St. Michaels

St. Michaels is a residential care home providing personal and nursing care to five people who have autism or and learning disabilities at the time of the inspection. The service can support up to five people. The service is made up of four flats located in one building and a purpose-built bungalow with its own enclosed garden area within the grounds.

St Michaels is a specialist service for people that have anxious or emotional behaviour that has previously limited their quality of life and experiences. Each person lives in their own flat or a bungalow. The staff team and service provided is organised around people’s individual needs.

People’s experience of using this service and what we found

People we spoke with told us they were happy and felt safe living at St. Michaels. There were sufficient staff to meet people’s needs and keep them safe. Staffing was regularly reviewed by the registered manager and amended to meet people’s needs. People were supported by consistent staff teams. Staff understood and were passionate about safeguarding people from the risk of abuse.

Staff knew people well, and understood the risks aligned to each individual. For example, some people lived with epilepsy. Staff were clear on how best to support them safely, and aware of any recent seizures, and any medication they may need. People’s homes were clean and well maintained.

The registered manager and staff demonstrated they cared and respected the people living at St. Michaels. Staff had positive relationships with people and were passionate about ensuring each person lived their life to the fullest. People were clearly engaged in the service, people were involved in decoration, and people’s unique skills had been used to create logos for a group they were a part of.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

This service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

Right support:

• Model of care and setting maximises people’s choice, control and Independence. People were empowered to make day to day decisions and were not restricted. People were encouraged and enabled to be as independent as possible.

Right care:

• Care is person-centred and promotes people’s dignity, privacy and human rights. Staff were passionate about supporting people to achieve the best outcomes for them. People were discussed and promoted as individuals.

Right culture:

• Ethos, values, attitudes and behaviours of leaders and care staff ensure people using services lead confident, inclusive and empowered lives. There was a positive culture within the service, demonstrated by all staff and the registered manager. People were observed to look happy, smiling and making jokes with staff.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was Good (published 11 February 2020).

Why we inspected

We received concerns in relation to incidents between people, the management of behaviours which people could find challenging and the culture of the service. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

The overall rating for the service has not changed. This is based on the findings at this inspection.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe and well-led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for St. Michaels on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

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 is a service for five people who have autism and learning disabilities. It is a specialist service for people that have anxious or emotional behaviour that has previously limited their quality of life and experiences. Each person lives in their own flat or a bungalow. The staff team and service provided is organised around people’s individual needs.

The service is made up of four flats located in one building and a purpose built bungalow with its own enclosed garden area within the grounds. At the time of the inspection, there were five people using the service.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that was appropriate for them and inclusive.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence. The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

People’s experience of using this service and what we found

People and staff were positive in their feedback. One person told us, “I am happy, I feel safe and well looked after”. Other people responded well with the staff who supported them, they were settled and comfortable in the company of staff; staff were confident and competent when they supported people. Staff commented there had been a period of transition and change following the arrival of the new manager but felt improvement had been made and morale improved.

At this inspection, the service had Improved. There were enough staff to support people safely.

The service is required as a condition of its registration with CQC to have a registered manager in post. The manager had been in post since July 2019 and was registered with CQC in January 2020.

Staff were familiar with people, risks had been assessed and staff knew people’s needs well.

The service was properly maintained, equipment was serviced, and safety checks took place; repairs and refurbishment had kept pace with the rate of wear. Furniture was appropriately replaced and no longer presented a risk to people using it.

Medicines were given by trained staff, they were stored securely, appropriate records were kept and staff competency assessments had taken place. Staff had been recruited safely and had received appropriate training and supervision.

Safeguarding training had been delivered. People told us or indicated that they felt safe. Staff helped people to understand when they were vulnerable and how to get help.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

The manager and staff had a shared vision for the service which focussed on people achieving their potential. The manager was aware of their regulatory responsibilities. Staff worked closely with other professionals to meet people’s needs. People were supported to be a part of their local community.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was Requires Improvement (published 11 January 2019.)

Why we inspected

The inspection was prompted in part due to concerns received about the management of the service, concerns about insufficient staffing, aspects of training and staff response to risks. A decision was made for us to inspect the home earlier than planned. We undertook a full inspection, including looking at the risks reported to us.

