St Michaels 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. St Michaels Home provide accommodation and personal care for up to 21 older people.

At the time of our inspection visit there were 17 people living in the home. The inspection visit took place on 26 February 2018 and was unannounced.

At the last comprehensive inspection on 10 January 2017, we found the provider was not fully meeting the standards required. We identified three breaches of the Health and Social Care Act 2008. This was in relation to care and treatment not always being provided in a safe way, there being insufficient action to safeguard people from improper treatment, and there being insufficient systems to monitor the quality of service in relation to the health, safety and welfare of people. The service was rated as ‘requires improvement’ with an ‘inadequate’ rating for the key question ‘well led’. We issued the provider with a warning notice and asked them to take the necessary action to improve.

Following the inspection on 10 January 2017, we asked the provider to complete an action plan and met with the provider to confirm what they would do, and by when, to improve the service. We returned to the home on 15 June 2017 to complete a focussed inspection. This was to check actions completed in relation to the warning notice and to review the key question of ‘well led.’ We found sufficient improvement had been made to address the breach of Regulation 17 related to the warning notice related to the management of the service and the quality of care people received.

At this inspection we found the provider had continued to make improvements to the service since we had last visited. We also found sufficient action had been taken to address the remaining two breaches in the regulations so that the home was no longer rated ‘requires improvement’. However, there remained some areas within the key question ‘well led’ that needed to be improved.

The manager, who was in post at the last inspection, had registered with us. 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’s needs were assessed before they moved to St Michaels so the registered manager could be confident those needs could be met. Risks associated with people’s care had been identified and documented in care plans so they could be managed. Care plans continued to be reviewed so they provided staff with sufficient information about people’s needs. Staff arranged for people to see a doctor where people had identified healthcare needs. Records confirmed visits had been undertaken and advice given.

The provider’s recruitment system required a series of checks to be made before new staff could work with people at the home. People told us they usually felt safe living at St Michaels Home and spoke positively of the staff team that supported them. They told us staff were caring and approachable and we saw enough staff were available to support people’s needs. Staff took time to get to know people and demonstrated this through their interactions with people. Staff respected people’s individuality and aimed to support their independence where possible.

Accidents and incidents were recorded and reported to us as required. One incident related to safeguarding people had occurred and we were told that it had been investigated and acted upon appropriately.

Staff who administered medicines had completed the necessary training to do this safely and people told us they received them as required. Ac

We carried out an unannounced comprehensive inspection of this service on 10 January 2017. Breaches of legal requirements were found. A warning notice was issued in relation to how the provider assessed and monitored the quality and safety of service provided. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches. We also met with the provider to discuss the improvements required.

We undertook this focussed inspection on 15 June 2017 to check that the provider had followed their plan and to confirm they now met the legal requirement in relation to the warning notice. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for St Michael's Home on our website at www.cqc.org.uk.

St Michael’s Home provides personal care and support for up to 21 people. At the time of our visit, there were 13 people living at the home.

During this inspection we found sufficient improvements had been undertaken to address the concerns highlighted in the warning notice. There were some areas still needing improvement but the manager was aware of most of these and was working to ensure these were addressed.

The manager was not registered with the CQC. 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. However, an application had been received by the CQC to register the manager employed at the home and this was in progress.

People and staff were complimentary of the new manager in post. They said the manager was effective, supportive and had made improvements to the service.

The provider had ensured systems and processes to monitor the quality and safety of care and services had been introduced. This included a process to obtain feedback from people and their family members so any areas for improvement could be identified. Staff and ‘resident’ meetings had taken place where their views of the care and services provided were sought. Actions had been taken in response to some of the issues raised to drive improvement within the home.

Health and safety actions related to the environment had been addressed to ensure the home was safe. Improvements to the environment were ongoing.

There was a central record of accidents and incidents so the provider could monitor these. However, some of these had not been reported to the CQC as required.

