St Michael's - Care Home with Nursing Physical Disabilities is registered to provide accommodation and nursing care for up to 36 people including people who require respite care. The home specialises in the care of people who have a physical disability. Most people at the home have complex needs in addition to their physical disability and as a result many of them have limited communication skills. At the time of our inspection there were 34 people living at the home. The home is a large building over three floors. There are communal lounges, a dining room and spacious grounds. The home has a chapel and bar area often used for social events in the evening. There is a physiotherapy area including a gym space and room where the activity team are based.

This inspection was unannounced and took place on 17 and 18 August 2016.

The home had a registered manager. 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.

People and relatives told us they felt safe. Most of the medication procedures in the home were safe but there was a risk staff would not know where guidance was for people who needed medicines ‘as required’. Medicines were stored safely.

People who required special diets received them and staff understood about special diets to meet people’s care and health needs. But one person was found with an un-thickened drink which led them to cough and had not been given the option to have it thickened.

Staff were supervised and received enough training to meet people’s needs.

A safe recruitment procedure was in place and staff received checks before starting to work with people.

Staff knew how to recognise and report abuse. They had received training in safeguarding adults from abuse and knew the procedures to follow if they had concerns.

There were sufficient staff available to enable people to take part in a range of activities according to their interests and preferences. The registered manager was currently recruiting more staff because they had identified people’s needs were changing.

People's health care needs were monitored and met. The home made sure people saw the health and social care professionals they needed and implemented any recommendations made which people agreed to.

Staff and the registered manager had understanding about people who lacked capacity to make decisions for themselves. However, some people had not had their records updated when they lacked capacity to be in line with the code of practice. Staff understood about Deprivation of Liberty Safeguards (DoLS) and the process to follow to make sure people’s human rights were respected.

Staff supported and respected the choices made by people. People’s diversity was respected. People had a choice of meals, snacks and drinks, which they told us they enjoyed.

People and their relatives thought the staff were kind and caring and we observed positive interactions. People’s privacy and dignity was respected.

Staff had good knowledge about people’s needs. Their care plans had met national standards for end of life care which helped to ensure best practice for people when nearing the end of their life. The needs of the people were reflected in their care plans.

Some audits were being completed by the registered manager and provider to identify shortfalls. They had both recognised further improvements were required to make the audits more comprehensive. When shortfalls had been identified the registered manager resolved them. There were systems in place to manage complaints and the registered manager demonstrated a good understanding of how to respond to them.

The inspection was carried out by one inspector, who answered the five questions; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and from looking at 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 they felt safe. Safeguarding procedures were robust and staff understood how to safeguard the people they supported.

People felt safe because their rights and dignity were respected and they were involved in making decisions about any risks they may take. When people were at risk, staff followed effective risk management policies and procedures to protect them.

Systems were in place to make sure that managers and staff learnt from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve.

The home had policies and procedures in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. Relevant staff had been trained to understand when an application should be made, and in how to submit one. This meant that people were protected from discrimination and their human rights were protected.

Is the service effective?

There was an advocacy service available if people needed it, this meant that when required people could access additional support.

Care plans reflected people’s current individual needs, choices and preferences. Specialist dietary, mobility and equipment needs had been identified in care plans where required.

People’s needs were taken into account with signage and the layout of the service enabling people to move around freely and safely. The premises had been sensitively adapted to meet the needs of people with physical impairments. People had access to appropriate space to see and look after their visitors, for activities, to spend time together or to be alone.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. People commented, “I love living here, this is my home”, “All my friends are here”, “I love it here”.

People using the service and staff 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. Appropriate professionals were involved in planning, management and decision making.

Is the service responsive?

Where appropriate, a person’s capacity was considered under the Mental Capacity Act. When a person did not have capacity, decisions were always made in their best interests. Advocacy support was provided when needed.

People completed a range of activities in and outside the service regularly. The home had its own adapted minibus, which helped to keep people involved with their local community.

