St Michaels

There was a registered manager in post. 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.

On the day of our inspection staff interacted well with people. People and their relatives told us that they felt safe and well cared for. Staff knew how to keep people safe. The provider had systems and processes in place to keep people safe.

Medicines were administered to people safely however systems for monitoring medicines were not consistent with national guidance.

We saw that staff obtained people’s consent before providing care to them. Where people could not consent, assessments to ensure decisions were made in people’s best interest had usually been completed. We found one occasion when this had not occurred.

We found that people’s health care needs were assessed and care planned and delivered to meet those needs. People had access to healthcare professionals such as the district nurse and GP and also specialist professionals. People had their nutritional needs assessed and were supported with their meals to keep them healthy. People had access to drinks and snacks during the day and had choices at mealtimes. Where people had special dietary requirements we saw that these were provided for.

There was usually sufficient staff available to meet people’s needs. Staff responded in a timely and appropriate manner to people. We observed occasions when staff were disturbed from what they were doing in order to provide assistance to people. Staff were kind and sensitive to people when they were providing support. People were treated with respect.

Staff were provided with training on a variety of subjects to ensure that they had the skills to meet people’s needs. The provider had a training plan in place. Staff had received regular supervision and appraisals People were provided access to leisure and social activities. They were supported to maintain relationships that were important to them.

Staff felt able to raise concerns and issues with management. Relatives were aware of the process for raising concerns and were confident that they would be listened to. Regular audits were carried out and action plans put in place to address any issues which were identified. Accidents and incidents were recorded and investigated. The provider had informed us of notifications. Notifications are events which have happened in the service that the provider is required to tell us about.

At the last inspection on 10 May 2016 we found that the provider did not have effective systems to assess and monitor the quality of care provided to people. We undertook a focused inspection on 23 November 2016 to check that they had followed their plan and to confirm that they now met legal requirements. At our inspection on 23 November 2016 we found the provider had made the necessary improvements.

This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Drovers Call on our website at www.cqc.org.uk.

St Michaels provides care for older people who have mental and physical health needs including people living with dementia. It provides accommodation for up to 47 people who require personal and nursing care. At the time of our inspection there were 32 people living in the home.

At the time of our inspection there was not a registered manager in post. 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.

Systems were in place to assess and monitor the quality of the service provided to people. The provider had told us what actions they would take to make improvements and we found at this inspection that the improvements had been sufficient to meet legal requirements. The provider had started to carry out audits on a regular basis. Where issues had been identified actions had been put in place. However we found some issues such as gaps in records had not consistently been addressed.

Regular meetings were held with staff and staff were encouraged to raise issues with the manager.

We could not improve the rating for well led because to do so requires consistent good practice over time. We will check this during our next planned comprehensive inspection.

There was a registered manager in post. 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.

On the day of our inspection staff interacted well with people. Staff knew how to keep people safe. Medicines were administered safely however there was an error in the records of medicines that require special storage and recording arrangements. Records had not been completed according to the provider’s medicine policy. Medication administration sheets (MARS) were completed fully however information sheets did not include people’s allergies.

The provider acted in accordance with the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). The MCA provides the legal framework to assess people’s capacity to make certain decisions, at a certain time. If the location is a care home the Care Quality Commission is required by law to monitor the operation of the DoLS, and to report on what we find.

We found that people’s health care needs were assessed and care planned and delivered to meet those needs. People had access to healthcare professionals such as the district nurse and GP and also specialist professionals. People had their nutritional needs assessed and were supported to eat enough to keep them healthy. People had access to drinks and snacks during the day and had choices at mealtimes. Where people had special dietary requirements we saw that these were provided for.

There were not always sufficient staff to meet people’s needs. People and their relatives told us that they felt well cared for but that they didn't always feel safe due to the lack of supervision. Staff were kind and sensitive to people when they were providing support and people had their privacy and dignity considered. Staff had a good understanding of people’s needs and were provided with training on a variety of subjects to ensure that they had the skills to meet people’s needs. The provider had a training plan in place and staff had received regular supervision.

We saw that staff obtained people’s consent before providing care to them. People were not provided with access to regular activities and leisure pursuits. Staff felt able to raise concerns and issues with the registered manager. Relatives were aware of the process for raising concerns and were confident that they would be listened to. Regular audits were carried out for areas such as falls and infection control. Audits had not identified some of the issues and we found where issues had been identified these had not always been addressed. The provider had informed us of incidents as required by law. Notifications are events which have happened in the service that the provider is required to tell us about. Accidents and incidents were recorded.

We found the planning and delivery of care did not always meet the service users needs' and did not ensure the safety and welfare of people. Following this visit we received an action plan from the provider to address the issues. We found that all of the actions in the plan were in progress.

During this visit we spoke with the manager, staff and four people. To help us to understand people's experiences we used our Short Observational Framework for Inspection (SOFI). SOFI allows us to spend. We observed four people for an hour.

We checked documentation, including five care records.

At this visit we found plans in place for activities and observed activities taking place with people on a group and individual basis.

During this visit we spoke with the manager, staff and four people. To help us to understand people's experiences we used our Short Observational Framework for Inspection (SOFI). SOFI allows us to spend time observing and helps us to record how people spend their time. We observed four people for an hour. We observed there was time when people did not receive any engagement with staff.

In order to assist us we were accompanied by an expert by experience. Experts by experience have experience in the area of care being inspected and spend time with people to obtain their views.

We checked documentation, including four care records. In all the records we looked at there were occasions when plans had not been updated to reflect revised care needs.

At our last visit people and relatives told us they did not feel there were enough activities. At this visit we found plans in place for activities but observed there was only a very short period of five minutes, when an activity took place for people in the communal area.

We found in all the care plans we looked at there were occasions when plans had not been updated to reflect the revised care needs.

To help us to understand people's experiences we used our Short Observational Framework for Inspection (SOFI) tool. The tool allows us to spend time observing and helps us to record how people spend their time. We carried out the tool for an hour and observed four people. We observed that interactions with people were positive but there was time when people did not receive any engagement.

We observed care and saw staff supported people to move at their own pace and safely. We observed two incidents when we felt people were at risk of injury.

We observed a staff member carrying out activities with a group of people. People and relatives told us they did not feel there were enough activities taking place.

We also looked at the administration of medicines and saw this was administered and stored appropriately according to guidelines.

We spoke with two relatives. They said, “The food is lovely” and “The staff are lovely.” They said they were always contacted if there was a problem.

We looked at consent and discussed this with staff. Staff were able to tell us about consent and we observed staff asked people if they wanted support before providing it.