About the service:

Mickley Hall is a care home for people who require personal or nursing care. The service can provide accommodation for up to 40 people. At the time of the inspection 37 people were using the service.

People’s experience of using this service:

The provider had made good improvements to the service since our last inspection on 11 January 2018.

Staff received better training, induction, supervision and support so they could effectively perform their roles.

The registered manager had resolved issues surrounding the recording, investigation and analysis of incidents and accidents.

Risk management at the service had improved.

The deployment of staff had improved at the service.

We found systems to make sure people received their medicines safely had improved.

The registered manager had submitted appropriate notifications to the Care Quality Commission and/or the local safeguarding authority.

We observed that many areas of the home required refurbishment, however the provider had a maintenance and refurbishment programme in place which showed clear timescales of how and when the works were to be completed.

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

People had access to a range of health care professionals to help maintain their health.

People were treated with dignity and respect and their privacy was protected; a range of activities were available to provide people with leisure opportunities.

People were confident in reporting concerns to the registered manager or staff and felt they would be listened to and their concerns would be addressed.

There were effective systems in place to monitor and improve the quality of the service provided. Regular checks and audits were undertaken to make sure full and safe procedures were adhered to.

Staff told us they felt they had a very good team. Staff and people said the registered manager was approachable and communication had improved within the service.

Rating at last inspection:

At the last inspection the service was rated requires improvement (report published 11 April 2018) This service has been rated requires improvement in the last two inspections.

Why we inspected:

All services rated "requires improvement" are re-inspected within one year of our prior inspection. We carried out this inspection to check whether the necessary improvements had been made to the service.

Follow up:

We will continue to monitor this service. We plan to complete a further inspection in line with our re-inspection schedule for those services rated good.

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

This inspection took place on 11 January 2018 and was unannounced. This meant the staff and registered provider did not know we would be visiting.

Mickley Hall is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The service can provide accommodation for up to 40 people. At the time of the inspection 33 people were using the service.

The manager had applied to register with the Care Quality Commission. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At the last inspection in May 2017 the service’s overall rating was ‘Requires Improvement’ with no breaches of the Health and Social Care Act 2008. At this inspection we found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also found a breach of Regulation 18 of the Care Quality Commission (Registration) Regulations 2009. The service’s overall rating is ‘Requires Improvement’.

Although people told us they felt safe, we found there were not effective systems and processes established at the service to ensure people were consistently safe and protected from improper treatment.

We saw the service’s accident and incident reporting process for staff to report concerns about risks, safety and incidents was not always operated effectively. This showed that risks were not always identified or managed. We saw there was a risk that reportable incidents may not be shared appropriately with the Care Quality Commission and/or the local safeguarding authority.

We found the registered provider had not ensured all the staff working at the service had been provided with safeguarding vulnerable adults training so they had an understanding of their responsibilities to protect people from harm.

At the last inspection we saw the deployment of staff required improvement to ensure people who were unable to summon assistance were not left unattended. We saw it was important to have staff supervision on hand to respond to people if they showed any signs of distress through facial expressions or coughing. Without a staff member in place we saw people were left at risk. At this inspection, we saw the deployment of staff required further improvement so people were not left unattended in the lounge area.

We found the management of medicines required improvement. Since the last inspection the provider had introduced an electronic medication administration record (EMAR) system. We saw medicines administration rounds took a very long time and that it was difficult to ensure people received their medicines at the correct time.

Although regular checks of the building were carried out to help keep people safe, we saw no action had been planned to enable people to access the garden area safely. If people and relatives chose to access this area, there was a notice stating they did so at their own risk.

We found the registered provider had not ensured that all the staff working at the service had received adequate training to ensure they had the appropriate skills and knowledge.

Although staff told us they felt supported, we found the registered provider had not ensured there was a robust system in place to ensure staff received appropriate support according to their policies.

In people’s records we found evidence of involvement from other professionals such as doctors, optician, tissue viability nurses and speech and language practitioners.

Throughout our inspection the atmosphere within the service was calm, supportive and friendly. We saw posi

We inspected Mickley Hall Nursing Home on 31May and the 5 June 2017.The inspection was unannounced on the first day. The service provided accommodation, nursing and personal care for up to 40 people living with a range of physical and mental disabilities. On the days of our inspection visits there were 34 people using the service.

