St Michaels Rest Home

St Michaels Rest Home is a residential care home providing accommodation and personal care for up to 29 people, some of whom had dementia. At the time of our inspection there were 22 people using the service.

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

At the last inspection we identified improvements were needed to ensure there was an effective quality assurance system to identify concerns and drive necessary improvement. At this inspection we found some improvements had been made. However, further improvements were needed to ensure consistent practice across all aspects of the service and fully embed changes into everyday practice.

Where areas for improvement were identified, an action plan was developed to ensure these were addressed. The manager and provider were aware of improvements needed to people’s care plans and records.

There was not enough for people to do each day. People spent each day with limited interactions and engagement. The provider had recognised this and was making changes which included external entertainers visiting the home. We identified this as an area that needs to be improved.

We received mixed and conflicting feedback about whether relatives were engaged and involved. Some relatives told us communication was poor and they were not provided with information about their loved one’s well-being. They also told us they were not updated with what was happening at the home. Other relatives told us they were regularly updated. Before the inspection, visiting professionals had told us that staff from the home did not always engage with them. However, a further professional gave us an example of how staff had worked with them to actively meet a person’s needs.

There was a complaints policy and we saw complaints received had been responded to appropriately. However, some relatives told us they were reluctant to make a complaint in case this impacted negatively on loved one’s care. We made a recommendation about this.

Concerns had been raised with CQC that people’s care and support needs in relation to personal hygiene were not being met. We saw that a number of people were at risk of self-neglect as they regularly declined various aspects of personal care throughout the day. Staff told us and records showed how they worked with people to help ensure they received the personal hygiene support they needed whilst respecting people’s choices.

Staff were positive about working at St Michaels. They knew people well and were committed to providing good care and support.

At the last inspection we identified improvements were needed in relation to infection prevention and control and environmental safety. At this inspection we found improvements had been made and the provider was no longer in breach of this regulation. The home was clean and tidy throughout. Concerns about odours had been brought to our attention previously. Although this is not something we identified during the inspection, staff told us where and why odours may occur. They also told us what actions were taken to prevent and address this.

Risks to people were well managed. Staff knew people well and understood how to support them safely. People were protected from the risks of harm, abuse or discrimination because staff knew what actions to take if they identified concerns. There were enough staff who had been appropriately recruited, to support people safely. Systems were in place to ensure safe medicine management.

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 requires improvement (published 3rd December 2020) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations. However further improvements were still required to develop the service and embed changes into everyday practice.

Why we inspected

This inspection was prompted in part by a review of the information we held about this service. In addition, the inspection was prompted due to concerns received about the care people received. As a result, we undertook a focused inspection to review the key questions of safe, responsive 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.

We have found evidence that the provider needs to make improvements. Please see the responsive and well-led key question sections of this report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for St Michaels Rest Home on our website at www.cqc.org.uk.

Follow up

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

St Michaels Rest Home is a residential care home providing personal care to 24 people who were living with a range needs associated with old age and dementia. The service can support up to 27 people.

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

The registered manager worked at the service most days and had a good understanding of her role and responsibilities. However, quality systems, did not always ensure safe care and up to date records in all areas. Systems for ongoing consultation with staff, and stakeholders including relatives had not been fully developed.

The home was not always clean and hygienic and staff practice did not promote good infection control practice in all areas. Risks associated with the safety of the environment and equipment were not always managed appropriately.

The staffing arrangements allowed for people’s needs to be attended to in a safe way. The registered manager kept the staffing numbers and dependency of people under review. Staff were recruited safely. People were protected from the risks of harm, abuse or discrimination because staff knew how to recognise any potential abuse and knew what actions to take if they identified any concerns. People received their prescribed medicines in a timely manner. There were suitable arrangements in place to assess and respond to any individual risks to people.

The registered manager knew people and staff well and approached both in a pleasant and positive way. She understood her responsibilities and was committed to delivering a high standard of care to each person in 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

The last rating for this service was good (published 4 January 2019).

Why we inspected

The inspection was prompted due to concerns received about the safety of people and the management of the service. As a result, we undertook a focused inspection to review the key questions of safe 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 inspection even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively. We reviewed the information we held about the service. There were no areas of concern identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from Good to Requires Improvement. This is based on the findings at this inspection. We identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014. Please see the action we have told the provider to take at the end of this report.

Follow up

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 with the local authority to monitor progress. We will continue to monitor information we receive about the service until we return to visit.

St Michaels Rest Home provides accommodation for up to 27 older people in one adapted building. At the time of the inspection 20 people were living there. People were living with a range needs were associated with old age and dementia. Accommodation is provided over three floors with a passenger lift that provides level access to all parts of the home.

There was a registered manager at the service. 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.

St Michaels Rest Home had been previously inspected in July 2017. Since then the owner of the home had changed their legal entity. Therefore, this was the first inspection of the home under this new legal entity. However, the owner and the management of the home remain the same. At the previous inspection the provider was meeting all the regulations. However, we asked the provider to make improvements to achieve a ‘good’ rating. At this inspection we found improvements had been made and a rating of ‘good achieved. However, we asked the provider to make further improvements to in relation to some records. We found some staff lacked confidence and were not always comfortable in our presence. We made a recommendation about this.

People’s dignity and privacy was respected. They were looked after by staff who knew them well and were kind and caring. Staff treated people with kindness, understanding and patience. People were supported to make decisions and choices about what they did each day, and helped to retain their independence.

People needs had been assessed and support and care was planned and delivered based on people’s preferences and choices. Group and individual activities were organised for people to take part in if they wished.

Risks to people were safely managed. Staff had a good understanding of the risks associated with the people they looked after. Individual and environmental risk assessments were in place and provided guidance. People’s medicines were ordered, stored administered and disposed of safely.

There were enough staff working to provide the support people needed. Recruitment procedures ensured only suitable staff worked at the home. People were protected from the risks of harm, abuse or discrimination because staff had a good understanding of safeguarding procedures.

Staff were received the training and support to deliver care in a way that met people's needs. They had an understanding of the Mental Capacity Act 2005 and DoLS and the need to involve appropriate people, such as relatives and professionals, in the decision-making process when people lacked capacity.

Staff ensured people had access to external healthcare professionals, such as the GP and specialist nurses as necessary and had established good links with local community resources.

People's nutritional needs were met and people had access to food and drink that met their needs and preferences.

People and visitors knew how to make a complaint and would talk to the registered manager if they had any concerns. The registered manager was well thought of and supportive. They had a good oversight of the service and knew where improvements and developments were needed.