We found no evidence during this inspection that people were at risk of harm from these concerns.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

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 is a service for five people who have autism and learning disabilities. It is a specialist service for people that have anxious or emotional behaviour that has limited their quality of life and experiences. Each person lives in their own flat or a bungalow and the staff team and service provided is organised around their individual needs. There is an office building where the management team are based and large garden areas, including secluded areas and fenced areas for people who need more security. The service is comprised of four flats located in one building, together with a purpose built bungalow with enclosed garden area within the grounds. At the time of the inspection, there were four people using the service.

The care service has been developed and designed in line with the values that underpin the ‘Registering the Right Support’ and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

The service had a registered manager, however, although still registered at the time of our inspection, the registered manager had not been in post since July 2018. A peripatetic manager oversaw the day to day running of the service while the provider was in the process of recruiting a new 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.

St Michaels was last inspected on 26 and 27 April 2016. At that inspection the service was rated as Good overall and in each domain, with the exception of the Responsive domain, which was rated as outstanding.

At this inspection, the service had declined. There were not always enough staff to safely support people or consider potential risks to staff. Insufficient priority had been given to some repairs which potentially presented a risk of harm. Water safety management checks were not completed in line with policy or guidance and some cleaning tasks intended to reduce the risk of waterborne infection were not completed. Although most equipment had been serviced and inspected, the safety inspection of a large gas appliance in the basement of the main building had not been completed. There were appropriate processes in place for ordering, administration and storage of medicines. However, records of medicines staff took with them when they accompanied people in settings outside of the service were not always completed.

Some training, including safeguarding training, had not always been completed within timescale. Consequently, a safeguarding matter emerged during the inspection because of how a person told us a member of staff had spoken to them. People were not safeguarded from situations in which they may experience abuse. In addition, supervision meetings with staff had not always taken place when planned which, if completed, may have highlighted overdue training. Management of the service had failed to fully address some of these issues to ensure compliance.

The registered and peripatetic managers had quality audits in place. However, this was not comprehensive enough to enable the service to assess, monitor and improve quality and safety service. The service management were not aware of some of the concerns found during this inspection.

The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards. The provider and staff understood their responsibilities under the Mental Capacity Act 2005.

Pre-assessments for people moving to the service were comprehensive. Potential risks to people’s health and welfare were identified. Each person had an up to date, personalised support plan, which set out how their care and support needs should be met by staff. These were reviewed regularly. People received the support they needed to access healthcare services and were supported to eat and drink enough to meet their needs. Staff ensured people's privacy was maintained when supporting with their personal care.

People were, as far as possible, supported to have choice and control of their lives and staff supported them in the least restrictive way. The policies and systems in the service supported this practice. Staff encouraged people to participate in activities, pursue their interests and to maintain relationships with people important to them. Relatives and visitors were welcomed at the service and a complaints procedure was available and in an accessible format if people wished to make a complaint.

Accidents and incidents were analysed and measures were in place to reduce the occurrence of repeated incidents. Referrals were made to specialist services and medical professionals when needed.

Services providing health and social care to people are required to inform CQC of important events that happen in the service, this is so checks can be made that appropriate action had been taken. The manager was aware that they needed to inform CQC of important events in a timely manner and had done so.

It is a legal requirement that a provider’s latest CQC inspection report rating is displayed at the service where a rating has been given. This is so that people, visitors and those seeking information about the services can be informed of our judgements. The provider had conspicuously displayed the rating in the reception area of the service and a link on their website to the latest CQC report.

We found five 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 this report.

St. Michaels is a service for five people who have autism and learning disabilities. It is a specialist service for people that have anxious or emotional behaviour that has limited their quality of life and experiences. Each person lives in their own flat and the staff team and service provided is organised around their individual needs. There is an office building where the management team are based and large garden areas, including secluded areas and fenced areas for people who need more security. Four flats were in one building and one ground floor flat was purpose built in the grounds. All flats have been modified and furnished to suit the needs of each person. The alterations and furnishings in two flats were a work in progress because people’s needs had changed or they had moved in recently.

The management team based at the service was made up of a registered manager and two deputy managers. 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.

The service provided was innovative and based around the needs of each individual. There was a ‘can do’ attitude in the culture of the staff team. Even in the most difficult circumstances, people were given opportunities to live as independently as possible and with as many opportunities for new and interesting experiences as possible.

