St Michael's Nursing Home

St Michael’s Nursing Home is a nursing home providing personal/ and nursing care to 59 at the time of the inspection. The service can support up to 65 people. St Michael’s Nursing Home accommodates people across two separate wings, each of which has separate adapted facilities.

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

At the time of the inspection, the location did not care or support for anyone with a learning disability or an autistic person. However, we assessed the care provision under Right Support, Right Care, Right Culture, as it is registered as a specialist service for this population group.

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

Right Support:

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.

Right Care:

People and their loved ones told us they were happy and safe living at St Michael’s Nursing home. People were supported by sufficient numbers of staff who had the training and skills to support people, including understanding the risk of abuse and how to report this.

People were supported safely with their medicines. There was detailed guidance in place to inform staff how best to support people, for example with transferring or maintaining healthy skin. When things went wrong there was a robust system in place to learn and improve.

The service was clean and well maintained. Staff completed checks on equipment to ensure it was safe to be used.

Right Culture:

There was a positive culture at the service, which encouraged positive outcomes for people. People and their loved ones were engaged with the service and felt their opinions were valued and used to improve the service. We received positive feedback from people, relatives, staff and healthcare professionals about the registered manager and their positive impact on the service.

The registered manager and staff completed a series of checks and audits to improve 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 9 June 2018).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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. The overall rating for the service remains good based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for St Michael's Nursing 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.

Care service description

St Michael’s Nursing Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. St Michael’s Nursing Home provides care for up to 65 older people who have nursing needs and who may also be living with dementia. The care home is based in a residential area of Westgate-on-Sea, with car parking on site, and public transport links close by. The service is arranged as two separate units over two floors of a detached building. There are communal lounges and dining areas. On the day of the inspection there were 53 people living at the service.

Rating at last inspection

At our last inspection we rated the service good. At this inspection we found overall the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. However, we did find an area, records that needed improvement. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection but one of the domains now requires improvement.

At this inspection we found the service remained Good.

Why the service is rated Good.

The service continues to be rated as good but some records needed improvement. Staff had not always completed some records accurately and concisely to show that people were getting the support and care that had been planned for them and for risks to be minimised. Records had been audited and checked but the inaccuracy of the records had not been identified as a shortfall. Other information in care plans and medicines records needed further details to make sure people were receiving consistent care from the staff in the way that suited them best. The registered manager took immediate action to address the issues.

People, staff and relatives told us that the service was well led and that the management team were supportive and approachable and that there was a culture of openness within the service. The registered manager was experienced and skilled in supporting people with complex health needs and continued to enhance their knowledge and skills. They had a clear vision for the service and this was shared by the staff. The registered manager worked with other professionals and outside agencies to ensure people had the support they needed. There were links with the local community. The registered manager had sought feedback from people, their relatives and staff about the service.

People felt safe in the service. Staff understood how to protect people from the risk of abuse and knew the action they needed to take to report any concerns in order to keep people safe. The management responded appropriately when concerns or complaints were made.

Staff understood people's specific needs and had good relationships with them. Throughout the inspection people were treated with dignity and kindness. People's privacy was respected. Staff were respectful and caring when they were supporting people. At the end of their lives people were supported to have a comfortable, dignified and pain –free death.

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.

People were assessed before they came to live at the service. Care plans contained the detail needed to show how all aspects of people’s care was being provided in the way they preferred. Risks to people's health and safety were assessed and there was guidance for staff to mitigate risk and keep people as independent as possible. There was a wide range of activities provided for people to participate in and enjoy. Activities continued to develop and improve.

The complaints procedure was on display to show people the process of how to complain. People, their relatives and staff felt confident that if they did make a complaint they would be listened to and action would be taken.

The service suited people's needs. The environment was clean, comfortable and well maintained. Environmental improvements had been since the last inspection and there were plans in place for this to continue. The management team and staff carried out regular environmental and health and safety checks to ensure that the environment was safe and that equipment was in good working order. There were systems in place to review accidents and incidents and make any relevant improvements as a result. Emergency plans were in place so if an emergency happened, like a fire, the staff knew what to do. Fire safety checks were carried out regularly. People were protected from the risk of infection.

People were supported to have a nutritious diet. Their nutritional needs were monitored and appropriate referrals to health care professionals, such as dieticians, were made when required. People received their medicines safely and when they needed them.

A system to recruit new staff was in place. This made sure that the staff employed to support people were fit to do so. There were sufficient numbers of staff on duty throughout the day and night to make sure people were safe and received the care and support that they needed.

The management made sure the staff were supported and guided to provide care and support to people. New staff received a comprehensive induction. Staff had regular training and additional specialist training to make sure that they had the right knowledge and skills to meet people's needs effectively. Staff said they could go to the registered manager and they would be listened to. Staff understood their roles and responsibilities as well as the values of the service.

The registered manager had notified the Care Quality Commission of events that were reportable.

The rating of 'Good' was displayed at the service and on the provider website.

