CQC report explained · a residential care home
What the CQC found at St Michaels
Rated Good: inspectors found the home performing well and meeting their expectations.
What inspectors found, October 2017
St Michaels was rated Good overall, but inspectors found that medicines and staffing arrangements were not consistently safe.
This was an unannounced inspection on 6 September 2017. Inspectors observed care, spoke with people, relatives and staff, and checked care plans, medicines, training records and quality checks.
The home was rated Good overall. Inspectors found kind and respectful care, suitable food and healthcare, personalised support for permanent residents, activities and an open management approach.
Safe was rated Requires Improvement. Medicines were usually given safely, but records and checks did not always follow national guidance. Inspectors also saw staff being interrupted or pulled away from activities to provide personal care.
The overall rating had improved from Requires Improvement at the previous inspection. The report says earlier issues had been addressed, but the medicine problems found during this inspection had not been identified by the home's own checks.
Kind and respectful care
Inspectors saw staff speaking gently, explaining care and protecting people's dignity. People and relatives said they felt well cared for.
“Staff were kind and gentle when providing care to people.” from the report
Health and nutrition
People had access to GPs, district nurses and specialist professionals. Their nutrition was assessed, and staff provided choices, snacks and support with meals.
“People had access to a range of healthcare services and professionals.” from the report
Personalised support
Permanent residents' care records included their preferences and practical needs. People could choose how their care was delivered and take part in activities.
“Care records for people who were at the home on a permanent basis were personalised.” from the report
Open management
Staff said they were supported and could raise concerns. People, relatives and staff described the manager as approachable.
“The registered manager created an open culture and supported staff.” from the report
Medicine records and checks
seriousSome 'as required' medicine protocols were incomplete, and two medicines had been recorded as given on an 'as required' basis when they were prescribed regularly. The home's quality checks had not found these problems.
“Systems were not always in place for the safe management of medicines.” from the report
Covert medicine decisions
seriousFor one person receiving medicine without their knowledge, a capacity assessment and best-interest arrangements had not been completed. The guidance for staff did not fully match national best practice.
“Where a person received their medicines without their knowledge (covertly) arrangements had not been put in place to ensure this was in their best interests.” from the report
Staff availability
needs fixingInspectors saw staff being interrupted and leaving activities to provide personal care. On two occasions, staff did not return to continue the activity.
“We also observed staff had to leave people with whom they were playing games etc. in order to assist people with their personal care.” from the report
Respite care records
needs fixingCare records for people staying for respite care did not contain enough detail. Inspectors said this could make it harder for staff to know how to provide the right care.
“However, we found care records for people receiving respite care lacked detail.” from the report
Delayed training
minorTwo new staff members said some training, including moving and handling, had not been provided quickly enough for them to fully carry out their roles.
“They said the delay they had experienced had meant they could not fully carry out their role.” from the report
- 01What changes have you made to ensure 'as required' and regular medicines are recorded and monitored correctly?
- 02How do you check that decisions about medicines given without a person's knowledge are supported by a capacity assessment and best-interest decision?
- 03How many staff are normally available on each shift, and how do you prevent staff being pulled away from activities or other residents?
- 04What information is now included in care records for people receiving respite care?
- 05How quickly do new staff complete moving and handling and other essential training?
This was an unannounced comprehensive inspection of the overall service and all five CQC questions, including observations, discussions and checks of five people's records. This explanation was written from the published report of 20 October 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, January 2017
Rated Requires Improvement; inspectors found better quality checks, but records were incomplete and there was no registered manager in post.
This was an unannounced focused inspection on 23 November 2016. Inspectors checked whether improvements had been made after a breach found at the May 2016 inspection. They observed care, spoke with staff and managers, and checked care plans, medicines records, meeting notes and audits.
The home had introduced regular checks and action plans. Inspectors found that legal requirements had been met. Staff meetings and support from managers were in place, and staff said managers were approachable.
However, some records were still incomplete or undated. Two of the three care plans checked had incomplete consent paperwork. The lock on the door where personal files were kept was broken, and there was no registered manager in post.
The overall rating was Requires Improvement. Well-led was also rated Requires Improvement because good management practice had not yet been shown consistently over time. The other four areas were not assessed in this focused inspection.
Quality checks improved
The home had started regular audits and put action plans in place when problems were found. Inspectors found that legal requirements had been met since the previous inspection.
“We found that some of the issues had been resolved and legal requirements had been met.” from the report
Staff felt supported
Staff said they could raise concerns with managers and felt listened to. They also said managers were approachable and available to help.
“You can now find solutions because managers are approachable.” from the report
Useful care information
The home had introduced medication identification sheets, hospital grab sheets and daily handovers to help staff understand people's needs and changes in wellbeing.
“This meant staff had access to relevant information to support them in their role.” from the report
Calm atmosphere
Staff described the home as focused on the people living there. A visiting professional also reported that the organisation and atmosphere had improved.
“They told us that the atmosphere in the home was calm and focussed around the people who lived there.” from the report
Incomplete records
needs fixingSome documents were not fully completed or dated. Two of the three care plans checked had incomplete consent forms, making it unclear whether people could consent.
“However during our inspection we still found some documentation which had not been fully completed or dated such as body maps.” from the report
Consent was unclear
needs fixingTwo care plans had incomplete consent forms. The records did not explain whether this was because people could not sign or lacked capacity.
“This meant it was unclear as to whether or not people were able to consent.” from the report
No registered manager
needs fixingThere was no registered manager in post at the inspection. An application had been made for the current manager to become registered.
“At the time of our inspection there was not a registered manager in post.” from the report
Broken lock on personal files room
needs fixingThe lock on the door to the room holding personal files was broken. Although the door was kept shut, inspectors said people could have accessed personal information.
“Although the door was kept shut anyone could have had access to personal information as a result.” from the report
- 01Has the manager's application to become registered been completed, and who is legally responsible for the home while this is outstanding?
- 02How are incomplete or undated records, including body maps, now identified and corrected?
- 03How do you record whether a person can give consent when they cannot sign a consent form?
- 04Has the broken lock on the room containing personal files been repaired, and how are personal records kept secure?
- 05What regular audits are now carried out, and how do you check that actions from those audits have been completed?
This was a focused inspection of Well-led only to check improvements after the May 2016 inspection; the other four question ratings were not assessed in this report. This explanation was written from the published report of 11 January 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.
Every inspection of St Michaels
4 rated inspections over 3 years: the service has improved, from Requires improvement to Good.
- October 2017Goodcurrent ratingup from Requires improvementSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- January 2017Requires improvementstayed Requires improvementWell-led: Requires improvement
- June 2016Requires improvementstayed Requires improvementSafe: Requires improvementEffective: GoodCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- March 2015Requires improvementSafe: Requires improvementEffective: GoodCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- March 2014
Report published without a new overall rating.
- November 2013
Report published without a new overall rating.
- July 2013
Report published without a new overall rating.
- July 2012
Report published without a new overall rating.
- November 2011
Report published without a new overall rating.
- January 2011
Registered with the Care Quality Commission on 20 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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These are self-employed carers on PrimeCarers, the introductory agency that runs this directory. Each has a profile with their own rates and reviews from families, and you choose who to talk to.
8 can care for a couple. 10 years' experience on average.
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