St Michaels Nursing Home

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.

We carried out an unannounced comprehensive inspection of this service on 11 October 2016. At which a breach of legal requirements was 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 this focused inspection on the 4 April 2017 to check that they had followed their plan and to confirm that they now met legal requirements related to Regulation 18. This report only covers our findings in relation to this topic. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for St Michaels Nursing Home on our website at www.cqc.org.uk.

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. On the day of our inspection there were 29 people living in the service, who required varying levels of support. The registered manager told us that the majority of people living at the home had low needs and that only people assessed as having low needs had been admitted since the last inspection due to the home’s staffing levels.

At the time of our inspection the service had a registered manager. However, they were working their notice period and due to leave employment at St Michaels Nursing Home on the 12 May 2017. 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. After the inspection, we were informed about plans to recruit a new manager and how the provider would be monitoring the quality of care during this transition.

At this focused inspection on the 4 April 2017, we found that improvements to the number of staff had been made and the warning notice had been met.

The manager also told us that staffing levels had been increased since the previous inspection.

Feedback from staff regarding the staff numbers was mixed. One staff member told us that they thought the staffing numbers were fine. Another member of staff told us that it was variable.

We saw that care staff were present most of the time in communal areas such as the lounge and dining room. On occasions we saw that there was very little interaction between staff and people. Staff appeared to have low morale and did not look happy in their work and we have fed this back to the provider for action.

We undertook this unannounced comprehensive inspection to look at all aspects of the service and to check that the provider had followed their action plan, and confirm that the service now met legal requirements. We found improvements had been made in the many of the required areas. Improvements had been made in respect to cleanliness and infection control, people being treated with dignity and respect, inconsistent care planning and delivery and people’s consent to care and treatment. However, we continue to have concerns in respect to staffing levels. Further areas of improvement were also identified in relation to person centred care, quality monitoring and meeting people’s social and recreational needs.

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. On the day of our inspection there were 26 people living in the service, who required varying levels of support.

There was a manager in post, who had applied to become the registered manager. However, at the time of our inspection, they were not registered with the CQC. 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’s safety was sometimes being compromised as people and staff commented they felt there were not enough care staff to provide safe care. Our own observations supported this. Staffing levels were stretched and staff were under pressure to deliver care in a timely fashion. One person told us, “The staff are so rushed, they don’t have enough time to do anything”. Another person said, “The staff don’t always answer the call bell and I have sometimes waited ages for someone to come”.

Several people commented they were well looked after by care staff. However, care was not always personalised to the individual. For example, people did not always get up or go to bed when they wished. It was recognised that staff had a good understanding of person centred care and knew people’s routines well. However staffing levels at the service did not allow staff to routinely meet people’s preferences in relation to how their care was delivered.

There were some arrangements in place to meet people’s social and recreational needs and in response to the previous inspection, the service now employed a dedicated activities co-ordinator. However, we could not see that activities were routinely organised for everybody or for people at the weekend or in the evening, and staff struggled to make time to engage socially with people due to staffing levels.

The manager had introduced a range of quality assurance audits to help ensure a good level of quality of care was maintained. We were given several examples of improvements made since the previous inspection, such as improvements to the environment and infection control, the mealtime experience, the analysis of accidents and incident, and improvements to care practice in light of people’s feedback. However, these audits had not fully ensured that people received a consistent and good quality service that met individual need. The provider had also not met all of the required improvements set out in their action plan created in light of the concerns identified at the previous inspection.

People felt well looked after and supported. We observed friendly and genuine relationships had developed between people and staff. One person told us, “The staff are lovely, always smiling and friendly even when they are rushed off their feet”. Another person said, “The staff are lovely, kind and considerate”. Care plans described people’s needs and preferences and they were encouraged to be as independent as possible.

People were being supported to make decisions in their best interests. The manager and staff had received training in the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS).

Accidents and incidents were recorded appropriately and steps taken to minimise the risk of similar events happening in the future. Risks associated with the environment and equipment had been identified and managed. Emergency procedures were in place in the event of fire and people knew what to do, as did the staff.

When staff were recruited, their employment history was checked and references obtained. Checks were also undertaken to ensure new staff were safe to work within the care sector. Staff were knowledgeable and trained in safeguarding adults and what action they should take if they suspected abuse was taking place.

Medicines were managed safely and in accordance with current regulations and guidance. There were systems in place to ensure that medicines had been stored, administered, audited and reviewed appropriately.

