The inspection took place on 11 and 13 January 2017 and was unannounced. St Michael’s is a residential home for up to 45 people who have a variety of support needs, such as older people and people with a physical or sensory disability. There were 36 people living at the service at the time of the inspection.
There was a Registered Manager in post at the time of our inspection. 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.
At this inspection we identified breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.
There were not always enough staff as communal areas were often left unattended and situations were not monitored which left people at risk. Staff told us they felt more staff were needed. Some people told us they felt more staff were needed, however some people were satisfied.
Plans were not always in place to support people if they became agitated. Staff were also not trained to support people effectively who were experiencing periods of agitation.
Risk assessments and detailed plans were not always in place to try and prevent people from falling and if people had fallen. Action had not always been taken to support people from falling again and some people had continued to experience falls.
Medication Administration Records (MARs) had not always recorded whether people had had their topical medicines and PRN protocols were not always in place for people that had medicine that was to be taken ‘when required’.
All safeguarding allegations should be reported to the local safeguarding authority however we found an instance of one allegation that had not been reported. Other safeguarding incidents had been correctly reported to the local safeguarding authority.
The principles of the Mental Capacity Act 2005 (MCA) had not always been followed. Assessments had not always been carried out to help determine if people were still able to make decisions and if they could what type of decisions. Evidence of Lasting Power of Attorney (LPOA) had not been consistently sought and those who did have an LPOA did not always have the correct one in place regarding health and welfare.
Care plans were not always personalised and did not always contain full information about people and their preferences. Staff were sometimes used from an agency and new staff started periodically. This put some people at risk of not having their needs met or not having their preferences catered for as there was limited information available for them.
Audits of accidents and incidents or care plans had not been taking place so omissions had not been identified. Medicine audits were in place however these had not identified concerns relating to topical medicines.
Although there were occasional events for people to attend, overall people told us they were bored and there was not enough for people to do and they were not always supported to partake in hobbies.
People told us they felt safe and their relatives confirmed they felt their loved ones were safe in the home.
People felt staff were caring and that they were treated with dignity and respect. People had the choice of where they spent their time and were supported to maintain their privacy.
Safe recruitment practices were in place and staff had appropriate checks prior to starting work to ensure they were suitable to work with people who use the service.
People had access to other health professionals in order to maintain their health and wellbeing.
People were supported to have food and drinks of their choice that were appropriate for their needs.
People and relatives were encouraged to provide feedback or complain if they needed to and it was felt that this feedback was acted upon.
Staff felt supported and that they could approach the registered manager. There was an open door policy and staff all said they could raise concerns if necessary.
Staff and relatives knew who the manager was and felt able to go to them with queries. The manager had also been submitting notifications about the service, which they are required to do.
The registered manager had also arranged home managers meetings, establishing a local network of managers who could share best practice.