assessed and were managed safely by staff. Staff supported people to take their medicines or reminded them when they were due. People were protected from the risk of infection. Staff wore disposable aprons and gloves when providing people with personal care.

People spoke positively about the staff who supported them and had confidence in their skills and experience. Staff had regular supervisions and an annual appraisal. People enjoyed the lunchtime meals and some were supported by staff to prepare other meals in their homes. People had access to a range of healthcare professionals and support.

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

People were looked after by kind and caring staff who knew them well. In one person’s review they commented, ‘Excellent service, all staff lovely and caring'. People were encouraged to be involved in decisions relating to their care. People's diverse needs were catered for and they were treated with dignity and respect.

Care was personalised to meet people's needs. Care plans provided detailed information and guidance for staff on people's care and support needs, likes and dislikes, and the way they wanted to receive personal care. Information could be provided to people in an accessible format. Activities were organised according to people's preferences, interests and suggestions. Complaints were dealt with in line with the provider's policy.

People considered the service was well-organised. The care manager provided a visible presence and was available to people if they wished to discuss their care. People were encouraged in their involvement and development of the service and their feedback was encouraged. Quality assurance systems were in place to measure and monitor the standard of the service and drive improvement. Areas of concern identified at our previous inspection had been addressed.

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 5 November 2018).

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 was a planned inspection based on the previous rating.

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.

The accommodation is rented or partially owned, and is the occupant's own home. People's care and housing are provided under separate contractual agreements. The Care Quality Commission (CQC) does not regulate premises used for extra care housing; this inspection looked at people's personal care and support service. The building is owned by Saxon Weald and has a restaurant on site that provides a midday meal to everyone living at Margaret House under their service agreement. Communal areas are available on site where activities are provided.

Not everyone living at Margaret House receives the regulated activity. CQC only inspects the service being received by people provided with 'personal care'; help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided. At the time of the inspection, there were 21 people receiving the regulated activity.

This was the first inspection of the service since their registration with the CQC in March 2018, following a change in provider. Staff and the care manager (branch manager) were based in an office within the ‘extra care’ housing.

This inspection took place on 14 and 18 of September 2018. It was an announced visit, which meant the service was given 48 hours’ notice, to ensure staff were available to facilitate the inspection.

The service had an acting manager who was a registered manager at another service within the same organisation, and who had applied for registration as Manager of Margaret House with the CQC. 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.

Feedback that we received from people about staff and the service provided was very positive. However, the provider had not ensured all aspects of the service were safe or that the quality of the service was monitored. Systems and records did not support the safe management of medicines. Accidents and incidents were not recorded in a consistent way and did not demonstrate that they had been used effectively to reduce risks. They had not been reviewed or evaluated. Staff had not been trained on fire safety. Management systems had not been fully established to ensure suitable, accurate records were maintained in all areas. This included records relating to, accidents, medicines and ‘best interest’ meetings. We also found that the service had not notified CQC of all significant events which had occurred in line with their legal obligations in a timely way.

People were supported by staff they liked and who knew them well. Staff understood people’s needs and preferences. People were visited at times they wanted and staff stayed the correct amount of time to meet their individual needs.

There were enough staff working with the right skills to respond to emergency calls and people’s assessed needs. Staff had a good understanding of the procedures to follow to safeguard people from the risk of abuse and to protect people’s individual rights. People’s choices were assessed and staff delivered care in a person-centred way that reflected people’s wishes.

Staff recognised when people’s needs changed and staff ensured health and social care professionals were involved in regular reviews. Packages of care were updated as required and staff worked flexibly to respond to people’s needs.

People were supported by staff who were caring and kind and took account of people’s privacy and dignity. Where required, staff supported people to have enough to eat and drink and maintain a healthy diet.

There was an induction programme in place and rolling programme of essential training was being established. Staff were trained in the principles of the Mental Capacity Act 2005(MCA) and understood the importance of gaining consent from people. The management team knew the correct procedures to follow when people lacked capacity to make decisions.

People were asked for their view on the service and support they received and were aware of how to make a complaint. There was an open and positive culture at the service which had clear aims and objectives. Staff told us they felt supported, listened to and valued.

This is the first time the service has been rated Requires Improvement. We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of Regulation 18 of the Care Quality Commission (Registration) Regulations 2009. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.