Background to this inspection
Updated
29 September 2023
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.
This was a targeted inspection to check whether the provider had met the requirements of the Warning Notice in relation to Regulation 12 (Safe care and treatment) and Regulation 17 (Good Governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
Inspection team
The inspection was carried out by 2 inspectors.
Service and service type
St Michael’s - Care Home with Nursing Physical Disabilities is a ‘care home’. People in care homes receive accommodation and nursing and personal care as a single package under one contractual agreement dependent on their registration with us. St Michael’s - Care Home with Nursing Physical Disabilities is a care home with nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
Registered Manager
This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and for compliance with regulations.
At the time of our inspection, there was a registered manager in post; however, they were not present during the inspection.
Notice of inspection
This inspection was unannounced.
What we did before the inspection
We reviewed information we had received about the service since the last inspection. The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make. We sought feedback from partner agencies and professionals.
During the inspection
We spoke with 8 staff during the inspections, including the interim manager. We reviewed 5 care plans, risk assessments, governance and auditing documents and other documents relating to the safety of people living at the service.
Updated
29 September 2023
About the service
St Michael’s care home with physical disabilities is a nursing home providing personal and nursing care for up to 36 people. The service provides support to people with complex neurological and physical disabilities. At the time of our inspection there were 27 people using the service.
The building is a large period building, with a large communal dining area. There is a physiotherapy room on site.
People’s experience of using this service and what we found
We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence, and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people and providers must have regard to it.
Based on our review of the key questions safe, responsive and well-led, the service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture.
Right Support:
The provider failed to have oversight of the quality of care and safety. The provider and registered manager had not ensured people received safe or good quality care. This put people's safety at risk and meant people did not receive a safe service.
The service did not always give people care and support in a safe, clean and well-maintained environment.
People were not always able to pursue their chosen interests and achieve their goals because of staffing shortages at the service. The home was reliant on agency staff that did not always know people well. Staff did not always communicate with people in a way that met their needs.
People had some choice over their living environment and rooms were somewhat personalised.
Staff supported people in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice
Right Care
People were not always protected from abuse or the risk of harm; not all staff had completed necessary training to meet the needs of the service user, staff did not always recognise risk of harm to people, staff did not always escalate concerns as required, audits and monitoring of the service did not always identify risk and reoccurring concerns. An effective system was not in place for reporting and reviewing accidents, incidents and near misses involving people.
People's medicines were not always safely managed, this meant people were at risk of receiving or not receiving medicines which may not meet their current needs.
Health and social care professionals were involved in the care and support of the people living in the home.
Right Culture
There were not enough staff and there was a reliance on agency staff to meet people’s needs.
The provider and the manager had failed to implement a robust system to monitor the quality of the service. Improvement in areas of risk management had not been fully implemented in respect of the people’s safety and cleanliness. The geographic location of the service was isolated, the home being on a main road. There was no access to public transport nearby. The service had a vehicle to take people to appointments and on trips.
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 outstanding (published 6 November 2019)
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.
We have found evidence that the provider needs to make improvements. Please see the safe, responsive and well-led sections of this full report.
The overall rating for the service has changed from Outstanding to Inadequate based on the findings of this inspection. You can see what action we have asked the provider to take at the end of this full report.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for St Michael’s on our website at www.cqc.org.uk.
Enforcement and Recommendations
We have identified breaches in relation to safe care and treatment, person centred care, safeguarding, safe staffing and good governance at this inspection.
Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.
Follow up
We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.
Special Measures
The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.
If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.
For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.