People knew how to make a complaint if they were unhappy. One person had made a complaint and changes had been made as a result. People can therefore be assured that complaints are investigated and action is taken as necessary. People we spoke with felt confident to express any concerns or complaints about the service they received.

Is the service well-led?

There was a registered manager in post and all other conditions of registration were met.

The service worked well with other agencies and services to make sure people received their care in a joined up way. The service worked in partnership with key organisations, including the local authority and safeguarding teams, to support care provision and service development.

The service had a quality assurance system, records seen by us showed that identified shortfalls were addressed promptly. As a result the quality of the service was continuingly improving. Robust quality assurance and governance systems were in place and used to drive continuous improvement.

Concerns and complaints were used as an opportunity for learning or improvement.

During our inspection we spoke with five people who lived in the home, five visiting relatives and seven staff. We also observed the care provided to people throughout the day.

People who lived in the home and visiting relatives were very complimentary about the care provided. One person who lived in the home said “I’m looked after marvellously, it’s great. There’s so much to do and so many outdoor activities”. Another person said “This is a first class home. All the staff work so hard to produce a good result for us”.

The home looked generally clean and reasonably well maintained. Systems were in place to reduce the risk and spread of infection. However, some parts of the home were shabby and in need of refurbishment.

People told us they received the correct medication at the right times of day. One person said “The nurse always comes to my room at the right time to give me my medicines”. Another person said “I always have my medicines with my meals”. One person’s visiting relative said “The nurse always brings the medication every lunch time without fail”.

People who lived in the home and their relatives said there was enough staff to care for people’s needs. People said they were well looked after and staff usually responded quickly when needed.

We found the provider had effective systems in place to monitor the quality of service and to manage potential risks to people’s health and safety.

We spoke with 10 people who used the service, four relatives and eight staff. All people we spoke with told us they were happy with the care they received. Comments included; “you forget you’ve got an illness when you're here”; "I couldn't ask for better care." All staff we spoke with demonstrated a good knowledge of people's likes and dislikes. One member of staff said "we work around people's preferences and the way they like things done. We can usually accommodate requests".

There was always at least one trained nurse on duty who was responsible for ensuring that people's clinical needs were met. One visiting healthcare professional told us they felt the home provided a high standard of nursing care. They said staff involved other healthcare professionals when necessary and in a timely manner.

We saw people who liked to spend time in their personal rooms had access to a call bell. People said if they rang their bell for assistance staff responded quickly. Throughout the day we noted call bells were answered very promptly meaning that people did not have to wait for assistance.

All of the areas of the home we saw were clean and fresh. One member of staff took a lead role in ensuring that infection control policies and procedures were kept up to date. People who lived at the home told us they would be comfortable to talk with a member of staff if they had a concern. One person said "I would always speak with the manager, there's no need to worry about things".

People asked were happy with the care that they received. One person said “The carers are all very nice and helpful, they help you with anything you want.”

One person said that living at St Michaels was the “next best thing to being in your own home” and another person described it as a “home from home.”

People spoken with during the visit said that they were able to make choices about all aspects of their day to day lives. One person said “You can do what you want really, get up when you like and go to bed when you like.” Another person said “You can do whatever you want within reason.”

One person said “It’s all very good you can make choices about everything and there are meetings where you can make suggestions. I never feel judged but am accepted for who I am.”

The majority of people were aware of their support plans and said that they had had input into them. Everybody asked said that they received the care that they needed in the way that they wished to be supported.

People told us that their privacy was respected and staff treated them with respect. We saw that staff knocked on bedroom doors before entering.

People said that they felt safe at the home and were always well treated. People said that staff were “kind and polite” although two people told us that there were two members of staff who “could be bossy.” This information was passed to the management of the home at the end of the visit.

Everyone asked said that if they were unhappy with anything they would be comfortable to speak with the manager or a member of staff. All said that they were confident that any issues raised would be investigated and addressed.