CQC report explained · a residential care home
What the CQC found at Micholl's House
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Good
- People were safeguarded and individual and environmental risks were managed. Medicines were managed safely during the inspection, although the home had reported a higher than expected number of medicine errors over the year and there had been a problem with staff deployment during a medical emergency.
- Effective?
- Good
- Staff received induction, training and supervision. People were supported with decisions, health care and nutrition, although one professional felt some mental capacity records were not clear.
- Caring?
- Good
- People and most relatives described staff as kind and caring. Inspectors saw positive interactions and respect for privacy and dignity, but noted one occasion of minimal engagement and a concern about agency staff not engaging with people.
- Responsive?
- Good
- Care plans were detailed, reviewed and tailored to people's communication and support needs. People had access to activities, college and community opportunities, but some relatives felt activities were not always stimulating or person-centred.
- Well-led?
- Good
- The registered manager had made improvements, supported staff and used audits, meetings and surveys to monitor the home. The report also records that two relatives were not told about recent injuries, even though the home's policy said relatives should be informed.
What inspectors found, November 2017
Rated Good; inspectors found kind, effective care and clear improvement, but noted medicine errors, staffing gaps and concerns about activities.
This was an unannounced inspection on 10 and 11 October 2017. Inspectors spoke with people living at the home, relatives, staff and health professionals. They also checked care plans, medicine records, staff files and other records.
The home was rated Good overall and Good in all five areas: Safe, Effective, Caring, Responsive and Well-led. Inspectors found people were generally happy, staff were kind, risks were managed and care plans were being updated.
There were some concerns. The home had a higher than expected number of medicine errors over the year. There were staff vacancies, one shift was not organised well during a medical emergency, and some relatives felt activities and one-to-one support were not always sufficient.
The home had previously been rated Requires Improvement and had breached two regulations in September 2016. Inspectors found those breaches had been addressed and that the home had made good progress.
Improvement since the last inspection
The home had moved from Requires Improvement to Good. Inspectors found that the two previous regulatory breaches had been addressed.
“At this inspection we found those regulations had been met and the service had made good progress in improving the service which resulted in an overall good rating.” from the report
Kind relationships
People were generally happy with the care and had positive relationships with staff. Inspectors saw staff listening, giving people time and encouraging choices.
“Staff were kind, caring and gentle in their approach.” from the report
Care planning and risk management
Care plans included individual risks, communication needs and guidance for staff. They were reviewed when people's needs changed.
“People's care plans included a series of individual risk assessments. These were kept up to date and reviewed.” from the report
Staff training
Staff had training in areas including epilepsy, safeguarding, autism, medicines and moving and handling. New staff received induction and shadowed experienced staff.
“All permanent and bank staff had access to training the provider considered mandatory such as fire safety, food hygiene, first aid, epilepsy awareness, safeguarding of vulnerable adults, moving and handling and infection control.” from the report
Management and checks
The manager was described as approachable and had improved communication and teamwork. Audits were used to identify issues and track improvements.
“Quality assurance systems were in place to monitor the quality of service being delivered and the running of the service.” from the report
Medicine errors
needs fixingThe home had recorded more medicine errors than inspectors expected over the year. New training, stock checks and audits had been introduced, and the medicine records checked during the inspection were accurate.
“The home had a higher than expected number of medicine errors reported over the course of the year.” from the report
Staffing and supervision
seriousThe home had several staff vacancies and relied on bank and agency staff. On one unit, staff were not deployed effectively during a medical emergency, and some relatives raised concerns about one-to-one observations.
“However on one unit staff were not deployed effectively as two staff were involved in a review.” from the report
Mental capacity records
minorOne professional felt some mental capacity records did not clearly show how the capacity assessment had been carried out.
“The MCA's found in the person folder were a bit poor and there was not a clear way to tell how the capacity test had been implemented” from the report
- 01How many medicine errors have there been since this inspection, and what checks are now used to prevent them?
- 02How are staff vacancies being covered, and how do you make sure one-to-one observations are maintained on every shift?
- 03What activities are available for people who do not enjoy group activities, and how are these matched to each person's interests?
- 04How are mental capacity assessments recorded so families can see how decisions were reached?
