Archived: St Michaels Lodge

St Michaels Lodge is a ‘care home’. 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.

St Michaels Lodge can accommodate 13 people in one adapted building. At the time of inspection, six people with mental health support needs were living at the service .

At our last inspection in August 2017, we rated the service as requires improvement, we found the service to be in breach of regulation 11 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 – Need for consent. This was because of a failure to involve people in their assessments of capacity, lack of consideration for the least restrictive strategies to support people and lack of consideration of people's best interests. At this inspection, we found that some improvements had been made, and the service was no longer in breach of this regulation. However, further improvements were still required to make sure every person had the same opportunity for support with decision making, and to make sure all people’s interests were appropriately represented.

There was a registered manager in post who was also the provider of the service. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are 'registered persons'. 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. The registered manager was not available to see us on the day of inspection.

Staffing levels had improved since our last inspection, although this was not always consistent. During the day of our inspection, only one member of staff was on shift, when there would usually be two. This limited the amount of interaction and activity available for people. The staffing levels within the home required strengthening to fully enable a selection of meaningful activity for the individuals living at the service.

Improved quality monitoring systems and processes were in place and audits were taking place within the service to identify where improvements could be made. Further detail was required with environmental audits to ensure that maintenance and levels of cleanliness remained adequate.

Staff had an understanding of abuse and the safeguarding procedures that should be followed to report abuse. People had risk assessments in place to cover any risks that were present within their lives, but also enable them to be as independent as possible. All the staff we spoke with were confident that any concerns they raised would be followed up appropriately by the registered manager.

The staff recruitment procedures ensured that appropriate pre-employment checks were carried out to ensure only suitable staff worked at the service. References and security checks were carried out as required.

Staff attended induction training where they completed mandatory training courses and were able to shadow more experienced staff giving care. Staff told us that they were able to update their mandatory training with short refresher courses.

Staff supported people with the administration of medicines, and were trained to do so. The people we spoke with were happy with the support they received.

Staff were well supported by the registered manager and senior team, and had one to one supervisions and observations.

People were able to choose the food and drink they wanted and staff supported people with this. People could be supported to access health appointments when necessary. Health professionals were involved with people's support as and when required.

Staff treated people with kindness, dignity and respect and spent time getting to know them and their specific needs and wishes. People told us they were happy with the way that staff spoke to them, and they provided their care in a respectful and dignified manner.

People were able to contribute to the way in which they were supported. Care planning was personalised and mentioned people's likes and dislikes, so that staff understood their needs fully. People were in control of their care and were listened to by staff.

The service had a complaints procedure in place. This ensured people and their families were able to provide feedback about their care and to help the service make improvements where required. The people we spoke with knew how to use it.

The service worked in partnership with other agencies to ensure quality of care across all levels.

Communication was open and honest, and improvements were highlighted and worked upon as required.

There was a registered manager in post who was also the provider of the service. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. 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.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

Although people’s care and support files contained assessments of their capacity showing that they lacked capacity to make decisions in relation to their care there was no evidence that people had been involved in these capacity assessments. Best interest checklists had not been completed and there was no evidence to show that the provider had explored less restrictive options when developing people’s plans of care.

The staffing levels within the home required strengthening. The availability of staff had impacted upon the improvements that the provider had implemented. People could not be assured that staff would consistently engage positively with them because they were focussed upon other tasks within the home.

Formal quality assurance systems required strengthening. The provider had not identified the shortfalls that we found in relation to how people’s consent had been sought and their capacity to consent to their care assessed. The provider had not identified the shortfalls that we found in relation to the availability of staffing.

People’s plans of care required strengthening to provide personalised guidance for staff in providing people’s care in a person centred manner.

People could be assured that they would receive their prescribed medicines safely. Risks to people had been assessed and action taken to mitigate people’s known risks. Staff were confident in the steps that they should take if they felt people were at risk of harm.

Staff had received the training, support and supervision that they needed from the provider to work effectively in their role. Staff felt well supported in their work. People could be assured that they would be supported to access healthcare professionals.

