6 March 2018
During a routine inspection
St Michaels Lodge is a ‘care home’. 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.
St Michaels Lodge can accommodate 13 people in one adapted building. At the time of inspection, six people with mental health support needs were living at the service .
At our last inspection in August 2017, we rated the service as requires improvement, we found the service to be in breach of regulation 11 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 – Need for consent. This was because of a failure to involve people in their assessments of capacity, lack of consideration for the least restrictive strategies to support people and lack of consideration of people's best interests. At this inspection, we found that some improvements had been made, and the service was no longer in breach of this regulation. However, further improvements were still required to make sure every person had the same opportunity for support with decision making, and to make sure all people’s interests were appropriately represented.
There was a registered manager in post who was also the provider of 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. The registered manager was not available to see us on the day of inspection.
Staffing levels had improved since our last inspection, although this was not always consistent. During the day of our inspection, only one member of staff was on shift, when there would usually be two. This limited the amount of interaction and activity available for people. The staffing levels within the home required strengthening to fully enable a selection of meaningful activity for the individuals living at the service.
Improved quality monitoring systems and processes were in place and audits were taking place within the service to identify where improvements could be made. Further detail was required with environmental audits to ensure that maintenance and levels of cleanliness remained adequate.
Staff had an understanding of abuse and the safeguarding procedures that should be followed to report abuse. People had risk assessments in place to cover any risks that were present within their lives, but also enable them to be as independent as possible. All the staff we spoke with were confident that any concerns they raised would be followed up appropriately by the registered manager.
The staff recruitment procedures ensured that appropriate pre-employment checks were carried out to ensure only suitable staff worked at the service. References and security checks were carried out as required.
Staff attended induction training where they completed mandatory training courses and were able to shadow more experienced staff giving care. Staff told us that they were able to update their mandatory training with short refresher courses.
Staff supported people with the administration of medicines, and were trained to do so. The people we spoke with were happy with the support they received.
Staff were well supported by the registered manager and senior team, and had one to one supervisions and observations.
People were able to choose the food and drink they wanted and staff supported people with this. People could be supported to access health appointments when necessary. Health professionals were involved with people's support as and when required.
Staff treated people with kindness, dignity and respect and spent time getting to know them and their specific needs and wishes. People told us they were happy with the way that staff spoke to them, and they provided their care in a respectful and dignified manner.
People were able to contribute to the way in which they were supported. Care planning was personalised and mentioned people's likes and dislikes, so that staff understood their needs fully. People were in control of their care and were listened to by staff.
The service had a complaints procedure in place. This ensured people and their families were able to provide feedback about their care and to help the service make improvements where required. The people we spoke with knew how to use it.
The service worked in partnership with other agencies to ensure quality of care across all levels.
Communication was open and honest, and improvements were highlighted and worked upon as required.