CQC report explained · a residential care home
What the CQC found at Margaret House Care Home Ltd
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
- Safe?
- Requires improvement
- Risks had not always been reviewed or managed. Inspectors found unsafe medicines management, hazards in the building and inconsistent monitoring of two people's blood sugar levels.
- Effective?
- Requires improvement
- Staff had suitable training and people could access healthcare, but DoLS applications did not have supporting care plans or evidence of best-interests meetings. Health monitoring and food and fluid records were not always consistent.
- Caring?
- Requires improvement
- Inspectors saw sensitive and caring interactions, and people were generally satisfied. However, privacy was not always protected and some bedrooms and bedding were not well presented.
- Responsive?
- Requires improvement
- Care plans were sometimes brief, out of date or not accessible to staff, and one person had no care plan on file. People reported few activities and limited opportunities to discuss their experience.
- Well-led?
- Requires improvement
- The provider had audits and a positive culture, but these checks had not identified or corrected several problems. Records, medicines management, risk monitoring and opportunities for people to give feedback were not managed effectively.
What inspectors found, November 2022
Rated Requires Improvement; inspectors found kind staff but unsafe medicines, gaps in risk records and weak care planning.
Inspectors visited on 3 and 4 October 2022. The first visit was unannounced. They spoke with eight people, staff, the deputy manager, the nominated individual and a healthcare professional. They observed care, toured the building and checked care plans, staff files, medicines records and management records.
People said staff were helpful, pleasant and kind. Inspectors found enough staff, positive caring interactions, suitable training and support to access healthcare. People were satisfied with the food and felt safe. Infection control arrangements were also considered suitable.
There were important shortfalls. Risks were not always reviewed or managed, medicines were not always handled safely, and some records were incomplete or inconsistent. One person did not have an accessible care plan. Privacy, bedroom condition, activities and opportunities for people to give their views also needed improvement.
All five areas were rated Requires Improvement. The overall rating fell from Good at the previous inspection, published in 2019. The provider sent an action plan after the inspection, and the CQC said it would monitor progress.
Enough staff
Inspectors saw enough staff on duty and found a consistent staffing level. People said staff were usually available when needed.
“We observed there were sufficient staff deployed to meet people's needs.” from the report
Kind interactions
People spoke positively about staff, and inspectors observed sensitive and caring relationships during the visit.
“We observed sensitive and caring interactions between people living in the home and the staff.” from the report
Staff training
Staff received training that was refreshed regularly, and staff had annual appraisals.
“Staff confirmed they were provided with appropriate training which was refreshed at regular intervals.” from the report
Infection control
Inspectors were assured that the home had suitable arrangements for preventing and managing infection outbreaks.
“We were assured the provider was making sure infection outbreaks could be effectively managed.” from the report
Food choices
People were satisfied with the meals, and a choice was available. Inspectors found the lunchtime meal appetising and well presented.
“The meal looked appetising and well-presented.” from the report
Risks and building hazards
seriousRisk assessments were not always reviewed or complete. Inspectors found hazards including windows without restrictors, unsecured wardrobes and exposed wiring in the laundry area.
“Individual risks to people's health and safety had been assessed and recorded as part of the care planning system. However, the risk assessments had not always been reviewed and updated.” from the report
Medicines errors
seriousInspectors found errors in controlled-drug records, incorrect or unclear instructions and problems with medicine storage and equipment.
“People's medicines were not always managed safely.” from the report
Care plans and records
needs fixingSome care plans were out of date or too brief, and one person had no care plan available to staff. Health, food and fluid monitoring records were also not consistently completed.
“The provider had arrangements for developing individual care plans, however, the plans had not always been updated and there was no care plan on file for 1 person living in the home.” from the report
Privacy and bedroom condition
needs fixingMost bedroom windows did not have curtains, some blinds were broken, and a bathroom window had clear glass. Some bedrooms and bedding also needed improvement.
“This meant if people forgot to use the blinds, their privacy could be significantly compromised.” from the report
Few activities
needs fixingPeople said there were few social activities and that they were sometimes bored. Monthly discussions with people had not always happened.
“People told us there were limited social activities available in the home.” from the report
Weak oversight
seriousThe provider's audits had not identified or resolved several problems. People also had limited opportunities to give their views, with only one residents' meeting recorded in 2022.
“The provider had failed to operate effective systems to assess, monitor and improve the quality and safety of the service.” from the report
- 01What has been fixed since the inspection in relation to medicines errors, controlled-drug records, cream instructions and the medicines fridge?
