St Michaels House

Updated 25 March 2021

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.

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.

Inspection team

The inspection was carried out by one inspector.

Service and service type

St Michaels House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and we looked at both during this inspection.

The service had a manager registered with the Care Quality Commission. Registered managers and providers have legal responsibilities for how they run the service and for the quality and safety of the care provided.

Notice of inspection

Due to COVID-19, we telephoned the service immediately before we entered the home. This was to ensure we had appropriate personal protective equipment for the inspection.

What we did before the inspection

We reviewed the information we had about this service which included safeguarding information and statutory notifications the service had submitted. We used all this information to plan our inspection. We did not ask the provider to complete a Provider Information Return prior to this inspection. This is information we require providers to send us annually following their first inspection to give us some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.

During the inspection

We spoke with five people who lived at the home and two members of care staff. We also spoke with the acting manager and the provider.

Updated 25 March 2021

About the service

St Michaels House is a residential care home registered to support up to 13 adults with mental health conditions and/or people who misuse substances. There were nine people living at the home at the time of inspection.

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

People were satisfied living at the home and felt they received adequate care. However, there were continued failings in relation to the management, governance and oversight of the service.

The management team had failed to take sufficient action to make improvements from the previous inspection. The management team had been unable to implement effective governance structures to adequately review people’s care.

The management team had insufficient oversight of people’s care plans and risk assessments, and the audits that were in place were ineffective at identifying where improvements were required.

The management team did not ensure adequate records were maintained in relation to the care people received and had failed to audit key documents in relation to this.

The management team had an inadequate understanding of their role in ensuring, and reviewing, that people received the care they required. They failed to understand the requirements of how to run a Good service.

People did not have all the risk assessments they required to reduce their known risks. For example, one person at risk of malnutrition did not have a risk assessment in place giving guidance to staff to minimise this risk.

Since the last inspection the provider had introduced some personalised risk assessments however they were not regularly reviewed or updated when changes to people’s care needs had occurred.

Sufficient arrangements were in place to support people with their medicines and there were enough staff to support people safely. Adequate cleaning arrangements were in place.

For more information, please read the detailed findings section of this report. If you are reading this as a separate summary, the full report can be found on the Care Quality Commission (CQC) website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was requires improvement (published 5 March 2020) with well led rated inadequate and the service placed in Special Measures.

At our last inspection we found breaches of the regulations due to our concerns about the leadership of the service and insufficient risk assessments in relation to people’s care. The provider met with us after the last inspection to tell us what they would do and by when to improve. In addition, they have been required to submit monthly reports to the Commission outlining the improvements they were taking.

Not enough improvement had been made at this inspection and the provider was still in breach of the regulations.

This was a continued breach of Regulation 17 (Good governance) and Regulation 12 (Safe care and treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The service remains in Special Measures.

Why we inspected

We carried out this focussed inspection to follow up on the action we told the provider to take at the last inspection.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions and therefore we did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

We have found evidence that the provider needs to make improvement.

You can see what action we have asked the provider to take at the end of this report.

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

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 found breaches in relation to insufficient risk assessments relating to people’s care and insufficient leadership, oversight and governance of the service.

We will update the end section of this report to provide information about CQC’s regulatory response to the breaches found. We will do this once any action has concluded.

What happens next?

We are continuing to keep the service in special measures as we have rated it inadequate in a single key question over two consecutive inspections. This means we will keep the service under review and if it is still operating, will re-inspect within six months of the date we published this report to check for significant improvements.

If the registered provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question, we will take action in line with our enforcement procedures. This usually means that if we have not already done so, we will start processes that will prevent the provider from continuing to operate the service.

For adult social care services, the maximum time for being in special measures will usually be 12 months. If the service has shown improvements when we inspect it, and it is no longer rated inadequate for any of the five key questions, it will no longer be in special measures.