St Michaels Care Home is a privately owned and run care home by The Sisters of Mercy of the Union of Great Britain. It provides accommodation, personal care and support for up to 44 older people. People living at St Michaels may have a mental health need or may suffer from dementia.

At the last inspection, in January 2015 the service was rated Good. At this inspection we found the service remained Good.

The home had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 and associated Regulations about how the service is run.

There were processes in place to ensure the safety and well-being of those living at the service. Our observations and discussions with staff and relatives confirmed that the staffing levels were sufficient for the support which needed to be provided. Recruitment practices were robust and ensured that staff employed were suitable for their role.

The service operated within the principles of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). Information was in place in relation to capacity assessments and processes which were required to make decisions in a person's best interest. Staff sought people's consent before providing any care and support. They were knowledgeable about the requirements of the Mental Capacity Act (MCA) 2005 legislation.

Medication was administered safely by staff who had been appropriately trained. We were provided with evidence of competency assessments which had been carried out. Medication records were accurate and systems were in place to order repeat medication, dispose of medication and record any medication discrepancies. An audit of the administration of medicines was completed each month.

Records management was organised and records were fully completed. Relatives said that communication at the service was effective and staff kept them fully informed.

Staff received regular training that provided them with the knowledge and skills to meet people's needs. They felt they were well supported by the management team and had regular one to one supervision and annual appraisals.

People were supported by staff to eat and drink enough to meet their dietary needs and to promote healthy eating. Staff supported people to access healthcare services.

People were treated with kindness and compassion by staff; and had established positive and caring relationships with them. People were able to express their views about their day to day routines. Staff ensured people's privacy and dignity was promoted.

People's needs were assessed prior to them receiving a service. All care files contained individual care plans and risk assessments which were regularly reviewed and updated in order to minimise risk. Care plans were person centred and contained relevant information in relation to a person's wishes, choices and preferences.

The service had a complaints procedure to enable people to raise a complaint if the need arose. A complaints process was available at the service and we were informed by the manager, staff and relatives that any complaints or concerns could be discussed openly with the staff and managers.

Relatives told us their relatives were cared for in a safe and caring environment. The service regularly held meetings with the people living at the service. This meant that the people's ideas, suggestions and choices were listened and responded to.

Quality assurance systems in place to monitor the quality of the care provided. There was a variety of different audit tools and methods used to monitor and assess the quality of the service. These included internal and external audits as well as staff meetings and survey processes.

Further information is in the detailed findings below and yo

St Michaels Care Home is a privately owned and run care home by The Sisters of Mercy of the Union of Great Britain. It provides accommodation, personal care and support for up to 32 older people. People living at St Michaels may have a mental health need or may suffer from dementia.

We completed an unannounced inspection of the service on 15 January 2015. There were 32 people who lived in the service when we visited.

The home had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 and associated Regulations about how the service is run.

Health and social care professionals we spoke with were all positive in their comments about the support provided to people at the service.

The home had robust systems in place to keep people safe. We saw that staff followed these guidelines when they supported people, for example when people became confused, they knew how to safely support and comfort people.

Staff were aware of people’s individual risks and were able to tell us about the arrangements in place to manage these safely. There were sufficient numbers of care staff available to meet people’s care needs and people received their medication as prescribed and on time. Medication was stored safely and administered correctly. The provider had robust systems in place to detect any anomalies and errors and ensured they took prompt action to rectify these.

Staff were caring and respectful and had the required knowledge to meet people’s needs. Staff treated people with respect and were kind and compassionate towards them. People found the staff and management approachable and could speak to them if they were concerned about anything.

The provider had a robust recruitment process in place to protect people from the risk of avoidable harm. Records we looked at confirmed that staff were only employed within the home after all safety checks had been satisfactorily completed.

The service was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS). Appropriate mental capacity assessments and best interest decisions had been undertaken by relevant professionals. This ensured that the decision was taken in accordance with the Mental Capacity Act (MCA) 2005, Deprivation of Liberty Safeguards (DoLS) and associated Codes of Practice. The Act, Safeguards and Codes of Practice are in place to protect the rights of adults by ensuring that if there is a need for restrictions on their freedom and liberty these are assessed and decided by appropriately trained professionals.

There was a process in place to ensure that people’s health care needs were assessed. This helped ensure that care was planned and delivered to meet people’s needs safely and effectively. Staff knew people’s needs well and how to meet them. People were provided with sufficient quantities to eat and drink and their nutritional needs were met.

People were encouraged to lead the life style of their choice and staff supported them to meet their diverse needs and their privacy and dignity was respected.

People and their relatives were involved in making decisions about their care and support. Care plans reflected people’s care and support requirements accurately and people told us their healthcare needs were well managed.

People’s independence was encouraged and their hobbies and leisure interests were individually assessed. Staff encouraged and supported people to follow their interests and hobbies.

Staff interacted with people in a caring, respectful and professional manner. Staff were skilled at responding to people’s requests promptly and had a detailed understanding of people’s individual care and support needs.

There was an open culture and the manager and staff provided people with opportunities to express their views. There were systems in place to manage concerns and complaints. Concerns received from people had been recorded and included the action taken in response.

People understood how to make a complaint and were confident that actions would be taken to address their concerns.

The provider had effective quality assurance systems in place to identify areas for improvement and had taken appropriate action to address any identified concerns. Audits completed by the provider and registered manager and subsequent actions had resulted in improvements in the service. Systems were in place to gain the views of people, their relatives and health or social care professionals. This feedback was used to make improvements and develop the service.

