CQC report explained · a residential care home
What the CQC found at Care Home Service (Michael & William Houses)
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Good
- Medicines were stored and given safely, risks were assessed, repairs had been completed and infection control arrangements were effective. Staffing and safeguarding arrangements were also found to be suitable.
- Effective?
- Good
- People's needs and choices were assessed, staff had relevant training and healthcare was arranged when needed. Nutrition and hydration needs were met, although some people and relatives wanted the quality of food to improve.
- Caring?
- Good
- Staff were observed treating people with kindness, compassion and empathy. People were involved in decisions about their care, daily lives, where they lived and who supported them.
- Responsive?
- Good
- People had access to daily activities, support to maintain relationships and communication in formats they could understand. Care plans reflected people's needs and preferences, and complaints were investigated.
- Well-led?
- Good
- Inspectors found strong leadership, effective audits and action plans that drove improvements. People, relatives and staff were given opportunities to share their views.
What inspectors found, May 2023
Enham Trust – Care Home Service (Michael & William Houses) is rated Good after major improvements, although the campus setting and food quality need consideration.
This was an unannounced comprehensive inspection over three days. Inspectors spoke with 12 people living in the home, 11 relatives and 11 staff. They also reviewed care records, staff recruitment files and management records.
The home was rated Good in all five areas: Safe, Effective, Caring, Responsive and Well-led. Inspectors found that medicines, staffing, safeguarding, care planning, activities and management systems had improved.
The previous inspection rated the home Inadequate overall, with Safe and Well-led also rated Inadequate. The other three areas were Requires improvement. Inspectors said significant improvement had been made and that the home was no longer in breach of the regulations previously identified.
The home remains a campus setting, with several houses on one site sharing 24-hour staff. CQC said this type of setting is not in line with current best practice, although inspectors found people were being supported in a person-centred way.
Person-centred support
Despite the size of the home, inspectors found that people received individual support and were helped to make choices about their lives.
“Despite the service's size we found people were supported in a way that was person-centred, and promoted choice, inclusion, control and independence.” from the report
Safe medicines
A new electronic medicines system had been introduced. Records showed that people received their medicines as prescribed and that medicines were safely managed.
“People had their medicines available to them and records showed they had received their medicines as prescribed.” from the report
Respectful care
Staff understood people's communication needs and were observed respecting privacy, dignity and personal choices.
“Staff engaged positively with people, treated them with kindness, compassion and empathy.” from the report
Activities and communication
The home offered a range of activities and used pictures, gestures, symbols and other methods to help people understand information and express themselves.
“Staff ensured people had access to information in formats they could understand.” from the report
Improved leadership
Management oversight had strengthened. Audits and action plans were being used to track improvements and address problems.
“Robust governance systems were in place to monitor the quality of care provided within the service.” from the report
Campus setting
minorThe home is a campus with several houses sharing staff. CQC said this model is not in line with current best practice, although the provider was reviewing the service model and inspectors found people's support was person-centred.
“Campus settings for people with learning disabilities and/or autism are not in line with current best practice.” from the report
Food quality
minorSome people and relatives felt the quality of the food could be improved. The provider was aware and told inspectors about plans to improve this area.
“Some people and relatives told us they felt the quality of food provided could be improved.” from the report
- 01How will the review of the campus model affect where my relative lives and who supports them?
- 02What specific changes are being made to improve the quality of the food?
- 03How do you check that the electronic medicines system and 'when required' medicines records remain accurate?
- 04How will you make sure there are enough suitably trained staff, including when agency staff are used?
- 05How are people involved in choosing activities and in decisions about moving to the supported living service?
This was an unannounced comprehensive inspection covering all five key questions, including both the premises and the care provided. This explanation was written from the published report of 5 May 2023 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, June 2022
Enham Trust – Care Home Service (Michael & William Houses) was rated Inadequate and placed in special measures after inspectors found serious safety and leadership failures.
Inspectors visited without notice on 7, 8 and 17 February 2022. Three inspectors, a medicines specialist and an Expert by Experience spoke with 26 people, relatives, staff and professionals. They reviewed care, medicines, infection control, staffing, maintenance and management records.
The most serious concerns were unsafe premises, medicines systems, infection control and staffing levels. Inspectors found unresolved leaks and other maintenance problems, incorrect use of personal protective equipment, and records and guidance that did not always support safe medicines administration.