Our last inspection took place in August 2015. We identified concerns relating to inadequate levels of safety. This was a breach of Regulation 12 (Safe Care and Treatment) Health and Social Care Act 2008 (regulated activities) Regulations 2014. This was mainly in relation to how medicines were managed. We also identified areas of concern in how the service was managed. This was This was a breach of Regulation 17 (Good Governance) Health and Social Care Act 2008 (regulated activities) Regulations 2014.

Following this inspection we asked the provider to send us an action plan detailing how they would address these issues. The provider complied and sent us their action plan telling us about the improvements they intended to make. During this inspection we looked at whether or not those improvements had been met. We found mostly improvements had been made regarding well led and the administration of medicines.

The service had been without a registered manager for over 18 months. However a manager had recently been appointed. We were assured they would apply to be registered with CQC at the earliest possible convenience. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We found that while the service mostly met the breach of regulation 12, there were still issues with the administration of medicines. People with complex needs were left unattended in the dining area for long periods of time.

Some documentation relating to people was left unattended in an unsecure room which meant people’s confidentiality could have been compromised.

People’s dignity was not always promoted as some staff used the dining room as their own facility. This was also used by staff from another service. Some staff spoke over people’s heads and other staff ignored people and did not use common courtesy to them. People received care from staff who were appropriately trained and confident to meet their individual needs. They were supported to access health, social and medical care, as required.

People’s needs were assessed and their care plans provided staff with guidance about how they wanted their individual needs to be met. Care plans we looked at were centred on the individual and contained the necessary risk assessments and details of what was important to people. These were regularly reviewed and amended to ensure they reflected people’s changing support needs and wishes.

Policies and procedures were in place to help ensure people’s safety. Staff told us they had completed training in safe working practices. Generally we saw staff supported people with patience, consideration and kindness and their privacy and dignity was respected. However we saw instances where people’s dignity was not always supported. There were not enough facilities to offer people daily baths or showers.

People were protected from the risk of harm or abuse by thorough recruitment procedures. Appropriate pre-employment checks had been made to help protect people and ensure the suitability of staff who was employed.

Staff felt supported and there were systems in place to ensure this. The service had a system in place to review, care planning, care delivery, risk and ensuring people who lived at Mickley Hall were supported to pursue their hobbies and interests.

People were supported to fulfil their spiritual and religious needs.

This unannounced inspection was carried out on the 20 & 21 August 2015.

Mickley Hall provides accommodation and nursing care for up to 40 people living with physical and learning disabilities. At the time of the inspection there 37 people living there.

The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

There were enough staff to ensure people’s safety, however people’s needs were not always met in a timely manner.People told us they often had to waitto have their needs attended to.

Medicines were not always administered, recorded or managed appropriately. The storage of medicines were chaotic and staff could not always be sure people had received their medicines as prescribed.

Whistleblowing information was available to staff and they knew how to use it. Staff were aware of how to report and respond to allegations of abuse which meant people were better protected from the risk of abuse.

Staff had been appropriately trained to carry out their role, however they were not always supervised and supported. The registered manager understood their role in relation to the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).

People had their nutritional needs recognised and supported. People were assisted to eat in a manner that supported their dignity.

People were supported to access health and social care professionals on a regular basis. They were supported in relationships with their family members and friends. However, people’s hobbies and interests were not always well supported and people wanted more access to the community.

People or their relatives were involved in the decisions about their care. Care plans provided information on how to assist and support them in meeting their needs but the provider was not sure whether these were up to date and so was reviewing all care plans.

Staff were knowledgeable about people’s needs. They were mostly caring, kind and compassionate. However, we observed some occasions when staff did not treat people with respect or promote their dignity.

The management of the service was chaotic and the registered manager and the deputy manager did not work as a team. This left staff without clear direction and guidance. People’s records were not always kept in a confidential manner.

The service did not always have effective systems in place to assess, review and evaluate the quality of service provision. The provider was aware of some of the issues within the service and had taken action to start to make improvements. However, at the time of our inspection the improvements were not yet evident.