Some of the people who lived at St Michael's Care Home had complex needs but most were able to speak with us. We spoke with people who used the service on the day of our inspection. We gathered evidence of people's experiences of the service by observing how they spent their time and we noted how they interacted with other people who lived in the home and with staff. We also spoke with staff members. We looked at four people's care records. Other records viewed included staff rotas, training and supervision records, health and safety checks, staff and resident meeting minutes, medication records and records which related to the quality assurance of the service.

We considered our inspection findings to answer questions we always ask; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well-led?

This is a summary of what we found;

Is the service safe?

When we arrived at the service we were asked for our identification and asked to sign in the visitor's book. This meant that the appropriate actions were taken to ensure that the people who used the service were protected from others who did not have the right to access their home.

The Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The service was aware of new changes in the law with regard to DoLS. Where applications had needed to be submitted, appropriate policies and procedures were in place and had been followed. Relevant staff had been trained to understand when an application should be made and how to submit one.

We saw appropriate processes were in place with regard to medication and it’s administration, so that people could be confident they were protected from the unsafe use and management of medicines.

People told us they felt safe living in the service and that they would speak with the staff if they had concerns. We saw the service had processes in place which ensured that staff had the skills and knowledge to support people safely.

We saw that people's personal records including medical records were accurate and that staff records and other records relevant to the management of the service were accurate and fit for purpose.

Is the service effective?

People told us that they felt that they were provided with a service that met their needs. One person said: "Oh you can't fault them here, they look after my needs very well." People's care records showed that care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. The records were regularly reviewed and updated which meant that staff were provided with up to date information.

We found that there were enough trained, skilled and experienced staff to meet people's needs. Staff received the training they needed to provide care and support safely and were able to demonstrate that they understood the specific needs of the people who used the service and how those needs were to be met.

Is the service caring?

We saw that the staff interacted with people who lived in the service in a caring, and respectful manner. We saw that staff treated people with respect.

Staff had a good knowledge and understanding of people's care and support needs, including recognising and supporting them as an individual. Where people required assistance, staff provided this in a timely manner and at a relaxed pace. This ensured people received care and support consistently and in ways that they preferred.

People who used the service, their relatives, friends and other professionals involved with the service completed an annual satisfaction survey. 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 people’s wishes.

Is the service responsive?

People who used the service were provided with the opportunity to participate in activities which interested them. People's choices were taken in to account and listened to.

People told us that they knew how to make a complaint if they were unhappy. We saw that where people had raised concerns appropriate action had been taken to address them. People could therefore be assured that complaints are investigated and action is taken as necessary.

People's care records showed that where concerns about their wellbeing had been identified the staff had taken appropriate action to ensure that people were provided with the support they needed. This included seeking support and guidance from health care professionals, including a doctor and district nurse.

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way.

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and quality assurance processes were in place. This helped to ensure that people received a good service at all times.

The service had a quality assurance system in place and records seen by us showed that identified shortfalls were addressed promptly. The service had processes in place to collate the information they had gathered, identify the service's strengths and weaknesses, and plan the actions required to improve the experiences of people who used the service. This ensured continued improvement in the areas identified.

We gathered evidence of people’s experiences of the service by speaking with them, observing how they spent their time and we noted how they interacted with other people living in the home and with staff.

We saw that St Michael's provided a relaxed and homely environment for people. Staff were friendly and respectful in their approach and interacted with people who used the service in a confident and considerate manner. During the course of our inspection we saw that people were supported to express their views and choices by whatever means they were able to, and staff clearly understood each person’s behaviours and their way of communicating their needs. Staff looked after people's healthcare needs in a proactive way.

We noted that the environment at St Michael's was spacious, with sufficient communal areas to meet the needs of people who lived there. We saw that people were comfortable in their surroundings.

The staff team were well trained and supported to carry out their role. The provider had effective systems in place to monitor the quality and safety of service that people received.

We gathered evidence of people’s experiences of the service by talking with people, observing how they spent their time and noted how they interacted with other people living in the home and with staff.

We saw that St Michael's provided a relaxed and homely environment for people. Staff were friendly and respectful in their approach and interacted with people using the service in a confident and considerate manner.

During the course of our visit we saw that people were supported to express their views and choices by whatever means they were able to and staff clearly understood each person’s behaviours and their way of communicating their needs. Staff looked after people's healthcare needs in a proactive way.

The staff team were well trained and supported to carry out their role. The provider had effective systems in place to monitor the quality and safety of service that people received.

People with whom we spoke told us that their privacy, dignity and independence are respected and that their views on the support and care they receive are taken into account.

They also told us that generally they were able to make choices about aspects of their care. For example, we spoke with four people about how they are supported to choose what to eat each day. They told us that staff offer them a choice of meals each day and they can choose where they have these. They are also able to make a decision as to whether or not they participate in social activities.

One relative with whom we spoke confirmed they were happy with their relative’s care and support and found staff to be kind and caring.

One person said, in relation to personal care, “I can do most things myself but if I need help I can ask for it.”

People told us that they were satisfied with the level of care and support they received

at St Michaels. One person with whom we spoke told us "They look after me well here."

Those people with whom we spoke said they could choose whether or not to join in

activities and could spend time alone in their room pursuing their own interests if they preferred.

People with whom we spoke during the inspection were happy at the home and liked the way it was presented.

People with whom we spoke told us that they like the new, larger, open planned home and staff spoken with said they were getting used to the new layout now and that it was a pleasant home to work in.

People spoken with indicated that they were well looked after by the staff at St Michaels.

People told us that they felt comfortable talking with the staff about any issues that they had and that the manager was also always available for them to talk to.