Archived: St Michaels Nursing Home

St Michael’s is registered to provide personal and nursing care for up to 39 people. Some people may have a diagnosis of dementia. At the time of the inspection there were 27 people living in the home. The home was over two floors areas to support people with residential, dementia and nursing needs.

People's experience of using this service:

Our inspection in July 2016 found the service to be Good in all areas. At this inspection we found evidence the service did not meet the characteristics of Good in all areas. We have made two recommendations to the service about aspects of medicines and quality assurance. More information is in the full report.

The registered manager had completed audits on the service to help ensure the quality of service. However, these did not identify concerns we found during our inspection such as record keeping associated with medicines, consent, moving and handling and some aspects of the environment.

People felt safe and happy living at St Michael’s. People's risks were assessed and planned for and there were enough staff to meet people's needs and give people the time and reassurance they needed.

There was sufficient and adequately trained staff to support people safely. Most recruitment processes were robust. This helped to ensure staff were appropriate to work with vulnerable people. The provider had suitable systems in place to protect people from abuse. People were safeguarded from abuse and avoidable harm by trained staff who cared about people's wellbeing.

People had choices about what food to eat, how to spend their time and were involved in aspects of their care. Staff knew them well including their likes, dislikes and preferences and provided support to people in the way they liked.

Staff had adequate professional support to enable them to support people safely and effectively.

People were supported in a friendly and respectful way. People, relatives and staff got on well and staff were aware of people's personalities and behaviours. People told us staff supported them in a patient and unhurried manner. People and relatives said that staff were caring.

People knew how to make a complaint. There was an effective complaints process in place. Complaints were thoroughly investigated, and action taken to address the complaint raised.

Care at the end of people's lives had been considered and recorded in their care plans.

People and staff commented positively about the registered manager, administrator and staff

The service met the characteristics for a rating of good in three of the five key questions we inspected and rating of requires improvement in two. Therefore, our overall rating for the service after this inspection was requires improvement.

Rating at last inspection: Good (report published 7 November 2016)

Why we inspected: This was a scheduled inspection based on previous rating.

Follow up: We will continue to monitor the service through the information we receive until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

St Michael's Nursing Home provides accommodation for up to 39 adults who require nursing or personal care. The home provides support for older people, people with a physical disability and for people with dementia. On the day of our visit 31 people were living there.

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 providers they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At the previous inspection on 14 April 2014 the home was in breach of Regulation 10 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. At this inspection we found this had been rectified and people who lived in the home and their relatives were given opportunities to influence the decision making in the home. Also, that the quality monitoring in the home was identifying any issues in quality which needed rectifying.

People and their relatives were happy with the care and support provided in the home and were complimentary about the care they received. People told us they felt safe and that their needs were being met. Individual risks to people were assessed and processes put in place to help keep them safe. Staff were aware of, and understood the risks around, avoidable harm and knew how to safeguard people. Staff were recruited in a way which helped to ensure they were of suitable character to be working in the role of supporting people. People received the correct medicines in a timely manner.

Staff had received the necessary training to help make sure they supported people in a way which met their needs. Staff induction and supervisions were undertaken to help ensure this happened.

There were policies and procedures in place with regard to the Mental Capacity Act (MCA) 2005 and the registered manager had a good understanding of the Act. Staff understood the principles of gaining consent before offering people personal care.

People told us they enjoyed the food and adequate food and drink was provided. People were supported to access health care professionals when this was required.

There were caring and understanding relationships between people who lived in the home and staff. People were treated with dignity and respect. Staff enjoyed their role and were fully aware of what their responsibilities were. People were supported to make decisions and choices for themselves and individualised and detailed care plans helped staff to support this. Activities in the home were undertaken in groups but also on a one to one basis and people chose what they wanted to do. People were aware how to make complaints and were confident their concerns would be listened to.

The home had systems and processes in place to ensure people and their relatives were involved in what was happening in the home. Quality of service provision was monitored to ensure this was maintained. People knew who the registered manager was and staff felt well supported. Staff and people using the service had confidence in the management of the home.

