Michaelstowe

Michaelstowe is a residential care home providing personal care for up to 24 older people living with dementia and/or a physical disability. 21 people were living there at the time of the inspection. Accommodation is provided over three floors and a passenger lift provides access to the upper floors. Michaelstowe is owned by South West Care Homes Ltd who own and manage eight other care homes in the South West.

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

People told us the home was well managed and they felt safe and well cared for. Relatives praised the home. Staff were seen to be kind, caring and friendly and it was clear staff knew people and their relatives well.

There were sufficient numbers of staff employed to ensure people’s needs were met. Staff had time to sit and engage people in conversation and to support people’s involvement in social activities. Recruitment practices were safe.

Risks to people’s health, safety and well-being were assessed and management plans were in place to ensure risks were mitigated as much as possible. Staff were aware of their responsibilities to safeguard people.

People received their medicines safely and as prescribed. Medicine management practices were safe.

Quality assurance processes ensured people received safe care that met their needs and respected their preferences. People and their relatives were involved in making decisions about their care.

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 10 January 2019).

Why we inspected: The inspection was prompted due to concerns over the provider’s governance of their services and whether we could be assured people were receiving safe care. As a result, we undertook a focused inspection to review the Key Questions of Safe and Well-led only.

We found the service was being managed well and there was no evidence that people were at risk from unsafe care.

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.

The overall rating for the service has remained good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Michaelstowe 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.

Michaelstowe is a care home without nursing for up to 24 people. On the day of our inspection there were 24 people living at the service. It specialises in care for older people some who are living with dementia.

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.

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.

At the last inspection on 23 December 2016, the service was rated Good. At this inspection we found the evidence continued to support the rating of Good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Why the service remains Good:

We met and spoke with all the people living in Michaelstowe during our visit. However, not all people were able to fully verbalise their views. Due to people’s needs, we spent time observing people with the staff supporting them. Others could tell us about the care and support they received. Staff told us and we observed other methods of communication with people were used who could not verbally express their views, for example the use of visual objects.

People remained safe at Michaelstowe. People who were able to told us they felt safe living there. Comments received about the service included; “Look after you well here, well fed and no cause to complain. The staff are friendly and caring” also “People who look after us are brilliant, very good home and can’t find anything wrong with the place.” A relative said; “All staff very approachable, extremely caring, friendly. Mum’s happy – then I’m happy.”

People continued to receive their medicines safely by staff who had received regular training. People were protected by safe recruitment procedures. This helped to ensure staff employed were suitable to work with vulnerable people. People, relatives and the staff team confirmed there were sufficient numbers of staff to keep people safe. Staff confirmed they could meet people’s needs and support them when needed.

People’s risks were assessed, monitored and managed by staff to ensure they remained safe. Risk assessments were completed to enable people to retain as much independence as possible.

People continued to receive care from a staff team that had the skills and knowledge required to effectively support them. Staff had completed safeguarding training. Staff without formal care qualifications completed the Care Certificate (a nationally recognised training course for staff new to care). The Care Certificate training looked at and discussed the Equality and Diversity and Human Rights policy of the company.

People continued to receive a caring service. People were observed to be treated with kindness and compassion by the staff who valued them. The staff, many who had worked at the service for many years, had built strong relationships with people. All staff demonstrated kindness for people through their conversations and interactions. Staff respected people’s privacy. People or their representatives, were involved in decisions about the care and support people received.

People were supported to have maximum choice and control of their lives and, staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. People’s wishes for their end of life were clearly documented. People's healthcare needs were monitored by the staff and people had access to healthcare professionals as required.

People’s care and support was based on legislation and best practice guidelines, ensuring the best outcomes for people. People’s legal rights were upheld and consent to care was sought. People who required assistance with their communication needs had these individually assessed and met. People were able to make choices about their day to day lives. The provider had a complaints policy in place and records showed all complaints had been fully investigated and responded to.

The service responded to people's individual needs and provided personalised care and support. People’s equality and diversity was respected and people were supported in the way they wanted to be. Care plans were person centred and held full details on how people’s needs were to be met, taking into account people’s preferences and wishes. Information held included people’s previous history including medical and family history. People’s cultural, religious and spiritual needs were also documented.

