This inspection took place on 6 September 2017 and was unannounced. At our last inspection the overall rating for St Michaels was 'requires improvement'. St Michaels provides nursing and residential care for people who are living with dementia. It provides accommodation for up to 40 people who require personal and nursing care. At the time of our inspection there were 36 people living at the home.

There was 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.

On the day of our inspection staff interacted well with people. People and their relatives told us that they felt safe and well cared for. Staff knew how to keep people safe. The provider had systems and processes in place to keep people safe.

Medicines were administered to people safely however systems for monitoring medicines were not consistent with national guidance.

We saw that staff obtained people’s consent before providing care to them. Where people could not consent, assessments to ensure decisions were made in people’s best interest had usually been completed. We found one occasion when this had not occurred.

We found that people’s health care needs were assessed and care planned and delivered to meet those needs. People had access to healthcare professionals such as the district nurse and GP and also specialist professionals. People had their nutritional needs assessed and were supported with their meals to keep them healthy. People had access to drinks and snacks during the day and had choices at mealtimes. Where people had special dietary requirements we saw that these were provided for.

There was usually sufficient staff available to meet people’s needs. Staff responded in a timely and appropriate manner to people. We observed occasions when staff were disturbed from what they were doing in order to provide assistance to people. Staff were kind and sensitive to people when they were providing support. People were treated with respect.

Staff were provided with training on a variety of subjects to ensure that they had the skills to meet people’s needs. The provider had a training plan in place. Staff had received regular supervision and appraisals People were provided access to leisure and social activities. They were supported to maintain relationships that were important to them.

Staff felt able to raise concerns and issues with management. Relatives were aware of the process for raising concerns and were confident that they would be listened to. Regular audits were carried out and action plans put in place to address any issues which were identified. Accidents and incidents were recorded and investigated. The provider had informed us of notifications. Notifications are events which have happened in the service that the provider is required to tell us about.

We carried out an unannounced comprehensive inspection of this service on 10 May 2016. A breach of legal requirements was found. After the inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches.

At the last inspection on 10 May 2016 we found that the provider did not have effective systems to assess and monitor the quality of care provided to people. We undertook a focused inspection on 23 November 2016 to check that they had followed their plan and to confirm that they now met legal requirements. At our inspection on 23 November 2016 we found the provider had made the necessary improvements.

This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Drovers Call on our website at www.cqc.org.uk.

St Michaels provides care for older people who have mental and physical health needs including people living with dementia. It provides accommodation for up to 47 people who require personal and nursing care. At the time of our inspection there were 32 people living in the home.

At the time of our inspection there was not 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.

Systems were in place to assess and monitor the quality of the service provided to people. The provider had told us what actions they would take to make improvements and we found at this inspection that the improvements had been sufficient to meet legal requirements. The provider had started to carry out audits on a regular basis. Where issues had been identified actions had been put in place. However we found some issues such as gaps in records had not consistently been addressed.

Regular meetings were held with staff and staff were encouraged to raise issues with the manager.

We could not improve the rating for well led because to do so requires consistent good practice over time. We will check this during our next planned comprehensive inspection.

This inspection took place on 10 May 2016 and was unannounced. St Michaels provides care for older people who have mental and physical health needs including people living with dementia. It provides accommodation for up to 40 people who require personal and nursing care. At the time of our inspection there were 38 people living at the home.

There was 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.

On the day of our inspection staff interacted well with people. Staff knew how to keep people safe. Medicines were administered safely however there was an error in the records of medicines that require special storage and recording arrangements. Records had not been completed according to the provider’s medicine policy. Medication administration sheets (MARS) were completed fully however information sheets did not include people’s allergies.

The provider acted in accordance with the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). The MCA provides the legal framework to assess people’s capacity to make certain decisions, at a certain time. If the location is a care home the Care Quality Commission is required by law to monitor the operation of the DoLS, and to report on what we find.

We found that people’s health care needs were assessed and care planned and delivered to meet those needs. People had access to healthcare professionals such as the district nurse and GP and also specialist professionals. People had their nutritional needs assessed and were supported to eat enough to keep them healthy. People had access to drinks and snacks during the day and had choices at mealtimes. Where people had special dietary requirements we saw that these were provided for.

There were not always sufficient staff to meet people’s needs. People and their relatives told us that they felt well cared for but that they didn't always feel safe due to the lack of supervision. Staff were kind and sensitive to people when they were providing support and people had their privacy and dignity considered. Staff had a good understanding of people’s needs and were provided with training on a variety of subjects to ensure that they had the skills to meet people’s needs. The provider had a training plan in place and staff had received regular supervision.

We saw that staff obtained people’s consent before providing care to them. People were not provided with access to regular activities and leisure pursuits. Staff felt able to raise concerns and issues with the registered manager. Relatives were aware of the process for raising concerns and were confident that they would be listened to. Regular audits were carried out for areas such as falls and infection control. Audits had not identified some of the issues and we found where issues had been identified these had not always been addressed. The provider had informed us of incidents as required by law. Notifications are events which have happened in the service that the provider is required to tell us about. Accidents and incidents were recorded.

We carried out this inspection on 05 November 2014. This was an unannounced inspection

St Michaels specialises in the care of older people who have mental health needs including people living with dementia. It provides accommodation for up to 40 people and is registered to provide accommodation for persons who require nursing and personal care. At the time of our inspection there were 40 people living at the home.

At the time of our inspection there was 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.

On the day of our inspection we found that staff interacted well with people and people were cared for safely. People told us that they felt safe and well cared for. When we spoke with staff they were able to tell us about how to keep people safe.

