CQC report explained · a nursing home
What the CQC found at St Michael's Nursing Home
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Good
- Inspectors found people were protected from abuse and avoidable harm. Staffing, medicines, equipment, risk management and infection control were found to be safe.
- Effective?
- Good
- This key question was not inspected during this visit. Its previous rating was used in calculating the overall rating.
- Caring?
- Good
- This key question was not inspected during this visit. Its previous rating was used in calculating the overall rating.
- Responsive?
- Good
- This key question was not inspected during this visit. Its previous rating was used in calculating the overall rating.
- Well-led?
- Good
- Inspectors found an open, person-centred culture, good communication and effective checks and audits. This rating improved from Requires Improvement at the last inspection.
What inspectors found, April 2023
St Michael's Nursing Home was rated Good; inspectors found people were safe and the home was well-led, with its previous improvement in leadership recognised.
This was an unannounced inspection on 20 March 2023. Inspectors checked safety, infection control and leadership. They spoke with people, relatives, staff and a healthcare professional, observed care and reviewed records.
The home was rated Good overall. Inspectors found enough trained staff, safe medicines systems, suitable risk assessments and effective infection control. People and relatives said they felt safe and were happy with the care.
The home had an open and positive culture. People and relatives felt listened to, and staff said they were supported. The well-led rating improved from Requires Improvement at the last inspection to Good.
Only Safe and Well-led were inspected this time. The ratings for Effective, Caring and Responsive were carried forward from the previous comprehensive inspection in 2018.
Safe care
Staff understood how to identify and report abuse. People were supported safely with moving equipment, skin care risks and bedrails.
“People were protected from the risk of abuse. Staff knew how to identify the signs of abuse and would raise any concerns with the registered manager.” from the report
Medicines
Medicines were ordered, stored, given and disposed of through effective systems. Records were accurate and complete.
“Medicines were managed safely. Effective systems were in operation to order, store, administer and dispose of medicines.” from the report
Staffing and recruitment
Inspectors found enough staff and safe recruitment checks. People said staff responded quickly and were kind and caring.
“There were enough staff to support people. The registered manager kept staffing levels under review to make sure there were always enough staff on duty.” from the report
Positive culture
People's views were valued and staff supported people to remain independent. Relatives described staff and management positively.
“There was an open culture which was centred around people. People's views and experiences were valued, and staff included people in decisions which affected them.” from the report
Improved leadership
The home had quality checks, audits and systems for learning from incidents. The well-led rating improved from Requires Improvement to Good.
“At this inspection the rating has changed to good.” from the report
Inspectors raised no specific concerns in this report.
- 01How do you make sure there are enough suitably trained staff for my relative's needs on every shift?
- 02How will you manage and review my relative's medicines, including any medicines given when required or without their knowledge?
- 03What checks and audits will monitor my relative's safety, skin care, moving equipment and risk of falls?
- 04How will you involve my relative and our family in decisions, feedback and any changes to their care?
- 05What has changed in practice since the previous inspection, when the well-led rating was Requires Improvement?
This was a focused inspection of Safe and Well-led, including infection prevention and control; the other ratings were carried forward from the previous comprehensive inspection in 2018. This explanation was written from the published report of 6 April 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 2018
Rated Good overall; inspectors found kind, safe care, but records and oversight needed improvement.
This was an unannounced comprehensive inspection on 12 and 13 April 2018. Inspectors reviewed six care plans, risk assessments and medicines records. They also looked at staff records, audits and quality checks, observed care, visited all areas and spoke with people, relatives, staff and a health professional.
The home was rated Good for Safe, Effective, Caring and Responsive. People were treated kindly and with dignity. Inspectors found enough staff, safe medicines, suitable training, good food and activities, and support from health professionals when needed.
Well-led was rated Requires Improvement. Some records were incomplete or inaccurate. Checks had not found these problems. Issues included fluid records, special mattress settings, some end of life plans and guidance for some medicines. The manager acted immediately during the inspection, but the overall rating stayed Good.
Kind and respectful care
Staff knew people well, asked permission before helping and protected their privacy and dignity. Inspectors saw positive, calm and caring interactions.
“Staff consistently took care to ask permission before intervening or assisting.” from the report
Enough trained staff
Inspectors found sufficient nursing, care and other staff on duty. Staff received induction, ongoing training, supervision and competency checks.
“There were sufficient nursing, care staff and ancillary staff on duty to meet people's needs.” from the report
Personalised care and activities
Care plans covered people's routines, communication, health and personal preferences. The home provided group and one-to-one activities to help prevent isolation and boredom.
“People were supported to keep occupied and there was a range of activities on offer to reduce the risk of social isolation and boredom.” from the report
Safe medicines and health support
Medicines records generally showed that people received their medicines as prescribed and when needed. Staff involved doctors, nurses and other professionals when people's health needs changed.
“People's medicines continued to be managed safely. Accurate records were kept to show when people received their medicines.” from the report
Inaccurate fluid records
needs fixingSome fluid charts recorded how much staff gave people rather than how much they drank. This could make it harder to check whether someone had received enough fluid, although inspectors said people were hydrated.
“These charts had not been accurately completed as staff were entering the amount of fluid given to people and not the actual amount they had drank.” from the report
Mattress settings were not always checked
needs fixingSome pressure-relieving mattresses were not set at the correct level for the person's weight, although no one had developed pressure sores. The manager took action and discussed recording issues with staff.
“Some people were on fluid charts to monitor the amount of drinks they had throughout the day to make sure they were hydrated.” from the report
Care and medicines guidance needed more detail
needs fixingSome end of life care plans were incomplete. Guidance for medicines given when people were upset or restless did not contain enough information to ensure consistent use.
“Some end of life care plans needed further development to ensure people's wishes were recorded.” from the report
Management checks missed recording problems
needs fixingThe home's audits and checks had not identified the inaccurate or incomplete records. This was the reason Well-led was rated Requires Improvement.
“Checks and audits undertaken had not identified lack of accurate recording. There was a lack of oversight and governance in some areas.” from the report
- 01How were fluid charts changed after the inspection, and how do you now check that they record what people actually drink?
- 02How are pressure-relieving mattress settings checked and recorded for each person?
- 03Have all end of life care plans been completed with the person's wishes and preferred arrangements?
- 04What extra guidance is now in place for medicines given when someone is upset or restless?
- 05How do audits now identify inaccurate or incomplete care records before they affect care?
This was an unannounced comprehensive inspection covering all five key questions, the care provided and the care home environment. This explanation was written from the published report of 9 June 2018 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 St Michael's Nursing Home
3 rated inspections over 7 years: the service has held its Good rating throughout.
- April 2023Goodcurrent ratingstayed GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- June 2018Goodstayed GoodSafe: GoodWell-led: Requires improvement
- February 2016GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- February 2014
Report published without a new overall rating.
- January 2013
Report published without a new overall rating.
- March 2012
Report published without a new overall rating.
- September 2011
Report published without a new overall rating.
- December 2010
Registered with the Care Quality Commission on 29 December 2010.
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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