We found two breaches of the Health and Social Care Act and you can see what actions we told the provider to take at the back of the full version of this report.

Our inspection team was made up of a lead inspector. Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with two people using the service, four relatives, four staff and from looking at the records. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People were treated with respect and dignity by the staff. People told us that they felt safe and staff had received training in safeguarding and staff understood how to safeguard the people they supported. Systems were in place to make sure that managers and staff learnt from events such as accidents and incidents, complaints and concerns. This reduced the risk to people and helped the service to continually improve. People were cared for in a service that was safe, clean and hygienic.

Risk assessments were in place in individual care plans in relation to activities of daily living. Staff personnel records contained all the information required which meant that the provider could demonstrate that the staff employed to work in the home were suitable and had the skills and experience needed to support the people living there.

Medicines were stored and administered in line with the policies and procedures of the home. Information was recorded using an electronic handheld device by staff who were trained.

Is the service effective?

People told us that they were happy with the care they received and felt that their needs were met. It was clear from what we saw and from speaking with staff that they understood people's individual care and support needs and they knew each person well. One relative told us, "The carers are excellent".

Staff had received training to meet the needs of the people living in the home. People's health and care needs were assessed with them and some people were involved in writing their plans of care.

Specialist dietary, mobility and equipment needs had been identified in care plans where required. People's needs were taken into consideration in the layout and design of the service enabling people to move around freely in wheelchairs with automatically opening doors, ramps and level pathways in the garden.

Is the service caring?

People were supported by kind and attentive staff. We saw that staff were patient and gave encouragement when supporting people. People told us they were able to do things at their own pace and were not rushed. One person we spoke with told us, "It's home from home, there are no time limits, they understand that everyone's different". One relative said, "They're all good, they're kind".

Where shortfalls or concerns were raised, these were addressed. People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with their wishes.

Is the service responsive?

People regularly completed a range of activities inside and outside the service. The home supported people to attend local activities within the local community and invited people from the local community into the home. There were positive relationships with local organisations and the service had a dedicated team of volunteers who undertook a range of different activities to support people who lived in Mickley Hall. People knew how to make a complaint if they were unhappy.

Is the service well-led?

The service worked well with other agencies and services to ensure that people received their care in a joined up way. During our visit, we saw examples of collaborative working with other health professionals. The service had a quality assurance system which included planned audits. Staff, relatives and people who lived at Mickley Hall spoke positively about the management of the service and told us that they could talk with the manager if they had any concerns.

On the day of our site visit to Mickley Hall there were 37 people living at the home.

We spoke with three people who lived at Mickley Hall. One person said: “I’m quite happy here, most of the staff are alright, and they go out of their way to help you.” A second person said: “It’s alright, the staff are friendly enough, and there’s always something happening to keep me occupied.” The third person told us: “It’s alright, but I would prefer to be living in my own place. The staff are OK, they try to help, and there’s always something happening.” We asked about activities, and all three people said there was a lot going on. One person told us about an arts and music festival which was held at the home. The other two people talked about trips into town, shopping, and going to the cinema

Mickley Hall has a network of volunteers who come and support the staff. The volunteer role included volunteer drivers, and assisting people with trips out of the home, as well as involvement in entertainment and activities within the home.

We looked at eight outcomes from the Health & Social Care Act (2008). We found the staff to be friendly and approachable and our observations showed staff to be caring and focussed on the people who live at Mickley Hall.

On the day of our visit to Mickley Hall there were 39 people living at the care home.

We spoke with three people about living at the care home. All of the people were positive in their comments.

Among the comments we received were:

“The staff are very helpful, very friendly, and they are very good at helping me.”

“I’m quite happy, I’d prefer to be at home in my own place, but I need help, and the

staff are here to give it to me.”

“The dining room has just been decorated and it’s really nice now, and we had (live) music here last night, with lots of people, it was really good.”

“Most of the staff are OK, I don’t have any problems.”

“I’m alright, the staff are pretty good, and I’ve got what I need.”

“I’ve got no complaints, I’d prefer not to be here, but at the moment it’s what I need.”