St Michael’s Nursing Home is a privately owned care home providing nursing care and support to up to 73 adults who have nursing needs and who may also be living with dementia. The care home is based in a residential area of Westgate-on-Sea, with car parking on site, and public transport links close by. The service is arranged over 2 floors of a detached building. On the day of the inspection there were 52 people living at the service.

There was a registered manager working 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 and associated Regulations about how the service is run.

There were risk assessments in place, including environmental risk assessments, to minimise risks and ensure that people remained safe. Systems were in place to make sure that the registered manager and staff learned from events such as accidents and incidents.

Health and safety audits of the environment and equipment were carried out regularly to make sure people were safe in the service. People each had a personal emergency evacuation plan, which detailed how they could be safely evacuated from the service in the event of an emergency.

All staff had completed safeguarding training and they knew what action to take in the event of any suspicion of abuse, and who to report to both internally or externally, such as the local authority safeguarding team. Staff knew about the whistle blowing policy, and were confident they could raise any concerns with the registered manager, who would take appropriate action.

People had their needs met by sufficient numbers of staff on duty. Staff were checked before they started to work at the service and regularly received training to ensure they had the skills and competencies to provide safe care. New staff received induction training and shadowed established staff before they started to work on their own. Staff met with the registered manager to discuss their role and practice, and had an annual appraisal to discuss their training and development needs.

Medicines were stored and administered safely. People had the support they needed to remain healthy and well. Staff responded to any changes in people’s health needs; people and relatives told us that staff always called their doctor if they felt unwell. Nursing staff ensured that medicines were managed and administered safely.

People’s care plans contained clear information about people’s care needs. They were reviewed regularly and updated so that staff were aware of people’s current needs. People or relatives had signed the plans to confirm they had agreed with the care to be provided. Records about people’s end of life care were not always completed fully and in some cases there was a lack of people’s personal histories to ensure that staff would know what was important to them. Some plans lacked detail on how people preferred to receive their care and support. This was an area for improvement.

The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS). At the time of the inspection the registered manager had applied for a DoLS authorisation 15 people who were at risk of having their liberty restricted. At the time of this inspection no one had an authorisation to restrict their liberty. When people were unable to make important decisions for themselves, relatives, doctors and other specialists who were involved in their care and treatment and decisions were made in people’s best interest.

People and relatives told us the staff were kind, and respected their privacy and dignity. People were encouraged to be as independent as possible. Staff were attentive and the atmosphere in the service was calm, and people were comfortable in their surroundings. Staff encouraged and involved people in conversations as they went about their duties.

People told us that they enjoyed their meals. If people were not eating enough their food was monitored. If required a referral was made to a dietician or their doctor, and supplements were provided as necessary so that they maintained a healthy diet.

People were given individual support to carry out their preferred hobbies and interests, such as knitting, playing games, and doing exercises. Staff were familiar with people’s likes and dislikes, such as how they liked their food and drinks and what activities they enjoyed.

The complaints procedure was on display to show people the process of how to complain. People, their relatives and staff felt confident that if they did make a complaint they would be listened to and action would be taken.

Audits carried out by the registered manager, and visits by the quality manager, helped to ensure people received a quality service. The action plan from the audits showed how the registered manager initiated improvements as the result of their findings. The service had systems in place for people to voice their opinions on the service and the care being provided.

The registered manager provided leadership to the staff and had oversight of all areas of the service. There was a culture of continuous improvement, so that people would feel increasingly well cared for. Staff were motivated and felt supported by the registered manager and senior staff.

The staff understood the vision and values of the service, such as person centred care, treating people with respect and maintaining their privacy and dignity. Staff told us the registered manager was approachable and they were confident they would not hesitate to raise any issues if they had any concerns.

People's needs were assessed before and when they first started to use the service. We found that people's health care needs were monitored and community health professionals were involved to provide advice and support when needed. We found that appropriate arrangements were in place for the safe handling, storing, disposal and giving of medicines.

People told us that the staff were nice, friendly and there was always enough staff to help them. We found that there was sufficient suitably qualified, skilled staff available throughout the home to meet people's needs.

Systems were in place to monitor the service that people received to ensure that the service was satisfactory and safe. People told us they did not have any complaints but would not hesitate to speak to the manger or staff if they had any concerns.

People looked relaxed, comfortable and at ease with each other and staff. One person said, "The staff help me when I need it. They come quickly if I ring the bell".

Everyone said that the food was 'good' and that they always had a choice. We saw that meals were nicely presented and peoples dietary needs were catered for.

We spent time with people and observed interactions between the people and the staff.

The staff we spoke with had knowledge and understanding of people's needs and knew people's routines and how they liked to be supported. We found evidnece that staff had the skills and the knowledge to meet the needs of people using the service and were supported by colleagues and managers.

People told us they felt confident to make a complaint and were happy with the outcome of complaints that they had made.

We found that the service was clean and odour free. The provider had processes in place to minimise the risk to people from the building, including fire.