The provider was acting in accordance with the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). The provisions of the MCA are used to protect people who might not be able to make informed decisions on their own about the care or treatment they received. This includes decisions about depriving people of their liberty so that they get the care and treatment they need where there is no less restrictive way of achieving this. If the location is a care home, the Care Quality Commission is required by law to monitor the operation of the DoLS, and to report on what we find. At the time of our inspection there one person who was subject to DoLS.

We found that people’s health care needs were assessed, and care planned and delivered

to meet those needs. People had access to other healthcare professionals such as a dietician and a GP.

Staff responded in a timely and appropriate manner to people. Staff were kind and sensitive to people when they were providing support and they had a good understanding of people’s needs. Although people had access to activities we saw that there was little opportunity for people to develop their interests on an individual basis.

People were supported to eat enough to keep them healthy. People had access to a range of snacks and drinks during the day and had choices at mealtimes. Where people had special dietary requirements we saw that these were provided for. We saw one care plan did not reflect the person’s nutritional needs and the care they were receiving.

Staff were provided with training on a variety of subjects to ensure that they had the skills to meet people’s needs. Staff obtained people’s consent before providing care to them.

Staff felt able to raise concerns and issues with management. We found people who used the service and relatives were clear about the process for raising concerns and were confident that they had a voice in the running of the service. Audits were carried out on a regular basis however; they had not picked up the concerns which we raised about health and safety issues relating to the storage of equipment.

On the day of our inspection we identified concerns regarding the safe management of laundry and prevention of cross infection.

At our last inspection of St Michaels we issued two compliance actions. We were concerned people were not protected from the risk of receiving inappropriate care. We were also concerned because people and relatives told us they did not feel there were enough activities.

We found the planning and delivery of care did not always meet the service users needs' and did not ensure the safety and welfare of people. Following this visit we received an action plan from the provider to address the issues. We found that all of the actions in the plan were in progress.

During this visit we spoke with the manager, staff and four people. To help us to understand people's experiences we used our Short Observational Framework for Inspection (SOFI). SOFI allows us to spend. We observed four people for an hour.

We checked documentation, including five care records.

At this visit we found plans in place for activities and observed activities taking place with people on a group and individual basis.

At our last inspection of St Michaels we issued a compliance action. We were concerned people were not protected from the risk of receiving inappropriate care. We found the planning and delivery of care did not always meet the service users needs' and did not ensure the safety and welfare of people. Following this visit we received an action plan from the provider to address the issues. We found that all of the actions in the plan were in progress.

During this visit we spoke with the manager, staff and four people. To help us to understand people's experiences we used our Short Observational Framework for Inspection (SOFI). SOFI allows us to spend time observing and helps us to record how people spend their time. We observed four people for an hour. We observed there was time when people did not receive any engagement with staff.

In order to assist us we were accompanied by an expert by experience. Experts by experience have experience in the area of care being inspected and spend time with people to obtain their views.

We checked documentation, including four care records. In all the records we looked at there were occasions when plans had not been updated to reflect revised care needs.

At our last visit people and relatives told us they did not feel there were enough activities. At this visit we found plans in place for activities but observed there was only a very short period of five minutes, when an activity took place for people in the communal area.

Many of the people who lived at the home had dementia and were unable to talk to us about their care. We spoke with staff and looked at records.

We found in all the care plans we looked at there were occasions when plans had not been updated to reflect the revised care needs.

To help us to understand people's experiences we used our Short Observational Framework for Inspection (SOFI) tool. The tool allows us to spend time observing and helps us to record how people spend their time. We carried out the tool for an hour and observed four people. We observed that interactions with people were positive but there was time when people did not receive any engagement.

We observed care and saw staff supported people to move at their own pace and safely. We observed two incidents when we felt people were at risk of injury.

We observed a staff member carrying out activities with a group of people. People and relatives told us they did not feel there were enough activities taking place.

We also looked at the administration of medicines and saw this was administered and stored appropriately according to guidelines.

We spoke with two relatives. They said, “The food is lovely” and “The staff are lovely.” They said they were always contacted if there was a problem.

We looked at consent and discussed this with staff. Staff were able to tell us about consent and we observed staff asked people if they wanted support before providing it.

As part of our inspection we spoke with a number of people who used the service.

People told us that they liked living at the home.

People said that the food was good and were given a choice of two dishes at mealtimes. Another person said she would like more choice at mealtimes particularly at tea time.

People said, “You get well looked after”.

People told us they could usually get help when they needed it.

Many of the people that used the service at St Michaels had dementia and therefore not everyone was able to tell us about their experiences. To help us to understand the experiences people have we used our Short Observational Framework for Inspection (SOFI) tool. The SOFI tool allows us to spend time watching what is going on in a service and helps us to record how people spend their time, the type of support they get and whether they have positive experiences.

When we visited St Michaels care centre people told us they were happy with the care they received.

We saw that the manager and staff respected and encouraged people’s lifestyle choices. We viewed two people’s rooms and saw that they had been personalised to reflect their identities and needs.

One person told us, “I have a lovely room and I am really happy here”.

Another person said, “it’s a smashing place”.

People told us they were part of the local community. We saw people coming and going as they wished whilst receiving support to make sure they were safe where needed.

One person told us, “I like to go out but when I am out I think about coming back because I feel its’ my home”.

When talking to people about activities at the home another person said, “look at the things laid on here. There are things going on every day and we can either get involved or not as we want”.

During our visit we also spent some time observing how two people were having their care needs met during lunch time in one part of the home.

During this period of observation we saw staff communicating with people in a sensitive way and using time to listen to what people were saying, taking any action needed to ensure people could choose what they wanted for lunch, whilst getting the support they needed to enjoy their meals.