20 May 2022
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.
On 22 March 2022, the site visit was completed by three inspectors and one medicine’s inspector. On 29 March 2022 one inspector attended the service.
An Expert by Experience spoke with people who used the service and spoke with relatives, by telephone. 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 Court is a ‘care home’. People in care homes receive accommodation and nursing and personal care as a single package under one contractual agreement dependent on their registration with us. St Michael’s Court is a care home with nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
The service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
At the time of our inspection there was not a registered manager in post. However, there was a manager covering the role who had not registered with the Care Quality Commission.
Notice of inspection
The first day of the inspection was unannounced. The second day of the inspection was announced. Inspection activity was completed on 19 April 2022, when final feedback was provided.
What we did before the inspection
We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority.
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 improvements they plan to make.
We used all this information to plan our inspection.
During the inspection
We spoke with two relatives, one person who used the service and observed care provided in the communal areas and staff giving people their medicines. We spoke with nine members of staff including the manager, registered nurse, carer, domestic, chef, and maintenance staff.
We reviewed a range of records. This included one person’s care records and 17 medication records. We looked at three staff files in relation to recruitment and a variety of records relating to maintenance.
After the inspection
We spoke with six relatives, five people who used the service and six members of staff including two registered nurses. We also received feedback from five health care professionals who visited the service regularly.
We reviewed further records after the inspection, including 13 care records, and a variety of records relating to management of the service, including policies and procedures.
20 May 2022
About the service
St Michael’s Court is a nursing home providing personal and nursing care to up to 86 people. The service provides support to older and younger people, some of whom may be living with dementia, a physical disability or sensory impairment. At the time of our inspection there were 38 people using the service.
The care home accommodates people across three separate floors, each of which has its own facilities, for example, dining room and lounges.
People’s experience of using this service and what we found
Medicines management required improvement. There was poor medicines administration practice seen and poor guidance in the records on how people would like to take their medication.
There was a lack of staff training with staff not receiving all required training. There were also no competency assessments to check staff’s understanding or spot checks to review care delivery.
There were times when the service appeared to be short of staff so the care provided was task-focussed more than person centred. People spoken with acknowledged at times there could be a shortness of staff in the mornings and around meals times, which could mean a wait.
The management oversight of the service needed improving and audits developed to monitor the quality of care and environmental issues to drive improvements.
People had choice about what they would like to eat and had enough. There were concerns people were not consistently being offered sufficient fluids.
Most staff were clear about escalating safeguarding concerns. People felt safe living in the service. They said, “Yes, I’m happy. I do feel safe. It’s because I don’t have to worry about anything.” They were complimentary about the choice of food and its availability.
People said they received their medication on time and there was not a long wait for pain relief. People said staff noticed if they were not feeling well and contacted the GP. They said they had visits from a chiropodist, physiotherapist as well as the hairdresser.
People spoken with said they felt the home was clean and staff wore appropriate personal protective equipment (PPE) when providing care to them and during the pandemic.
The manager was new and responded to our inspection in a positive way and was open about the shortfalls. There had been a lack of reporting of incidents to Safeguarding and CQC. However, since the new manager has been in post this has been addressed and these are now being completed appropriately and in a timely manner.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection and update
The last rating for this service was Good (report published on 12 May 2021).
Why we inspected
We received concerns in relation to the management of medicines and care of people who lived in the service, staffing, and environmental safety issues. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.
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.
For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.
The overall rating for the service has changed from Good to Requires Improvement based on the findings of this inspection.
We have found evidence that the provider needs to make improvements. Please see the safe, effective and well-led sections of this full report.
You can see what action we have asked the provider to take at the end of this full report.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for St Michael’s Court on our website at www.cqc.org.uk.
Enforcement and Recommendations
We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.
We have identified breaches in relation to safe care and treatment, staffing support and training and governance at this inspection.
Please see the action we have told the provider to take at the end of this report.
We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.