St Michaels Rest Home

Updated 15 December 2022

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.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was undertaken by three inspectors. Two inspectors visited the service and the third inspector contacted people’s families for feedback.

Service and service type

St Michaels Rest Home is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. St Michaels Rest Home is a care home without 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 compliance with regulations.

At the time of our inspection there was not a registered manager. There was a new manager in post and we were told they planned to submit an application to register.

Notice of inspection

The first day of the inspection was unannounced.

What we did before the 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 used information gathered as part of monitoring activity that took place on 8 September 2022 to help plan the inspection and inform our judgements. We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used all this information to plan our inspection.

During the inspection

During the inspection we reviewed the records of the home. These included three staff recruitment files, medicine records, accidents and incidents and quality audits along with information about the upkeep of the premises. We looked at six care plans and risk assessments along with other relevant documentation to support our findings. This included 'pathway tracking' two people living at the home. This is when we check that the care detailed in individual plans matches the experience of the person receiving care. It is an important part of our inspection, as it allows us to capture information about a sample of people receiving care.

During the inspection process we spoke with most people who lived at the home. However, not all were able to feedback to us verbally. We therefore gathered feedback from the relatives and representatives of 12 people. We spoke with 10 staff members, this included the provider and manager. We also received feedback from two further health and social care professionals.

We spent time observing people in areas throughout the home and could see the interaction between people and staff. We watched how people were being cared for by staff in communal areas, this included the lunchtime meals.

Updated 15 December 2022

About the service

St Michaels Rest Home is a residential care home providing accommodation and personal care for up to 29 people, some of whom had dementia. At the time of our inspection there were 22 people using the service.

People’s experience of using this service and what we found

At the last inspection we identified improvements were needed to ensure there was an effective quality assurance system to identify concerns and drive necessary improvement. At this inspection we found some improvements had been made. However, further improvements were needed to ensure consistent practice across all aspects of the service and fully embed changes into everyday practice.

Where areas for improvement were identified, an action plan was developed to ensure these were addressed. The manager and provider were aware of improvements needed to people’s care plans and records.

There was not enough for people to do each day. People spent each day with limited interactions and engagement. The provider had recognised this and was making changes which included external entertainers visiting the home. We identified this as an area that needs to be improved.

We received mixed and conflicting feedback about whether relatives were engaged and involved. Some relatives told us communication was poor and they were not provided with information about their loved one’s well-being. They also told us they were not updated with what was happening at the home. Other relatives told us they were regularly updated. Before the inspection, visiting professionals had told us that staff from the home did not always engage with them. However, a further professional gave us an example of how staff had worked with them to actively meet a person’s needs.

There was a complaints policy and we saw complaints received had been responded to appropriately. However, some relatives told us they were reluctant to make a complaint in case this impacted negatively on loved one’s care. We made a recommendation about this.

Concerns had been raised with CQC that people’s care and support needs in relation to personal hygiene were not being met. We saw that a number of people were at risk of self-neglect as they regularly declined various aspects of personal care throughout the day. Staff told us and records showed how they worked with people to help ensure they received the personal hygiene support they needed whilst respecting people’s choices.

Staff were positive about working at St Michaels. They knew people well and were committed to providing good care and support.

At the last inspection we identified improvements were needed in relation to infection prevention and control and environmental safety. At this inspection we found improvements had been made and the provider was no longer in breach of this regulation. The home was clean and tidy throughout. Concerns about odours had been brought to our attention previously. Although this is not something we identified during the inspection, staff told us where and why odours may occur. They also told us what actions were taken to prevent and address this.

Risks to people were well managed. Staff knew people well and understood how to support them safely. People were protected from the risks of harm, abuse or discrimination because staff knew what actions to take if they identified concerns. There were enough staff who had been appropriately recruited, to support people safely. Systems were in place to ensure safe medicine management.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 3rd December 2020) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations. However further improvements were still required to develop the service and embed changes into everyday practice.

Why we inspected

This inspection was prompted in part by a review of the information we held about this service. In addition, the inspection was prompted due to concerns received about the care people received. As a result, we undertook a focused inspection to review the key questions of safe, responsive and well-led only.

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 responsive and well-led key question sections of this report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for St Michaels Rest Home on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.