People were not always given enough information or involvement in decisions about the planned move from a care home to supported living. Some people felt isolated, and complaints about maintenance were not always dealt with promptly. Staff were described as caring, and care plans contained useful information.
The overall rating fell from Requires Improvement to Inadequate. Safe and well-led fell to Inadequate, while Effective and Caring stayed at Requires Improvement. Responsive fell from Good to Requires Improvement. The home was placed in special measures because of the Inadequate overall rating.
Caring staff
People and relatives described staff as compassionate. Inspectors also saw staff treating people with dignity and offering reassurance.
“People and relatives told us staff were caring and said they were compassionate in their approach.” from the report
Useful care records
Care plans and risk assessments gave staff useful information about areas such as moving and handling, epilepsy, nutrition and mental health.
“Care plans and risk assessments contained useful information to help staff to understand people's needs.” from the report
Recruitment and training
The home followed required recruitment checks. Staff received induction, training and regular supervision.
“Safe recruitment practices were followed with regular supervision and training provided.” from the report
Communication support
Staff used visual aids, communication plans and personalised systems to help people understand what was happening and express themselves.
“Staff had good awareness, skills and understanding of individual communication needs, and they knew how to facilitate communication” from the report
Food and healthcare support
People were supported with personal diets, healthy eating and healthcare appointments. Adapted cups and cutlery helped people to be more independent at meals.
“People with complex needs received support to eat and drink in a way that met their personal preferences as far as possible.” from the report
Unsafe premises
seriousMaintenance problems included leaks, heating faults, broken equipment and an unsecured threshold. One person's bedroom door could not be opened from inside until it was repaired.
“The provider failed to ensure the premises used by the service provider was safe to use for their intended purpose.” from the report
Unsafe medicines systems
seriousStaff did not always follow safe processes. Some guidance was unclear or conflicted with prescriptions, and controlled drugs were not stored as required.
“Staff did not always follow systems and processes to administer, record and store medicines safely.” from the report
Infection control
seriousInspectors regularly saw staff wearing personal protective equipment incorrectly. Entry arrangements and the layout and hygiene of the premises were not suitably managed.
“We were not assured that the provider was using PPE effectively and safely.” from the report
Insufficient staffing
needs fixingPeople and relatives reported delays with call bells and said there were not enough staff for activities and support. Inspectors were sometimes unable to see staff in communal areas.
“We could not be assured sufficient staff were consistently deployed to meet people's needs at all times.” from the report
Poor involvement in the move
seriousThe home had not recorded capacity and best-interest decisions for everyone affected by the move to supported living. People said information was confusing and incomplete.
“We found no records of people agreeing to move home or agreeing to the new model of care.” from the report
Weak leadership and oversight
seriousInternal audits did not identify serious problems found by inspectors. Governance and leadership concerns had continued across several inspections.
“Since our inspection on 6 July 2016, Enham has been issued with a breach of regulation 17, good governance in each of its last four inspections.” from the report
- 01Which repairs identified in the report have now been completed, including leaks, heating, lifts, hoists and bedroom doors?
- 02How are medicines now checked so that guidance matches prescriptions and staff record refusals and variable doses correctly?
- 03What staffing levels are in place in each house, and how do you check that call bells and personal care are answered promptly?
- 04How has each person been involved in decisions about the move to supported living, including capacity, best-interest decisions and alternative options?
- 05What changes have been made to management audits so that risks in the premises, infection control, medicines and care are identified quickly?
This was an unannounced comprehensive inspection covering all five key questions, including an evening visit; the previous overall rating was Requires Improvement and was published on 16 May 2020. This explanation was written from the published report of 29 June 2022 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of Care Home Service (Michael & William Houses)
6 rated inspections over 7 years: the service has improved, from Requires improvement to Good.
- May 2023Goodcurrent ratingup from InadequateSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
Read what inspectors found at Care Home Service (Michael & William Houses) →
- June 2022Inadequatedown from Requires improvementSafe: InadequateEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Inadequate
Read what inspectors found at Care Home Service (Michael & William Houses) →
- May 2020Requires improvementstayed Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: GoodWell-led: Requires improvement
- March 2019Requires improvementstayed Requires improvementSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- July 2018Requires improvementstayed Requires improvementSafe: InadequateEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- August 2016Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Requires improvement
- June 2013
Report published without a new overall rating.
- February 2013
Report published without a new overall rating.
- April 2012
Report published without a new overall rating.
- January 2011
Registered with the Care Quality Commission on 4 January 2011.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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