The provider had taken steps to improve the culture within the home through introducing a programme of person centred care training and introducing a schedule of activities for people. We have made a recommendation in the main body of the report in relation the how the programme of activities and engagement for people could be strengthened.

The provider had a system in place to manage complaints.

At this inspection we found the service to be in breach of one regulation of the Health and Social Care Act 2008 (Regulated activities) Regulations 2014. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

There was a registered manager in post who was also the provider of the service. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. 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.

The provider had failed to implement appropriate quality assurance systems which had resulted in the shortfalls that we found during this inspection failing to be identified or acted upon. We also found that the home had not been adequately maintained and the provider did not have plans in place to address the maintenance of St Micheals Lodge.

People could not be assured that they would receive their prescribed medicines. We found that there was an excess stock of people’s medicines which the provider told us meant that people had not received these medicines. There were insufficient processes in place to ensure that all prescribed medicines had been given.

People’s capacity to consent to their care and support had not consistently been considered by the provider. People were subject to some restrictions where their capacity to consent to the restrictions had not been assessed or processes followed to ensure that the restrictions were in their best interests.

People did not always experience positive interactions and relationships with staff. Staffing levels within the home were not always sufficient to facilitate activities or positive engagement with people.

There was a task led culture in the home. We found a number of examples of poor care where people were not treated with dignity and respect. We also found examples whereby changes in people’s care and support needs had not been responded to appropriately. People’s care was not always based upon their preferences and feedback from people about their care and support was not sought.

There was a breach of four regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The overall rating for this service is 'Inadequate' and the service is therefore in 'special measures'. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People told us they felt safe. Safeguarding procedures were robust and staff understood how to safeguard the people they supported. People's ability to manage their finances had been assessed and appropriate arrangements put in place.

No person in the home was subject to Deprivation of Liberty Safeguards. We saw no restrictions on people's liberty. Specific training on the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards had been provided for staff. The Mental Capacity Act and Deprivation of Liberty Safeguards is legislation used to protect people who might not be able to make informed decisions on their own about the care they receive.

Is the service effective?

All people we spoke to told us the care and support provided was good and they got on well with staff. They said staff cared for them well and listened to them. One person told us, 'The staff are good, they help us when we need it'. Another said, 'Staff are great ' this is the best care home I've been in'.

People's needs were assessed and care and support was planned and delivered in line with their individual care plans. Care plans considered all aspects of the person's circumstances and were centred on them as an individual. Information was given on how best to provide different aspects of a person's care. This helped staff provide care and support according to the person's needs and choices.

Improvements were needed in supporting staff through a structure of regular supervision and a system of appraisal.

Is the service caring?

We observed effective communication and good relationships between the staff on duty and the people living in the home. Staff made sure they gave individual time to those people who needed this. This helped to make sure people felt listened to and that their needs were met.

Is the service responsive?

People told us they were encouraged and supported by staff to take part in daytime activities both in the home and in the community. This meant that the provider was promoting the wellbeing of people who used the service by taking account of all their needs.

Information on how to make a complaint was available in the home and in the information pack given to people who used the service and their representatives. There had been no recent complaints.

Is the service well-led?

The service had a quality assurance system in place. We found that a range of internal quality checks were carried out to assess and monitor the quality of service that people received. Any action needed to improve the service was identified and followed up.

People who used the service were asked for their views about the quality of care and support being provided. This meant that the care and service provided was informed by the comments made by people who used the service.

Improvements had been made in the maintenance of accurate and appropriate records since our last inspection.

We found that improvements had been made in the standard of cleanliness, and that refurbishment had taken place in parts of the home.

We found that people were well cared for and we saw that staff interacted well with people in a way that demonstrated that they were knowledgeable about people's likes and dislikes.

We had concerns that some of the care records had not been completed in a timely way. We found that there were no records which demonstrated the arrangements to safely manage people who could be at risk due to smoking cigarettes in their bedroom.