1 June 2018
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
The inspection took place on 27 September, 3 October 2017 and 15 May 2018. It was unannounced. It was carried out by two inspectors.
Before this comprehensive inspection we reviewed the information we held about the service, including previous inspection reports and the provider’s action plans following the inspections. We looked at notifications which had been submitted. A notification is information about important events which the provider is required to tell us about by law. Due to technical problems, the provider was not able to complete a Provider Information Return. This is information we require providers to send us at least once annually to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.
During our inspection, we observed care in the communal areas of the service which included observing how people were supported during their lunch and with their medicines. We spoke with 12 people living at the service. We also spoke with six visitors including a visiting healthcare professional, three care staff and the nurse on duty, the manager and the provider. We also sampled feedback surveys the service had received from people living at the service, their relatives and visiting healthcare professionals.
We looked at care records for 12 people, medication administration records (MAR), a number of policies and procedures, five staff files, staff training, induction and supervision records, staff rotas, complaints records, accident and incident records, audits and minutes of meetings.
1 June 2018
The inspection took place on 27 September, 3 October 2017 and 15 May 2018. It was unannounced.
We carried out an unannounced comprehensive inspection of this service on 11 October 2016. At which breaches of legal requirements were found. A warning notice was served in respect of Regulation 18. This was because people’s safety was sometimes being compromised as there were not enough care staff to provide safe care.
After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach. We undertook a focused inspection on the 4 April 2017 and found that they had followed their plan and met legal requirements to comply with the warning notice.
St Michaels Nursing Home is registered to provide accommodation and care, including nursing care for up to 39 older people with a range of medical and age related conditions, including arthritis, frailty, mobility issues and dementia. The home has 30 bedrooms, some of which may be used as double occupancy. During our inspection there were 29 people living in the service who required varying levels of support.
The provider appointed a new manager in June 2017. The manager had an application in progress to become registered with the commission. 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.
People were protected from risks to their health and wellbeing. Up to date plans were in place to manage risks, without unduly restricting people’s independence.
People said they felt safe at the service and knew who they would speak to if they had concerns. The service followed the West Sussex safeguarding procedure, which was available to staff. Staff knew what their responsibilities were in reporting any suspicion of abuse.
People were treated with respect and their privacy was promoted. Staff were caring and responsive to the needs of the people they supported. People's health and well-being was assessed and people's needs were met in an individualised way.
People’s medicines were managed safely. People had enough to eat and drink throughout the day and night. The mealtime was an inclusive experience.
There was an open and friendly culture combined with a dedication to providing the best possible care to people. Staff were approachable, professional and keen to talk about their work. The atmosphere in the service was happy and calm. People were engaged and happy; they interacted and chatted with each other. Every person we spoke to, without exception, was complimentary about the caring nature of the staff. People were occupied and happy at the service. We saw that there were activities that people could be involved in. The manager told us that the activities were always under review to ensure that they met the needs of the people currently living at the service. People were engaged and occupied during our visit.
Staff were able to do their jobs safely and to a good standard. They felt the support received helped them to do their jobs well.
There were enough staff on duty to support people with their assessed needs. The manager considered people’s support needs when completing the staffing rota and staffing levels were calculated appropriately. The manager followed safe recruitment procedures to ensure that staff working with people were suitable for their roles.
People benefited from receiving a service from staff who worked well together as a team. The manager and the staff team took pride in their work and were looking for ways to improve the service. Staff were confident they could take any concerns to the manager and these would be taken seriously. People were aware of how to raise a concern and were confident appropriate action would be taken.
People had their capacity assessed on admission to the service. Mental capacity assessments were completed for people and their capacity to make decisions had been assumed by staff unless their assessment showed otherwise. Staff adhered to the Mental Capacity Act 2005 code of practice and supported people in line with their deprivation of liberty safeguard authorisations.
The premises and gardens were well maintained. Maintenance and servicing checks were carried out, keeping people safe. People were able to contribute to improve the service. People had opportunities to feedback their views about the home and quality of the care they received.