The inspection took place on 27 June and 4 July 2018 and was unannounced. 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. It can accommodate up to 45 people in one adapted building and there were 36 people using the service at the time of our inspection.

At the last inspection we identified that improvements were needed to the quality of care and to governance systems in place to monitor care. This inspection was to check that improvements had been made. We found many improvements had been made however we found other concerns. At this inspection we identified one new breach and one continued breach of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we took at the back of the full version of the report.

This is the second time the home has been rated as ‘requires improvement’.

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.

Systems were not always effective at identifying and remedying issues, such as incorrect information in care plans and poor recording.

The policies and systems in the service did not support the principles of the Mental Capacity Act 2005 (MCA). There were not always appropriate assessments being carried out and decisions in people’s best interest were not always recorded.

Safe recruitment processes were not always being followed to ensure that staff were suitable to work with people who used the service.

People had a choice of food and drink which they enjoyed however the monitoring of what food and drink people were having was not always sufficient which could put people at risk. Plans in relation to some people’s health conditions were not always detailed enough.

There was mixed feedback about staffing but overall we found there were sufficient amounts of staff to support people and they did not have to wait.

People received their oral medicines as prescribed however we could not be assured that people always received or were offered their topical medicines as prescribed.

People told us they felt safe and people were protected from potential abuse by staff who understood their responsibilities and appropriate safeguarding referrals were made. Risks to people were assessed and planned for to try and protect people. People were also protected as infection control measures were in place and the building was safely maintained. Lessons were learned when things had gone wrong as action was taken following feedback.

People had access to other health professionals, appropriate referrals were made and guidance was followed. Staff training had improved and staff were supported effectively to care for people. Information about people and changes were shared in handovers and printed care plans. The building was suitably adapted to cater for the needs of people living there.

People were treated with kindness and respect and people’s choices were respected. People were encouraged to be independent where possible and people’s dignity was maintained by staff. There were positive interactions between people and staff and relatives could visit at a time that was convenient to them.

People were supported to be involved with activities, both activities and events within the home and trips out to local attractions. People and relatives were involved in developing their plan of care and staff knew people well. People had their diverse needs considered and were assisted with their communications needs when necessary. People had the oppor

The inspection took place on 11 and 13 January 2017 and was unannounced. St Michael’s is a residential home for up to 45 people who have a variety of support needs, such as older people and people with a physical or sensory disability. There were 36 people living at the service at the time of the inspection.

There was a Registered Manager in post at the time of our inspection. 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 this inspection we identified breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

There were not always enough staff as communal areas were often left unattended and situations were not monitored which left people at risk. Staff told us they felt more staff were needed. Some people told us they felt more staff were needed, however some people were satisfied.

Plans were not always in place to support people if they became agitated. Staff were also not trained to support people effectively who were experiencing periods of agitation.

Risk assessments and detailed plans were not always in place to try and prevent people from falling and if people had fallen. Action had not always been taken to support people from falling again and some people had continued to experience falls.

Medication Administration Records (MARs) had not always recorded whether people had had their topical medicines and PRN protocols were not always in place for people that had medicine that was to be taken ‘when required’.

All safeguarding allegations should be reported to the local safeguarding authority however we found an instance of one allegation that had not been reported. Other safeguarding incidents had been correctly reported to the local safeguarding authority.

The principles of the Mental Capacity Act 2005 (MCA) had not always been followed. Assessments had not always been carried out to help determine if people were still able to make decisions and if they could what type of decisions. Evidence of Lasting Power of Attorney (LPOA) had not been consistently sought and those who did have an LPOA did not always have the correct one in place regarding health and welfare.

Care plans were not always personalised and did not always contain full information about people and their preferences. Staff were sometimes used from an agency and new staff started periodically. This put some people at risk of not having their needs met or not having their preferences catered for as there was limited information available for them.

Audits of accidents and incidents or care plans had not been taking place so omissions had not been identified. Medicine audits were in place however these had not identified concerns relating to topical medicines.

Although there were occasional events for people to attend, overall people told us they were bored and there was not enough for people to do and they were not always supported to partake in hobbies.

People told us they felt safe and their relatives confirmed they felt their loved ones were safe in the home.

People felt staff were caring and that they were treated with dignity and respect. People had the choice of where they spent their time and were supported to maintain their privacy.

Safe recruitment practices were in place and staff had appropriate checks prior to starting work to ensure they were suitable to work with people who use the service.

People had access to other health professionals in order to maintain their health and wellbeing.

People were supported to have food and drinks of their choice that were appropriate for their needs.

People and relatives