This is a summary of what we found.

Is the service safe?

People had been cared for in an environment that was safe, clean and hygienic. Staff had a good understanding of the needs of people living in the home. They were able to describe different people’s needs and what care they required. We saw that people’s needs were assessed and care and treatment was provided in line with their individual care plan. We looked at four care records and saw that assessments had been carried out across all activities of daily living such as falls, tissue viability, nutrition and the management of bed rails.

CQC monitors the operation of the Deprivation of Liberty Safeguards, which applies to care homes to ensure that proper legal processes are in place if a person lacks capacity to make decisions and their liberty is being restricted in some way. While no applications have needed to be submitted, proper policies and procedures were in place. Relevant staff had been trained to understand when an application should be made, and how to submit one.

We saw that each person had a medication administration record (MAR) chart which recorded what medication they were having. We saw that all of the MAR charts were signed and demonstrated that medication had been given at the appropriate times.

Is the service effective?

People told us that they were happy with the care that had been delivered and their needs had been met. We saw from observations and from speaking with staff that they had a good understanding of the peoples care and support needs. One person said “It is marvellous I couldn’t wish for better”. A visitor said “It is excellent. He seems very comfortable here”.

We saw that there was a well - balanced nutritious menu in place and people had choices from the menu. We spoke to four people; one person said "We get choice about food and what we want to eat. The food is good." Another person said " I am a poor eater but they give me what I want to eat".

Is the service caring?

People we spoke to said they were very happy with the care they received. One person said “Care staff are very good”. Staff were observed speaking to people in a respectful and caring way. They were also observed helping people to mobilise and also encouraging people to do as much for themselves as they could. We spoke to one visitor who said “I think the staff are brilliant. I see them knocking on doors before going into bedrooms.” Another visitor said “They are wonderful here and my relative is very comfortable”.

Is the service responsive?

People’s needs had been assessed before they moved into the home. Records confirmed people’s preferences, interests and hobbies. The activities coordinator held records of individual people and what activities they liked to be involved in. Staff were observed speaking to people in a respectful and caring way. They were also observed helping people to mobilise and encouraging them to do as much for themselves as they could.

Is the service well led?

We saw that a customer satisfaction survey had recently been carried out but the home had not had any responses returned. We spoke to five visitors who said that they would approach the manager if they had any concerns about the service and that the manager was always very approachable. We did not however, see any evidence that any information from these informal discussions were recorded. We saw that a number of environmental audits had been carried out, one of which was a fire inspection which had actions for the home to implement. Information was available on progress with the actions.

We looked at the care plans for three people and found that where people where people had the capacity to consent, they were asked for their consent and their wishes were respected. People we spoke with told us, “The staff are lovely, they always ask me if I want some help or before they give me my tablets” and, “When I was unwell, staff asked me if I wanted them to call the Doctor, rather than just calling anyway.”

We found that people were provided with a choice of suitable and nutritious food and drink. There was a rolling four week menu in place which contained a range of different and nutritious meals. We saw that people’s care plans considered whether they needed alterations to or support with their diet due to any medical conditions, such as diabetes.

We saw that as a result of flood damage, extensive refurbishment of some parts of the home had been completed. We found that maintenance and refurbishment of the home which had been planned prior to the flooding was still ongoing but that remedial repairs had been undertaken to reduce any risks to people living in the home.

We found that people’s needs were assessed and that care was being planned and provided in a way which met those needs. We saw that people were receiving input from specialist teams about their medical conditions on a regular basis and that there was appropriate information available to staff within the home.

Everyone we spoke with told us they thought the people using the service at St Michaels were safe. People told us that the staff and the manager were approachable.

Overall the premises were safe, secure and mostly suitable for purpose however we noted some inconsistencies in the maintenance of the home, specifically with regards to bathrooms and hallway carpets.

We found that people had their comments and complaints listened to and acted on. Relatives we spoke with told us that they had never had any complaints about the home, only a few minor ‘niggles’.