Care records were detailed and had been reviewed so that staff had the up to date information they required to meet people’s needs. Staff completed daily records to confirm the care and support they provided to people. Sometimes these records did not show the actions detailed in care plans had been carried out consistently. However, staff knew about people's needs and the actions they needed to take to manage risks associated with their care.

Staff training was ongoing to ensure all staff completed the required training to meet people’s needs safely. New staff had completed essential training.

People told us their needs were being met and were complimentary of the staff. Risks associated with people’s care had been assessed, including nutritional needs, and arrangements were in place to ensure these could be met.

St Michael's Home is a two storey building and provides personal care and accommodation for up to twenty one older people. On the day of our visit there were 15 people in the home.

The inspection took place on 10 January 2017 and was unannounced.

During our last comprehensive inspection on 18 May 2016, we found the provider was not fully meeting the standards required. We identified two breaches of the Health and Social Care Act 2008. This was in relation to care and treatment not always being provided in a safe way and there being insufficient monitoring of the health, safety and welfare of people. Improvements were required included medicine management and ensuring care plans were accurate to support staff in managing risks related to people’s care such as nutritional risks.

We asked the provider to make improvements and they sent us an action plan stating they would take the necessary action to comply with the legal requirements. During this inspection we found insufficient action had been taken to maintain the improvements made.

The service did not have 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. It was of concern that there had not been a registered manager in post since November 2015.

There was a senior care staff member who was in charge on the day of our visit and they were carrying out some of the management duties in the absence of a manager. The senior care staff member had had not been allocated enough management hours to do these duties effectively. People were complimentary of the senior care staff member who supported the inspection process. There was a ‘compliance’ manager who had been appointed by the provider to provide some additional management support to the home but this did not include care duties.

Sometimes staffing arrangements were not effective to ensure people’s needs were met. People told us they had to wait to be supported. Staff knew about risks associated with people’s care and there was a system in place for them to communicate changes to each other. However, people’s care and support needs were not always accurately recorded in care plan records to make sure there was a consistent approach to managing them by staff. This included risks associated with moving and handling people and supporting people with behaviours that challenged staff and others.

People told us they did not feel involved in planning their care and had limited opportunities to discuss any changes or how liked their care and support to be provided. Some social activities were provided but people felt they were limited in what social activities they could do. Information about people’s interests and hobbies was not always available to staff to help them provide person centred care.

Where people were at risk of poor health, due to not eating or drinking enough, there were processes to monitor their food and fluid intake to help ensure their nutritional needs were met. However, records were not always clear to show instructions given by health professionals were followed. People told us they were provided with sufficient drinks and they sometimes liked the meals but were not always given a sufficient choice.

Some staff had completed some training considered essential to meet people’s needs but there were gaps in training that needed to be addressed. New staff had not consistently completed induction training or been given access to the policies and procedures they were required to follow to ensure they worked safely when supporting people. Staff had limited knowledge of the principles of the Mental Capacity Act and Deprivation of Liberty Safeguards so that they understood how

This inspection took place on 18 May 2016 and was unannounced.

St Michael’s home is a residential care home providing care and accommodation for a maximum of 21 people. At the time of our visit, the home was fully occupied.

The service did not have 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. Since our inspection in August 2015, the registered manager left, and the new manager started working at the service six months ago. They had not applied to be registered with the CQC.

At our last inspection there was breach in Regulation 11, Consent to care. During this visit we checked improvements had been made. We found most people were able to make day to day decisions, and staff understood how to make decisions in a person’s best interest. Applications for Deprivation of Liberty safeguards (DoLS) had either been made, or were in the process of being made to the local authority, when people had been deprived of their liberty. However, the manager acknowledged they and their staff would benefit from further training about the Mental Capacity Act and DoLS.

There were insufficient audits in place to enable the provider and manager, identify where quality and safety was being compromised, and to respond to appropriately. There was no record of meetings attended by the provider to determine how the home was meeting its requirements under the Health and Social Care Regulations.