- 05How will you inform relatives about accidents or injuries in line with the home's reporting policy?
This was an unannounced inspection of the overall service, covering all five CQC questions and checking whether improvements required after the September 2016 inspection had been made. This explanation was written from the published report of 17 November 2017 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, November 2016
Rated Requires Improvement; inspectors found kind care and good health support, but safeguarding, privacy, staffing duties and management needed improvement.
This was an unannounced, comprehensive inspection on 14 and 15 September 2016. The inspector spoke with people, relatives, staff and health professionals. They observed care, checked records and medicines, and reviewed the home and its systems.
The home was rated Good for Effective and Responsive. Staff were trained, people had access to health professionals, meals met people's needs, and care plans and activities were in place. People and relatives were generally positive about the care.
The home was rated Requires Improvement overall, and also for Safe, Caring and Well-led. Inspectors found that a safeguarding concern had not been properly investigated or reported to CQC. Some risks were not fully managed, staff were sometimes taken away from care duties, and one person's privacy and dignity were not promoted.
Staff recruitment
Recruitment checks were in place, including criminal records checks and health checks. Staff had induction, training and supervision to support them in their roles.
“Safe recruitment procedures ensured people were supported by staff with the appropriate experience and character.” from the report
Health support
People could see a range of health and social care professionals. Health guidance was included in care plans and hospital passports were available.
“People had access to health and social care professionals.” from the report
Food and nutrition
People were offered varied meals, choices and alternatives. Staff followed dietary guidance and monitored food, fluids and weight where needed.
“People were provided with a varied diet.” from the report
Kind interactions
Inspectors saw staff being patient, gentle and supportive in many interactions. Staff often encouraged independence and understood people's communication needs.
“They were caring and gentle whilst supporting people.” from the report
Complaints and feedback
People and relatives had information about complaints and could give feedback through meetings, surveys or directly to staff.
“Systems were in place to enable people to raise concerns and give feedback on the service.” from the report
Safeguarding was not handled properly
seriousAn allegation involving a staff member and bruising was not clearly investigated. The provider also failed to notify CQC about the allegation.
“This was a breach of Regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) 2014.” from the report
Some risks were not fully managed
needs fixingFalls records did not clearly show the level of risk or how it should be managed. There was also no risk assessment for disposable gloves being accessible to people.
“It is recommended the provider ensures all areas of risk are identified and managed.” from the report
Care staff had non-care duties
needs fixingCare staff were responsible for cooking, cleaning and laundry as well as care. Inspectors were concerned these duties could take staff away from people, particularly at night.
“Care staff were responsible for the cooking of all meals on each unit and the cleaning of their unit which included people's bedrooms and the communal areas.” from the report
Privacy and proactive support
needs fixingOn one unit, staff did not engage people proactively or try to prevent distress. One person's privacy and dignity were not protected when they were unwell in a communal area.
“One person was frequently distressed.” from the report
Medicine errors
needs fixingMedicine records checked had no gaps, but the home had a high number of medicine errors. The provider had introduced reviews and measures to reduce them.
“The home had a high number of medicine errors.” from the report
- 01What has changed in the way safeguarding allegations are investigated and reported to CQC since this inspection?
- 02How do you make sure care staff are available to support residents when they are also cooking, cleaning or doing laundry?
- 03What steps have reduced medicine errors, and how are families told about any medicine mistake?
- 04How do staff protect privacy and dignity when someone is unwell or distressed in a communal area?
- 05What community activities are currently available, and how are cancelled activities replaced?
This was an unannounced comprehensive inspection covering all five key questions and providing an overall rating; the previous inspection on 8 May 2014 found the service compliant in the areas checked. This explanation was written from the published report of 4 November 2016 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 Micholl's House
2 rated inspections over a year: the service has improved, from Requires improvement to Good.
- November 2017Goodcurrent ratingup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- November 2016Requires improvementSafe: Requires improvementEffective: GoodCaring: Requires improvementResponsive: GoodWell-led: Requires improvement
- June 2014
Report published without a new overall rating.
- September 2013
Report published without a new overall rating.
- October 2012
Report published without a new overall rating.
- November 2011
Report published without a new overall rating.
- May 2011
Registered with the Care Quality Commission on 17 May 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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