St Margaret's Nursing Home

Updated 15 January 2021

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was carried out by two inspectors on site and one Expert by Experience who carried out telephone and video calls with people and relatives. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

St Margaret’s Nursing Home 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.

The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority who commission the service. We also sought feedback from Healthwatch. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England. Healthwatch told us they had not visited the service or received any comments or concerns since the last inspection. A local authority commissioner told us they had not received any concerns about the service.

We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We used all of this information to plan our inspection.

During the inspection

We spoke with four people who used the service and four relatives about their experience of the care provided through video calls and through telephone calls. We spoke with seven members of staff including a cook, care staff, lead senior carer, a nurse, the registered manager. This included telephone calls with staff to help with social distancing within the service.

We reviewed a range of records. This included four people’s care records and multiple medicines records. We looked at three staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including audits, risk assessments and procedures were reviewed.

After the inspection

We continued to seek clarification from the provider to validate evidence found. We looked at training data and quality assurance records.

Updated 15 January 2021

About the service

St Margaret's Nursing Home is a nursing home providing personal and nursing care to 20 people aged 65 and over at the time of the inspection. Some people were living with dementia, some had mobility difficulties, sensory impairments and some were cared for in bed. Accommodation is

arranged over two floors. There was a passenger lift for access between floors. The service can support up to 25 people.

People’s experience of using this service and what we found

People told us they felt safe. Comments included, “They make sure everything is okay for you. They check you are alright, so I feel safe” and “They sort out my medication for me and they ask me if I want any pain killers. They always wait with you when you take your medicine.”

Relatives told us they were happy with the care their loved one’s received. Comments included, “The staff are brilliant, [loved one] is extremely well looked after” and “They know what to do, you couldn’t want for better staff.”

Staff had been recruited safely to ensure they were suitable to work with people. People had regular staff who they knew well. People were well supported by competent, knowledgeable and well-trained staff. Staff were well supported by the management team.

The premises were clean and free from odours. We were assured that the provider’s infection prevention and control policy was up to date. People and relatives told us, “I think the cleanliness is excellent”; “The room has been redecorated and new carpet and when I used to visit it was spotless. You never get any unpleasant smells”; “The staff always wear their PPE, so I am protected” and “Cleaning is fantastic, no smells ever.”

Risks to people’s safety had been well managed. Risks to the environment had been considered as well as risks associated with people's mobility and health needs. The provider continued to have systems in place to monitor accidents and incidents, learning lessons from these to reduce the risks of issues occurring again.

The design and layout of the service met people’s needs. Sign posts were in place which helped people living with dementia.

Prior to people moving in to the service their needs were assessed. These assessments were used to develop the person’s care plans and make the decisions about the staffing hours and skills needed to support the person.

Meals and drinks were prepared to meet people's preferences and dietary needs. Most people told us they liked to the food, some people told us the food was alright. We discussed this with the registered manager who arranged to do a meal survey with people.

The service was well-led. The management team carried out the appropriate checks to ensure that the quality of the service was continuously reviewed, improved and evolved to meet people’s changing needs. The registered manager promoted an open culture and was a visible presence in the service, staff felt listened to and valued.

People were protected from abuse and avoidable harm. People’s medicines were well managed. If people or their relatives wanted to complain they knew how to do so.

People were treated with dignity and respect. People’s views about how they preferred to receive their care were listened to and respected. People and relatives told us staff were kind and caring.

People had access to a range of different activities throughout the week. People told us that they took part in these. Activities were also provided for people who received their care and treatment in bed.

People received good quality care, support and treatment including when they reached the end of their lives. People had been involved in planning and discussions about their wishes and preferences in relation to their end of life care.

When people needed medical attention, this was quickly identified, and appropriate action was taken. For example, if people were losing weight referrals were made to dieticians, or if people fell regularly, they were referred to a fall’s clinic. Nursing staff worked closely with the GP and other health professionals.

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 and update

The last rating for this service was requires improvement (published 21 May 2019).

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

The inspection was prompted in part due to concerns received about staff training, moving and handling practice and some risks not being effectively managed. This inspection was also carried out to follow up on action we told the provider to take at the last inspection.

We found no evidence during this inspection that people were at risk of harm from this concern.

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 coronavirus and other infection outbreaks effectively.

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.