The manager had worked hard to update people's care plans and risk assessments. However, not all care plans and risk assessments reflected people's current needs, and inconsistencies were identified during our visit which might put people at risk. Subsequent to our visit, a serious incident happened at the home. Whilst an investigation into this incident is on-going, initial findings indicate that the risks associated with this person’s care and support were not managed safely.

People received their medicines as prescribed, but medicines were not always kept secure from people and administration not always recorded correctly.

There had been issues with staff leaving their employment and the use of agency workers to cover staff shifts. This was being rectified and the use of agency staff had reduced. There were enough staff available to meet people’s needs. Recruitment practice reduced the risks of employing unsuitable staff at the home.

There had been concerns raised about people not receiving the food and fluids necessary to keep them healthy. This was because the cook had left their employment, and food and fluid monitoring was inadequate. We found improvements had been made but there were still concerns about the records kept in relation to this. A cook was in place and people told us they enjoyed their meals..

Staff were caring towards people, and respected their dignity and privacy. People were supported to pursue their hobbies and interests and maintain relationships with people important to them.

People told us they felt safe living at the home, and the manager worked with safeguarding authorities when there were concerns about people’s safety. Staff understood their responsibilities to safeguard people who lived in the home. Health care professionals were involved when necessary to provide healthcare support to people.

The manager had worked hard to improve the quality of care provided by staff. They supervised staff, observed staff practice, and worked alongside staff to ensure good care was provided. They had increased the number of staff working on the morning shift to provide better care for people. However, staff had not undertaken all training the provider considered essential to meet people’s health and social care needs.

We foun

This inspection took place on 18 August 2015 and was unannounced.

St Michael's is a two storey residential home which provides care to older people including a limited number of people who are living with dementia. St Michael's is registered to provide care for 21 people and at the time of our inspection, there were 17 people living at St Michael's.

A registered manager was 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 and associated Regulations about how the service is run.

All the people we spoke with told us they felt well cared for and safe living at St Michael's and this view was shared by relatives. People told us staff were respectful, caring, kind and helped promote their independence as much as possible. Staff protected people’s privacy and dignity when they provided care and asked people for their consent before any care was given.

Care plans contained accurate and relevant information for staff to help them provide the individual care and treatment people required. Care records reflected people’s wishes and how they preferred their care to be delivered. Risk assessments provided information for staff to keep people safe and these were updated when people’s needs changed. People received support from staff who had the knowledge to care for them and staff ensured people’s personal and confidential information was kept safe and secure.

People told us they received their medicines when required. Staff were trained to administer medicines which meant people received their medicines from suitably trained and experienced staff.

The provider had effective recruitment procedures that helped protect people. All the necessary checks had been completed on potential staff before a decision was made to employ them at the home.

The registered manager and staff had limited understanding of how the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS) affected the service people received. Staff understood they needed to respect people’s choices and decisions and where people had capacity, staff followed people’s wishes. Where people did not have capacity to make certain decisions, decisions were made on people’s behalf, sometimes with the support of family members. However, we found assessments of people’s capacity and records of best interests’ decisions had not always been completed.

DoLS are safeguards used to protect people where their freedom or liberties are restricted. We found examples where three people’s freedom maybe restricted and applications had been approved by the authorising body. This showed these restrictions were least restrictive but there was no evidence in people’s individual care records to show whether these people lacked capacity or not.

Staff were caring and compassionate in their approach to people. People were given choices about how they wanted to spend their day so they were able to retain some independence in their everyday life. Family and friends were able to visit when they wished and the registered manager and staff encouraged relatives to maintain a role in providing care to their family member.

There was a range of activities available for people living in the home that promoted their health and wellbeing.

There was a system of checks that identified and improved the quality of service people received. These checks and audits helped ensure actions had been taken that led to improvements. People told us they were pleased with the service they received and if they suggested improvements, these were acted upon quickly. No formal written complaints had been received by the provider but people’s concerns were listened to and the registered manager and staff responded in a timely way.

You can see what action we told the provider to take at the back of the full version of the report.

