Archived: Margaret Allen House Residential Home

Margaret Allen House is a residential care home for 15 people, including people living with dementia. There are two floors accessed by a passenger lift and the lounge and dining room are based on the ground floor. An unannounced inspection took place on 24 and 30 August 2017. At the time of the inspection, 15 people were living at the home.

When we visited there was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like 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. However, during our inspection the registered manager was unavailable. The service was being overseen by a senior manager who was assisted by a team leader from another service. Since the inspection, the team leader has been promoted to manager.

After our inspection, we received information from the provider about a safeguarding alert, which was being investigated.

People living at the home were positive about living at the home and said they would recommend it to others. However, some people said they would like more to do to fill their time. People had good relationships with staff and they said staff were usually kind and caring. There had been some changes in the staff team but people mainly described the staff team as stable. Agency staff were being used to supplement the care team until newly recruited staff had completed their induction. People had not been provided with an opportunity to formally provide feedback on the service in the form of a survey. However, they felt informed about changes relating to the service.

The provider had created a Learning and Development Team that had set up an academy induction which starts staff on the Care Certificate. This ensured all newly recruited staff had received mandatory training before arriving on their first shift. This training took 6.5 days. The whole induction process takes six months once the staff member has completed further training on site in the care home. However, staff did not benefit from regular on-going support such as supervision, team meetings and observation of their practice. Staff morale was described by some team members as low, which they said negatively impacted on how the staff group worked as a team.

People were offered a choice of meals. They were supported with their health needs and had access to health professionals, when necessary. They told us staff respected their privacy and dignity. However, there were occasions when some staff practice undermined people’s privacy.

Staff knew how to recognise and respond to allegations of abuse. During the inspection, we shared feedback with the senior manager about concerns regarding staff practice, which a staff member said had not been managed appropriately. Subsequently the senior manager completed an investigation. Staff confirmed they had been spoken to about their practice but records were not found to corroborate this action. After our inspection, the senior manager completed an unannounced spot check visit to the home to monitor staff practice.

Staffing levels were based on a tool to assess the level of people’s care needs. Changes had been made to increase staffing availability at night in recognition of people’s increased needs. Following feedback during the inspection, the senior manager said the way the afternoon and evening shift was run would be reviewed. It had been identified that the staff rota had been poorly managed resulting in a risk of staff working excessive hours; this rota was now being overseen by senior staff to ensure there was an appropriate mix of staff skills and experience.

Quality assurance reports had highlighted improvements were needed in the running of the service. Care records and staff practice were not reviewed regularly to ensure they were meeting the needs of people. Risks to people were being reviewed and action was now taking place to ensure they were managed appropriately There had been delays in addressing the areas of concern highlighted by the quality assurance reports, including the security arrangements of the building. In response to these delays, a senior staff member from another service and a senior manager were now reviewing staff practice, care records and making environmental changes. They had begun work to deliver training to care staff in the completion of care records and risk assessments to make them effective and meaningful. As part of this review, improvements had been made to medicine practice at the home.

The Care Quality Commission (CQC) is required to monitor the operation of the Mental Capacity Act (2005) (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are put in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way, usually to protect themselves or others. At the time of the inspection two applications had been made to the local authority in relation to people who lived at the service. CQC had been notified about the outcome of one of these applications as it had been authorised, which they are legally required to do.

At the last inspection, the service was rated as Good. However, at this inspection the overall rating was Required Improvement. We judged there was one breach of regulation. You can see what action we told the provider to take at the back of the full version of the report.

Is the service safe?

The service was safe because improvements had been made to the management of medication. The registered manager recognised their responsibility to ensure equipment was well maintained and safe. However, we had some concerns around the management of identified risks to people's health and well-being. For example, the quality of records, relating to hydration and pressure area care, needed to be improved to show these risks were being managed to ensure people's safety and well-being. CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have needed to be submitted, the registered manager understood when an application should be made, and how to submit one.

Is the service effective?

People living at the home told us they were happy with the care at the home. People's health and care needs were assessed, and people were happy with the quality of their care. People living at Margaret Allen House told us there were residents' meeting, and said they generally felt listened to by staff, although their request for social activities to be increased had not been effectively addressed. People told us there was not enough to do and people said they were bored.

Is the service caring?

People were treated with respect and their dignity was maintained by the staff. People were supported by caring staff. People's opinions were sought by staff and people told us they felt listened to at residents' meetings. Our conversations with the registered manager and care staff demonstrated they were caring and committed to their role to provide good quality care.

Is the service responsive?

We looked at people's care plans and we saw the management team generally contacted health and social professionals appropriately when people's needs changed. However, there were delays to address areas of improvement identified by the provider as resources were not always provided to make the improvements occur in a timely manner.

Is the service well-led?

We could see steps had been taken to address performance issues for some staff to help them develop their skills. There were quality assurance processes in place to monitor the quality of the service for people living at the home.

There were 15 people living at the home on the day of our visit.

We spent time with all of the people living in the home and spoke more meaningfully with ten of the people. We spoke with five members of staff.

The home had a homely, friendly and respectful atmosphere. People told us "we are looked after properly" and "I can't fault anything".

Staff knew all the people's needs at the home well. Each person had a care file which contained all the information needed to meet their care needs fully.

People received nutritious, appealing and home cooked meals and were very complimentary of the food. Comments included "love the food", "cooking is good" and "it's (the food) very nice".

Staff demonstrated that they understood the signs of abuse and how to report any concerns. The home was aware of the process to follow in cases of suspected abuse.

People at the home told us that they did not have any complaints but that if they did they would speak to the manager.

We looked at the handling of medicines in the home and saw that these were not always being recorded accurately or safely.

Staff we spoke with were able to show a good understanding of the importance of determining if a person had the capacity to give consent to their care and treatment. We observed people being treated compassionately with their individual needs considered.

There was a relaxed atmosphere where people looked well cared for and were seen to be comfortable and at home in the environment. One person told us: "I'm very contented here, the staff are excellent". Another person who used the service told us: "I think it is really, really good here, the food is excellent and the staff are wonderful".

We were shown around the home by staff, decoration and carpets in some rooms appeared tired and stained. Hallways were clean without obstructions. Furniture was clean and functional.

We were also told: "I really enjoy working here and feel very supported by the senior carers". Each staff member told us they enjoyed their work and this was evident from the observations we made.

We were shown a comments book and a complaints book kept in the reception area, which any relative or visitor could document any complaints or concerns. No complaints had been recorded.