Staff were dedicated and worked hard to get to know people so that they could provide a service tailored to each individual. They found ways to help people overcome the barriers to their relationships with other people, and that had limited their opportunities to go out and about and live an ordinary lifestyle. People were making evident progress with their social skills and awareness, managing their health and wellbeing and developing their daily living skills.

Before people moved in staff found out the best way to communicate and support communication with the person and what was important to them. A moving in plan was designed with the person to make sure they had all the preparation needed for them to move in and settle down.

The staffing levels and buildings were designed to maximise people’s opportunities to be as independent as possible whilst keeping them as safe possible. The staff team were motivated and spoke confidently about their roles and the people they supported. Staff said they felt well supported by the management team and had the training they needed to meet people’s needs.

People were involved in the recruitment of staff, including being part of the interview team where possible. Staffing levels were reviewed and changed in response to the needs of the people. One person needed the support of four staff when out in town or doing activities outside the service but their needs had changed and they now only required three staff at these times. When people were trying new activities the staffing level was assessed specifically for this and a higher level of staff was provided to make sure, as far as possible that the new experience was a success.

Staff and the management team had an excellent understanding of managing risks and had supported people that had previously challenged services to reach their full potential. People said or expressed that they felt safe in the service and staff had a very clear understanding of what constituted abuse. Staff spoke up for people if they thought there may be at risk of potential abuse.

Staff assumed people had capacity and respected the straightforward decisions they made on a day to day basis. When people needed help or could not make a particular decision on their own, staff supported them. Decisions were made in people's best interests. The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards. The registered manager and staff showed that they understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). The people at the service had been assessed as lacking mental capacity to make complex decisions about their care and welfare. Applications had been made and granted to deprive people of their liberty because they needed staff with them or near to them all the time to make sure they were kept as safe as possible.

People were supported to say what they thought about the service. Staff had one to one meetings with people to give them the opportunity to express themselves in whatever way they were able to. Pictures, photos, objects, experiences and technology were all used to help people express themselves so that they were able to say how they wanted to be supported and share concerns when needed. There was a clear complaints procedure and process that was designed to suit the

Mealtimes, buying and preparing food and drinks were all organised individually with each person and they were encouraged to be as involved as much as possible. People who had previously only eaten food as it was presented to them, were getting into the kitchen and making the food and going to the supermarket to choose it. Staff understood and encouraged healthy eating and if people needed their food and drink intake monitored it was done in a way people could understand.

People attended health checks and were supported to maintain a healthy lifestyle. Good plans and records were kept about people’s health conditions that needed monitoring. Community health professionals were involved and their advice was included in the care provided. Staff had worked together with community professionals to prepare people for health care checks, including compiling photo stories and going through the practical steps with the equipment to help people understand and cope with necessary procedures. When people needed to take medicines these were kept under review and there were safe administration procedures. People were helped to understand their medicines and were supported to take control of them as much as possible.

People were encouraged to try new experiences and develop new interests. Staff helped people to express themselves and supported people so that they felt secure enough to try unfamiliar things. People were going out and doing different activities that they had not previously been able to and were living a varied and active lifestyle. People had access to the internet and social media and used this to follow their interests and keep in touch with family and friends.

The registered manager used effective systems to continually monitor the quality of the service and had on going plans for improving the service people received.

A health and social care professional commented, “If I had other people that I was looking to place with similar needs to the residents there, I would consider St Michael’s as an option.”

One person did speak to us with regard to his care. He said staff had discussed his support and preferred routines and felt that his views and opinions were considered and said that he was able to give consent with regard to the care he received. He added "I enjoy going out and like my key worker. I am able to choose my holiday" He spoke of his planned holiday to Devon and how he had been involved in making decisions around where he wanted to go and the hotel he wished to stay at.

We saw that people were treated with dignity and their privacy was respected. Staff were seen during the day offering people choices and being given time to make decisions. People who used the service had the opportunity to discuss and take part in all aspects of life within the service as they wished or their capacity allowed.

Through direct observation, discussions with staff and records viewed we could see that the service actively encouraged people to be members of the wider community. The service provided imaginative and varied opportunities for people to develop and maintain social, emotional, communication and independent living skills. The staff had a strong ethos and focused on involving people in all areas of their lives.