Staff had received essential training and there were opportunities for additional training specific to the needs of people, including caring for people with pressure damage and palliative (end of life care). Staff had received both one-to-one and group supervision meetings with their manager, and formal personal development plans, such as annual appraisals were in place. One member of staff told us, “It is vitally important that the training is good, as we need the right skills to help people, and it is”.

People were encouraged and supported to eat and drink well. There was a varied daily choice of meals and people were able to give feedback and have choice in what they ate and drank. One person told us, “The food is very good and there’s plenty of it. The staff will help you with cutting it up if you need to”. Special dietary requirements were met, and people’s weights were monitored with their permission. Health care was accessible for people and appointments were made for regular check-ups as needed.

People were encouraged to express their views and feedback received showed people felt staff were friendly and helpful. People said they felt listened to and any concerns or issues they raised were addressed. People were also encouraged to stay in touch with their families and receive visitors.

Staff were asked for their opinions on the service and whether they were happy in their work. They felt supported within their roles, describing an ‘open door’ management approach, where managers were always available to discuss suggestions and address problems or concerns.

This inspection took place on 11 and 12 June 2015 and was unannounced.

St Michael’s nursing home provides accommodation and nursing care for up to 39 people. There were 29 people living at the home when we visited. The home provides support for older people and people who are living with dementia. People had a range of nursing and care needs and required different levels of care and support from staff relating to health and mobility. Accommodation is provided over three floors with a dining area, communal lounge and conservatory.

The service did not have a registered manager in post on the day 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. A new manager had been in post since May 2015 but had not yet applied to register. The manager had been re-employed at St Michael’s Nursing Home after a period of absence.

Some aspects of the service were not safe. People were not protected from the risk of infection as the provider did not have arrangements in place for keeping the service clean and hygienic. The provider did not always follow policies and procedures in line with current relevant guidance.

The dependency tool used to assess staffing levels was not consistently completed to ensure there were sufficient staff deployed. It was not ensured that staffing levels were changed to reflect peoples needs.

Consent to care and treatment was not always sought in line with legislation and guidance. People were not always involved in decisions regarding their care and treatment. When people did not have capacity to consent formal processes were not followed to protect their rights.

People received enough to drink but did not consistently receive the support they required to eat. Choices were limited and the food served did not always reflect people’s preferences.

People’s care records contained little information about choices, preferences and life history of individuals. There were inconsistencies in the recording of daily notes.

There were some examples of positive relationships between people and staff during our visit but this was not consistent. People raised concerns that staff were rushed when delivering care and people’s dignity was not upheld.

People told us they felt safe living at the service and felt able to raise concerns with staff. Staff knew what action to take if they suspected abuse and had received training in keeping people safe. Assessments and reviews of risk had been undertaken.

The provider had arrangements in place for the safe ordering, administration, storage and disposal of medicines. People were supported to get medicine they needed when they needed it. People were supported to maintain good health and had access to healthcare services when needed.

At the time of inspection we found that there were a number of areas that required improvement. Although the provider had a quality monitoring system in place, this had not been effective in identifying and actioning areas for improvement. The manager and provider advised that there had been a period of instability when there was no manager in post.

We found a number of 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 report.

We were told that the registered manager had left since March 2013. The owner confirmed that the deputy manager who had been acting up had since been appointed as manager of the service. They were going through the process of registration with the Commission.

Staff told us that before people received any care and treatment they were routinely asked for their consent. This was confirmed during our discussion with people we spoke with. People also told us; 'staff are polite and helpful', 'I am well looked after', 'I have my electric scooter and can go out whenever I want', 'the food is good and plenty', 'I can have my meal in my room'.

The level of hygiene and cleanliness was good at the time of our visit. They told us that people were given the choice to choose colour scheme and personalisation of their room. This was prominent around the premises and people spoken with confirmed the same.

We found that there were sufficient staffs with the right skill mix to meet people's needs.

The complaint procedure was displayed in the reception area. People spoken with were aware of their rights to raise concerns and be listened to.

People told us they were very happy in the home and everyone remarked on the kindness of the staff. We were told that people felt confident that any concerns were always quickly addressed. One person told us 'Nothing is too much trouble' for the staff.

People told us that staff understood their needs and provided appropriate care and support. We were told that staff were responsive when people asked for assistance and quickly dealt with any issues. One person told us "It depends on the time of day but the bell is usually answered quickly.'

We found care was recorded appropriately, with potential risks to people's safety monitored, assessed and updated in a timely manner.

We noted that the registered manager had not always provided the required notifications on the incidents that occurred in the home. This was rectified on the day of our visit by the registered manager submitting the missing notifications.