St Margarets Nursing Home

Updated 28 January 2022

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008.

As part of CQC’s response to care homes with outbreaks of COVID-19, we are conducting reviews to ensure that the Infection Prevention and Control (IPC) practice is safe and that services are compliant with IPC measures. This was a targeted inspection looking at the IPC practices the provider has in place. We also asked the provider about any staffing pressures the service was experiencing and whether this was having an impact on the service.

This inspection took place on 20 January 2022 and was announced. We gave the service one days notice of the inspection.

Updated 28 January 2022

St Margaret's is a care home which provides nursing care and support for up to 28 predominantly older people. At the time of the inspection there were 27 people living at the service. Some of these people were living with dementia. The service occupies a detached house over two floors with a passenger lift for access to the upper floors.

This unannounced comprehensive inspection took place on 15 November 2018. The last comprehensive inspection took place on the 5 December 2017 when the service was not meeting the legal requirements. We issued a warning notice against the service due to repeated breaches of the regulations. The service was rated overall as Requires Improvement at that time.

We carried out a focused inspection on the 8 February 2018 to review the actions taken by the service to meet the requirements of the warning notice. At that time, we inspected the service against two of the five questions we ask about services: is the service well led and is the service safe? No risks, concerns or significant improvement were identified in the remaining Key Questions through our ongoing monitoring or during our inspection activity so we did not inspect them. The service had taken action to address the concerns we had regarding fire door closures, oxygen signage and very hot water coming from the hot taps in sinks used by people living at the service. We had been concerned that there were not enough appropriately sized moving and handling slings to meet people’s needs. At the focused inspection we found the service had ensured each person had their own appropriately named sling. Infection control issues highlighted at the December 2017 inspection regarding overflowing bins without lids, and sluices which were unlocked had been addressed. Staff recruitment had been reviewed to ensure all staff had appropriate checks completed before commencing working at the service. Whilst the service had met the requirements of the warning notice we required a period of embedded and sustained improvement before the overall rating of the service was changed. We carried out this comprehensive inspection to review the service’s overall rating.

People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

We spent time in the communal areas of the service. Staff were kind and respectful in their approach. They knew people well and had an understanding of their needs and preferences. People were treated with kindness, compassion and respect.

People told us, "There is always enough staff. I can talk to any of the staff if I was worried and they listen and help you. One carer is one of the best, they know me and I know I don’t need to worry about anything whilst they are around,” “They (staff) do make sure I have my medication on time especially my Insulin. They always ask if I am in pain and if so they will give me something to ease the pain.”

The service was warm, comfortable and appeared clean with no odours. People’s bedrooms were personalised to reflect their individual tastes. The service had some pictorial signage to support people who were living with dementia, who may require additional support with recognising their surroundings. The premises were regularly checked and maintained by the provider. Equipment and services used at St Margaret's were regularly checked by competent people to ensure they were safe to use.

Care plans were well organised and contained accurate and up to date information. Care planning was reviewed regularly and people’s changing needs were recorded. Daily notes were completed by staff.

The service had identified the minimum numbers of staff required to meet people’s needs and these were being met. The service had no staff vacancies at the time of this inspection.

There were systems in place for the management and administration of medicines. It was clear that people had received their medicine as prescribed. Regular medicines audits were being carried out on specific areas of medicines administration and these were effectively identifying if any error occurred such as gaps in medicine administration records (MAR).

Meals were appetising and people were offered a choice in line with their dietary requirements and preferences. Where necessary staff monitored what people ate to help ensure they stayed healthy. People told us, “There is always plenty to drink but I like to have a beer a day and friends bring that in,” “I think meals here are second to none. Fantastic and a lot of choice, I always eat in the dining room and food is hot if meant to be hot” and “I eat very little. The food here isn’t too bad and you get a couple of choices. I eat in my room as the meals are at set times.”

People had access to activities. An activity co-ordinator was not in post but care staff shared the provision of activities. There was little recording of who attended activities and if people enjoyed them. People told us they were bored, and “There are no activities here apart from watching TV,” “I would say no activities take place here, very little goes on here. I like a singer but she only comes once a month. We do have fish and chips Fridays. which I look forward to.” We discussed this with the registered manager who assured us they would discuss the provision of relevant and meaningful activities with people. We have made a recommendation about this in the Responsive section of this report.

The use of technology to help improve the effectiveness of care provision was limited. People did have call bell to summon assistance when needed.

Staff were supported by a system of induction training, supervision and appraisals. The registered manager had records that enabled them to have an overview of staff support requirements.

Risks in relation to people’s daily life were assessed and planned for to minimise the risk of harm. However, we found some care plan reviews did not always incorporate a review of all risk assessments.

People were supported by staff who knew how to recognise abuse and how to respond to concerns. The service held appropriate policies to support staff with current guidance.

People's rights were protected because staff acted in accordance with the Mental Capacity Act 2005. The principles of the Deprivation of Liberty Safeguards were understood and applied correctly. However, some consent forms had been signed by family members who did not hold the legal power to consent on behalf of another person. The registered manager addressed this during the inspection.

There were effective quality assurance systems in place to monitor the standards of the care provided. Audits were carried out regularly by nurses and senior management staff. However, we identified that some aspects of the care plan reviews were not always robust.

The registered manager was supported by a deputy manager, the provider and a team of motivated and long standing staff. The staff team felt valued and morale was good.

Staff told us, “I am happy here, we get good support,” “In all the years I have been here I think this is the best St Margaret's has ever been” and “We all get on and it's like a family.”