This inspection was completed by one inspector. We spoke with two people and three relatives of people who used the service. We also spoke with the registered manager, deputy manager and three care staff who provided care to people. We also spoke with a visiting health care professional who provided treatment to people living at St Michael's. The evidence we collected helped us to answer five key questions; is the service safe, effective, caring, responsive and well led?

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service, their relatives and staff told us.

If you want to see the evidence that supports our summary, please read the full report.

Is the service safe?

People we spoke with told us they felt safe. One person we spoke with said: “Oh yes, the staff are ever so kind”.

The staff we spoke with knew and understood the procedures they needed to follow to ensure people remained safe. Staff were able to tell us the different ways people might experience abuse that could place them at risk. Staff knew what their responsibilities were and what steps to take if they suspected abuse had taken place. We found staff had received training in safeguarding vulnerable adults.

The provider and staff understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). We were told that no DoLS applications had been made. Staff were able to describe when an application should be considered. We saw records that showed staff had received training in mental capacity.

We saw the home was clean and maintained. People told us if they needed anything repaired or replaced, this had been done with minimal delay.

We found equipment was maintained and regularly serviced. We found the provider carried out regular fire checks and ensured people and staff knew what to do in the event of an emergency.

Is the service effective?

People had an individual care plan which explained what their needs were. People and relatives told us they had been involved in the care assessment and their contributions were listened to. Risk assessments were reviewed and identified current risks.

People had access to health care professionals which supported their health care needs.

We found staff had received the necessary training that enabled them to provide suitable and appropriate care for people.

Is the service caring?

People were supported by staff that provided care at people’s preferred pace. Staff were attentive and responded appropriately to people’s requests. Staff promoted individual choice and supported people who wanted to remain as independent as possible. We found individual wishes were taken into account.

Is the service responsive?

People received help and support from other health professionals when required, such as doctors, dentists and opticians.

People were supported to participate in activities inside and outside of the home.

People told us they were able to raise any concerns they had, although all the people we spoke with were satisfied with the service they received.

The service had systems in place to monitor the care provided to people. This included regular reviews with people and relatives. We found people, relatives, staff and visitors completed satisfaction questionnaires and actions were taken when improvements had been identified.

People told us that concerns were listened to and acted on.

Staff said they had a handover at the start of each shift to update them of any changes in people’s needs since they were last on duty.

We saw there were systems in place for people to alert staff if they required assistance. Call bells were installed in people’s rooms. People we spoke with said staff responded to call bells promptly.

Is the service well led?

The service worked alongside other health care professionals and agencies to make sure people received the care they required. We spoke with one visiting health care professional who told us that from their experience, people were well looked after and received the necessary treatment without delay. Relatives confirmed that outside health professionals had provided care and support to their family members.

St Michael's had an effective system in place that assured them of the quality of service they provided. The service completed regular checks and sought the views of people who used the service and visitors. The service also gained the views of staff and we found the service listened and acted upon these views.

People’s care records and other records were accurate, available and completed.

We visited St Michael’s Home on Wednesday 29 May 2013. There were 19 people at the home on the day of our visit. We spoke with eight people who used the service, the manager, deputy manager all the staff on duty and two visitors to the home. We spent time in the communal areas observing people’s experience and how staff interacted with them.

We found that were possible people had given their consent to the care and treatment to be provided. We saw that staff asked people about their choices.

We asked people what it was like to live at St Michaels Home. Overall people were positive about living in the home. People said, “Its fine”, and “Not bad, could be worse. It suits me.”

Staff had a good knowledge of people's needs and responded appropriately. We looked in detail at the care provided to two people who lived at St Michaels Home. The care and support plans we viewed held good information and were easy to understand.

We found the home clean and procedures were in place for minimising infections.

The procedure for recruitment made sure staff were safe to work with people and that staff had the skills and knowledge to support people who lived at St Michael’s Home

All the records we requested to see were available. Documents we viewed were accurate and up to date.

