St Michaels Nursing Home

Updated 6 July 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection, we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection team consisted of 2 inspectors and an expert by experience who spoke with people’s relatives by off-site telephone calls. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

St Michael’s Nursing Home is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement, dependent on their registration with us. St Michael’s Nursing Home is a care home with nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was a registered manager in post.

This inspection was unannounced.

What we did before the inspection

We reviewed information we received about the service since initial registration in December 2022. We sought feedback from local authority care commissioners who work with the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and any improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke with 6 people who used the service and 9 relatives; 2 nurses, including the nurse clinical lead/deputy manager; 6 care staff, including 1 senior and 1 team leader; a cook, a cleaner, a laundry assistant. We also spoke with the registered manager; 1 external senior support manager and the nominated individual for the provider. The nominated individual is responsible for supervising the management of the service on behalf of the provider.

We observed how staff interacted with people and reviewed a range of records. This included 8 people's care plans, multiple medicines records, complaints, staffing and management records. This included meeting minutes, equipment maintenance records; quality, care and systems audits along with some of the provider's operational policies for people's care and safety. Following the inspection, we continued to seek clarification from the provider, to validate evidence found.

Updated 6 July 2023

About the service

St Michaels Nursing Home is a residential care home providing accommodation, personal and nursing care for up to 39 people in one adapted building, which includes a ground floor extension. At this inspection there were 29 people using the service, including 16 people receiving nursing care.

People’s experience of using this service and what we found

People's care and daily living arrangements were mostly individualised but not always ensured in a timely or responsive manner. Related management improvements were identified. This included, to ensure increased opportunities for people to participate in activities they enjoyed and were meaningful to them. However, this was not yet fully demonstrated as embedded or sustained ongoing.

Risks to people’s safety associated with their health condition, environment and any equipment used for their care were accounted for. Health and reportable incidents were routinely monitored and analysed, to help inform or improve peoples’ care and prevent any reoccurrence when needed.

The provider’s safeguarding, emergency contingency planning and staffing measures, helped to protect people from the risk of harm or abuse. People’s medicines were safely managed to ensure people received their prescribed medicines, as and when they should.

The environment was suitably adapted, clean, well maintained and designed to meet people’s needs. We were assured the provider was meeting with requirements and nationally recognised government guidance concerned with the prevention and control of infection, including COVID-19.

Overall, there were effective arrangements for the assessment, planning and delivery of peoples’ care, in line with nationally recognised standards and the law. Introduction of an electronic care plan record keeping system was in progress, to optimise accessibility and the timeliness of record keeping.

People were generally well supported to maintain or improve their health and nutrition through consultation with relevant external health professionals, when needed for people’s care. Standardised and lawful information sharing, helped to ensure people's care was consistently informed when they needed to move between services.

Staff were informed, trained and supervised for their role. People were supported to have maximum control of their lives and staff supported them in the least restrictive way possible. The provider’s related policies and systems supported this practice.

Overall, staff were caring to ensure people’s dignity and rights. Staff knew people well and overall understood how to communicate with people, in a way they understood.

The service was generally well managed and led. Regulatory requirements were being met. Staff we spoke with understood their role and responsibilities for people’s care.

The provider had established effective governance arrangements for routine service monitoring and oversight, to ensure the quality and safety of people’s care. A range of service improvements were demonstrated, either made or in progress from this, which also included remedial actions when things went wrong.

The provider strove to work in partnership with relevant authorities, care partners and others with an interest in people’s care at the service. Related consultation and feedback was used to help inform and improve the service.

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

Rating at last inspection This service was registered with us on 21 December 2021 and this is the first inspection.

The last rating for the service under the previous provider was requires improvement, published 27 June 2019.

Why we inspected

The inspection was prompted in part due to concerns we received about safety with regard to staffing and the management of risk; including from a provider notification following an incident where a person sustained a serious injury. This incident is subject to further investigation by CQC, as to whether any regulatory action should be taken. As a result, this inspection did not examine the circumstances of the incident. We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe and well-led sections of this full report.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

The overall rating for the service is good.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.