The service continued to be well led. Clear leadership and governance was provided with the provider’s governance framework, monitoring the management and leadership of the service. The provider’s values and vision were embedded into the service, staff and culture. The provider had monitoring systems which enabled them to identify good practices and areas of improvement. People, relatives and staff said the registered manager was approachable and made themselves available to speak to people. The provider and the management team listened to feedback and reflected on how the service could be further improved.

People lived in a service which had been designed and adapted to meet their needs. The provider monitored the service to help ensure its ongoing quality and safety.

A registered manager was employed to manage the service. 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 registered manager was not present during the inspection. A temporary manager, who was registered to manage another home owned by the same company, was managing the service in the absence of the registered manager.

We last inspected Michaelstowe on 29 and 30 September 2015 and breaches of legal requirements were found. We asked the provider to take action to ensure people’s needs were met in relation to the risk of malnutrition, to ensure the safe management of medicines and to ensure accurate record keeping. The provider sent us an action plan detailing the improvements they would make by the end January 2016. At this inspection we found improvements had been made.

People’s nutritional needs and risks were monitored and action was taken if concerns were identified. People’s medicines were managed safely. New systems had been introduced and regular audits were carried out. A new care planning system had been implemented which allowed staff to easily maintain and share accurate records regarding people’s needs. It also enabled the manager to have an overview of the records and care provided.

People told us they felt safe using the service. There were risk assessments in place to help reduce any risks related to people’s care and support needs. Staff had received training in how to recognise and report abuse and were confident any allegations would be taken seriously and investigated to help ensure people were protected. The recruitment process of new staff was robust. The manager was recruiting new members of staff and had increased the staffing levels to better meet people’s needs.

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

The inspection took place on 16 and 18 November 2016 and was unannounced. The inspection was carried out by one inspector.

Prior to the inspection we reviewed the records held on the service. This included the Provider Information Return (PIR) which is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We also reviewed notifications. Notifications are specific events registered people have to tell us about by law.

During the inspection we spoke with four people. We reviewed three people’s records in detail. We also spoke with five members of staff and reviewed three personnel records and the training records for all staff. Other records we reviewed included the records held to show how the registered manager reviewed the quality of the service. This included a range of audits, questionnaires to people who live at the service, minutes of meetings and policies and procedures.

Following the inspection we sought the views of a social care professional, who knows the service well. This was a care home practitioner. We also spoke with a relative of someone who lives at Michaelstowe, following the inspection.

We saw people's privacy and dignity being respected at all times. We saw and heard staff speak to people in a way that demonstrated a good understanding by staff of people's choices and preferences.

We looked at care records for six people. We spoke with staff about the care given to these people, looked at records relating to them, met with them and observed staff working with them.

We saw that people's care records described their needs and how those needs were met. We saw that people's mental capacity had been assessed to determine whether they were able to make particular decisions about their lives.

We saw that medication was administered by suitably trained staff. People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to administer and record medication.

During our visit to the home we saw sufficient staff on duty to meet the needs of people living in the home. However staff and people who used the service felt the home needed more staff to spend time sitting and talking with people. One staff said 'We never have time to sit and talk to people' and one person living in the home said, 'There never seems to be enough staff available'.

There were effective systems in place for safeguarding people from abuse and monitoring the quality of the service to ensure that people's views were listened to and action taken where required.

People living at the home we spoke with told us they were looked after well. One said 'I am very happy here indeed.'

Many people living at this home had dementia. People looked happy and well cared for.

We found that people's privacy and dignity was protected. People exercised choice in their daily lives.

Where people did not have the capacity to take decisions about their care their rights were protected.

People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. Care plans were reviewed regularly and as necessary. Records showed that prompt referrals were made to health professionals and their advice was followed. Procedures were in place to deal with emergencies.

We saw that people were relaxed in the company of staff. They were kept safe from abuse because staff knew about abuse and how to report this. Their were sufficient numbers of skilled staff on duty to meet people's needs.

There was enough equipment to promote the independence and comfort of people who use the service.

All records were kept securely and were well maintained.