12 February 2015
During a routine inspection
The premises did not meet patient’s needs. The Margaret Centre was in need of refurbishment There were no suitable washing facilities for patients in the Margaret Centre. All the accommodation at the Margaret Centre was in single rooms which did not have en-suite toilet facilities. All patients used commodes due to the lack of toilet facilities rather than because of levels of independence or support needs. We also found concerns for the safety of patients due to the gas boiler room not meeting current fire regulations.
The service did not have effective systems to manage and monitor the prevention and control of infection. The service was not using clinical hand wash basins as required by a clinical setting. The service had no dedicated and compliant domestic cleaning facility which meant staff were storing hazardous substances in the gas boiler room putting patients at risk.
Record keeping and storage was not always safe. Clinical note files had a considerable volume of loose and ad hoc documents. We found on the day of the inspection it was not always easy to access information in a timely manner.
The majority of staff we spoke with told us they had not received a recent appraisal and did not have regular supervision meetings for the in-patient unit. The training information provided showed that most staff had not attended mandatory training in the last 12 months which included health and safety, medication, and Mental Capacity Act 2005 (MCA) & Deprivation of Liberty Safeguards (DoLS). Senior staff told us they could provide further documentation for supervision and appraisals however because of poor record keeping it could not be found.
We found staff morale was low. Staff told us they had no clear leadership for the service, high sickness levels, inappropriate acute admissions, and not enough investment in training needs for staff. Inadequate systems were in place to ensure the delivery of high quality care. During the inspection we identified failings in a number of areas. These included managing risks, infection control, record keeping, safety and suitability of premises, training and supporting staff.
Relatives told us they were happy with the care and support provided. We found that some systems were in place to help ensure people were safe. For example, staff had a good understanding of issues related to safeguarding vulnerable adults. People knew the procedures for reporting any concerns and had confidence senior staff would respond appropriately to any concerns raised. The service had a system to report and record accidents and incidents. Staff had a good understanding of the Mental Capacity Act 2005 (MCA) and DoLS. Medicines were stored and administered safely.
People in the community and patients of the service were able to access complimentary therapies. We found people and their relatives’ feedback was encouraged through questionnaires and regular listening events which provided opportunities to people and their relatives to address and discuss issues.
We found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.