We visited the service on 15 June 2012 to check some improvement that we had required during 2011.

We spoke with one person who used the service and their relative. They told us that care workers and managers at the home made sure that they got access to any health care professionals that they needed when they needed to.

When we inspected the service in February 2011 we found that the provider was not complying with regulations for the safety and quality of people's care. We required that it made a number of improvements. We shared our concerns with Solihull Council.

When we inspected the service again in the summer of 2011 and then again in the autumn of 2011 we found that the provider was making some improvements. However these improvements were slow and not properly planned. Risks to people posed by their condition or illness were not being as safely managed as they should have been. The quality of care and of the environment was not being monitored by the provider. The provider waited for us and other agencies to point out problems.

Solihull Council visited the home almost weekly between May 2011 and February 2012 to monitor people's safety. The council and district nursing managers kept us informed. In November 2011 Solihull Council told us that they were seeing steady improvement in the service.

In December 2011 we met with the provider. We talked about our confidence in the future of the service and the provider's continuing registration with us and the importance of complying with regulations. In February 2012 Solihull Council told us that they had started placing people at the home again. In March 2012 we registered the new manager for the service.

We visited the service and carried out an inspection on 18 and 19 April 2012. We found considerable improvements in the management of people's care and welfare. We found that the risks posed to people by their health conditions were being managed. People's welfare and care was kept under regular review by good systems of care management. The provider was only admitting people to the home that it could safely care for. The provider was making sure that people got access to health professionals as soon as they needed them.

The environment of the home, its installations, fixtures and fittings were in good repair. The home was clean and warm. Staffing levels were sufficient to meet people's needs. Care workers were supported with good leadership and training. We saw them treating people with respect and warmth. They were attentive to people's needs. They helped people to keep as much of their dignity and independence as possible.

We saw that the provider had put in place systems to regularly check on the quality of the service. These included asking the views of people who used the service and the care workers who delivered it.

We spoke to one of the people whose care we followed. They told us they were 'very happy' at the home. They said " It’s marvellous they can't do enough for you. Oh yes you've only got to sneeze and they want to know why."

When we carried out a review of this service in February 2011 we found that there were care plans in place to direct staff how to care for people but the home was slow to assess and manage risk. We found that people with sensory disability and dementia were particularly disadvantaged. Staff did not have the training to meet these needs.

In May 2011 Solihull Council told us that because of concerns about standards of care it had stopped placing people that it paid for at the home.

When we carried out a further review of the service and visited the home in August, September and October 2011 we found some improvements. We also found that the providers poor understanding of and commitment to assessing and monitoring the quality of the service and reluctance to resource improvements in a timely way has had an impact on health and welfare and on the environment and the safety and suitability of equipment and installations in the service.

The people that we spoke with who were able to communicate with us made positive comments about the home. One person said of our public report "It will be mostly good I imagine". We noticed that another person with a severe hearing disability got little stimulation from care workers.

In view of the major concerns identified and our low confidence in the providers ability to sustain any improvements made without the constant scrutiny of external agencies we are in communication with the provider company about the future of this service.

One person we spoke to during our visit told us they were very happy at the home.

We visited the home on 10 February 2011. We spoke to eight people who lived at the home. We spoke to two relatives about the care given in the home. Some people living at the home have communication difficulties. This limited the amount of discussion we could have with them.

People told us they were happy with their care. People living at the home generally like the meals on offer, but in one persons view they missed home cooking. People living at the home told us that they liked their bedrooms. We were also told by people living at the home that the staff were kind and caring.

Relatives told us they could visit the home when they liked and they were always offered a drink on arrival. One relative told us they were always contacted immediately if there had been a change in their relatives well being. One relative told us that the layout of the big lounge did not allow for intimate conversations to take place between groups of people.

A health care professional told us they had no overall concerns about the home. They also told us that there had been a number of new staff and that there were issues with communication between staff. This had resulted in a number of occasions where instructions in relation to care had had to be repeated.