- 02How are individual risks, including diabetes monitoring, now reviewed and recorded?
- 03Does every person now have an up-to-date care plan that staff can access, and how are people involved in reviewing it?
- 04What improvements have been made to bedroom privacy, bedding, blinds, bathroom windows and other worn or damaged areas?
- 05How many activities and residents' meetings are now taking place, and how are people's views recorded and acted on?
This was an unannounced full inspection covering all five key questions, including infection prevention and control; all five ratings were Requires Improvement and the previous Good ratings were from 2019. This explanation was written from the published report of 3 November 2022 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, November 2019
Rated Good; inspectors found safe, kind and personalised care, with some records and recruitment checks needing improvement.
This was an unannounced planned inspection on 30 October 2019. One inspector observed care, spoke with five people, the manager and two care staff, and contacted a relative. They also checked care records, medicines, staffing, recruitment, training, complaints and quality checks.
The home was rated Good in all five areas: Safe, Effective, Caring, Responsive and Well-led. People said they felt safe and were treated kindly. Inspectors found enough staff, safe medicines practice, suitable training, good links with health professionals, personalised care and activities that reflected people's interests.
There were some areas to improve. These included developing financial risk assessments, making recruitment checks more consistent, recording consent for help with finances, removing duplicated information in care plans and correcting external complaints contact details. The overall rating stayed Good, as did the rating at the previous inspection published on 22 June 2017.
Kind relationships
People described staff as kind and caring. Inspectors observed positive interactions, and staff took time to talk with people and understand their preferences.
“People were treated with patience, care and kindness.” from the report
People felt safe
People said they felt safe and happy living in the home. Staff understood safeguarding and knew how to report concerns.
“People told us they felt safe and were happy living in the home.” from the report
Personalised care
Care plans included people's routines and preferences. People were involved in decisions and supported to maintain their independence.
“The registered manager and staff planned people's care and support in line with their choices and preferences.” from the report
Activities and connections
People could take part in individual and group activities, go out locally and keep in contact with friends and family.
“People were provided with a range of activities either on an individual basis or as a group.” from the report
Supportive leadership
The home had systems for monitoring quality and learning from incidents. Staff said they felt supported and valued.
“The registered manager and provider monitored all aspects of the service.” from the report
Financial risk records
needs fixingInspectors said risk assessments about supporting people to manage their finances needed further development. The manager agreed to address this.
“We discussed further developing assessments in relation to supporting people with managing their finances.” from the report
Recruitment checks
needs fixingRecruitment checks were completed, but inspectors identified inconsistency in obtaining full employment histories and health questionnaires promptly. Improvements were being made.
“We discussed how the process could be improved, such as by requesting health questionnaires in a timely way and by consistently obtaining full employment histories.” from the report
Consent records
needs fixingThe home needed to record consent more clearly in areas such as support with managing finances. The manager addressed this during the inspection.
“We discussed the importance in recording people's consent in areas such as supporting with management of finances.” from the report
Care plan duplication
minorSome care plan information was duplicated. The manager was reviewing the records to improve them.
“The registered manager was undertaking a review of the information in care plans as some of the information was duplicated.” from the report
Complaints information
minorThe complaints procedure gave incorrect information about contacting external agencies. The manager corrected this after the inspection.
“However, we found the information about contacting local external agencies was incorrect.” from the report
- 01How do you assess and manage risks when someone needs help with their finances?
- 02How do you record a person's consent when staff support them with managing money?
- 03What checks do you complete before new staff start, including full employment histories and health questionnaires?
- 04How do you make sure care plans are kept accurate and are not duplicated?
- 05How can residents or relatives contact external agencies if they want to make a complaint?
This was an unannounced planned inspection covering all five CQC questions, including the premises and the care provided; all five ratings remained Good from the previous inspection. This explanation was written from the published report of 22 November 2019 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of Margaret House Care Home Ltd
4 rated inspections over 6 years: the service has held its Requires improvement rating throughout.
- November 2022Requires improvementcurrent ratingdown from GoodSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
Read what inspectors found at Margaret House Care Home Ltd →
- November 2019Goodstayed GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
Read what inspectors found at Margaret House Care Home Ltd →
- June 2017Goodup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- June 2016Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Requires improvement
- January 2015
Registered with the Care Quality Commission on 21 January 2015.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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