About the service Mickley Hall is a nursing home providing personal and nursing care to 40 people who have physical disabilities. At the time of inspection 29 people were receiving support.
People’s experience of using this service and what we found
There had been some improvements in the systems to monitor and assess the service provided, such as accident and incident analysis. However, the governance systems in place were not robust enough to identify the shortfalls we found during this inspection. Although people told us they felt safe at the service, we found inconsistencies with information around risks to people and how staff should respond to these. Infection prevention and control measures were in place but were not always being followed. Staffing levels were not always appropriate to meet people’s needs. Medicines were managed safely. Staff were recruited safely, however, we recommended the provider reviews their recruitment policy.
Records had not always been completed accurately to show whether care tasks had been carried out and whether people had participated in activities. People’s nutritional needs were met. However, people were not always supported to eat in a caring or considerate way. People told us the food was nice and we observed it was appetising and varied. We recommend the provider reviews mealtimes to ensure it promotes a better experience for people. Staff training was not always up to date and there was no evidence of the clinical training nursing staff had completed.
People did not always receive person centred and dignified care. Some people's care plans were inaccurate and lacked information about people's needs, which meant staff were not provided with clear guidance to support and care for people. People’s records did not reflect what activities they had been involved with.
People provided positive feedback about staff. We observed good interactions between people and staff. Staff treated people with dignity and respect and knew their needs well. Feedback from relatives about staff's caring manner and approach was very positive.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. However, meetings were not always held to ensure it was in their best interests.
We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.
The service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture. The model of care and the setting did not maximise people's choice, control and independence. People's own rooms were personalised. The care people received was not always person-centred and did not promote people's dignity.
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 20 May 2020) and there were multiple breaches of regulation across all domains. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made/ sustained, and the provider was still in breach of regulations.
Why we inspected
This was a planned inspection based on the previous rating. 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.
Enforcement
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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.
We have identified breaches in relation to safe care and treatment, person centred care, need for consent, staffing and governance.
Please see the action we have told the provider to take at the end of this report.
Follow up
We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
Special Measures
The overall rating for this service is ‘inadequate’ and the service is therefore in 'special measures'. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.
If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.
For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions, it will no longer be in special measures.