Background to this inspection
Updated
26 October 2019
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 Care Act 2014.
Inspection team
This inspection was carried out by an inspector and an Expert by Experience. 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 Lodge is a ‘care home’ for people with mental health needs. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The home accommodates a maximum of ten people. At the time of our inspection there were nine people living at the home.
The service had a manager registered with the Care Quality Commission. 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.
Notice of inspection
This inspection was unannounced.
What we did before the inspection
We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections.
We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service.
During the inspection
We spoke with seven people who used the service. We spoke with four staff including three support workers and the registered manager who is also the nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider.
We reviewed a range of records. This included three people’s care records, associated risk assessments and monitoring tools. We looked at three staff files in relation to recruitment. A variety of records relating to the management of the service, including policies and procedures were reviewed.
After the inspection
We continued to seek clarification from the provider to validate evidence found. We requested further documentation related to quality assurance. We spoke with the local authority.
Updated
26 October 2019
About the service
St Michael’s Lodge is a residential care home providing personal and nursing care to nine people with mental health needs aged 25 and over at the time of the inspection. St Michael’s Lodge can accommodate up to 10 people in one adapted building.
People’s experience of using this service and what we found
We found improvements were required to the management of the service. The registered manager had failed to notify us of two notifiable serious incidents in August 2018. Staffing levels were not always adequate to meet people’s needs.
People told us they felt safe and staff treated them well. Staff understood their responsibilities for reporting any suspicions of abuse.
People’s risks were assessed, and guidance provided to reduce these. However, the fire risk assessment did not take account of people smoking inside the house. Systems were in place to safely manage medicines. Lessons were learnt when things went wrong, however follow up information was not always documented.
People were cared for by staff who received appropriate training to effectively carry out their role. Staff worked with professionals to support people’s care needs.
People were asked for their consent before care was provided. 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.
People’s nutrition and hydration needs were met.
Care plans documented people’s preferences, likes and dislikes. People’s communication needs were documented in their care plan. Staff were caring and kind and spoke attentively to people.
People were supported by staff who knew people well. People were supported to maintain their independence and their dignity was valued and respected. People were encouraged to make daily living decisions and staff supported them to make their own choices.
People were supported to participate in activities and follow their own interests. People knew how to raise a concern if they were unhappy about the service they received.
There were systems in place for monitoring the quality of the service, however, we found management presence at the service was not enough to ensure the smooth running of the service. The provider knew what was expected of them in terms of Duty of Candour, they had spoken with the local authority and relatives concerning incidents at the home.
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 15 March 2017).
Why we inspected
This was a planned inspection based on the previous rating.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for St Michael’s Lodge on our website at www.cqc.org.uk.
Enforcement
We have identified breaches in relation to staffing levels, recruitment, governance and notification of other incidents.
Please see the action we have told the provider to take at the end of this report.
Follow up
We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.