We inspected St Michaels Nursing Home on the 11 October 2016. We previously carried out a comprehensive inspection at St Michaels Nursing Home on 11 and 12 June 2015. We found the provider was in breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because we identified concerns in respect to cleanliness and infection control, people not being treated with dignity and respect, inconsistent care planning and delivery, people’s consent to care and treatment, staffing levels and quality monitoring. The service received an overall rating of ‘requires improvement’ from the comprehensive inspection on 11 and 12 June 2015. After this inspection, the provider wrote to us to say what they would do to meet the legal requirements in relation to these breaches.
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.