Archived: St Michaels Support & Care

Updated 16 March 2018

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.

This inspection took place on 24, 25 and 31 January 2018, was unannounced, and was undertaken by two adult social care inspectors and an expert by experience. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service. Their involvement was phoning people using the service to ask them their views of the service.

We gave the service 48 hours’ notice of the inspection visit to ensure the registered manager would be present and to help arrange visits to where people were receiving the service, as the service is spread across a wide geographical area ranging from Watford to Ilford. The registered manager was present for the inspection, but in her role as a locality manager for some of the provider’s services. The manager of the service (the ‘DCA manager’) was also present during the inspection, and had applied to CQC for registration as manager of the service.

Before the inspection, we checked for any notifications made to us by the provider and the information we held on our database about the service and provider. Statutory notifications are about important events which took place at the service, such as safeguarding incidents, which the provider is required to send to us by law.

Inspection site visit activity started on 24 January 2018 and ended on 31 January 2018. It included visits to four of the supported living schemes, on 24 and 25 January, to meet people living at those schemes, staff working with them, to see how staff interacted with people, and to check records kept at the schemes. We visited the office location on 31 January 2018 to meet the registered manager and office staff, and to review care records and staff files.

There were 30 people using the service at the start of our inspection visits. During the inspection, we spoke with 17 people using the service, eight support staff, two scheme managers, the registered manager and the DCA manager. We also contacted a local authority and other community professionals involved in the service for their views, receiving two replies.

During our visits we read 11 support plans for people using the service and other records about people’s care and support including for medicines, incidents and care delivery. We looked at the personnel files of five staff members to look at their recruitment records, training and supervision. We read records about the management of the service such as staff visit rotas, incident summaries and quality audits. We also requested further specific information about the management of the service from the management team before, during and after our visits.

Updated 16 March 2018

This was the first inspection of this service at this location. We gave the provider two days’ notice of the inspection, to ensure the registered manager would be present. It was also to help arrange visits to where people were receiving the service, as the service is spread across a wide geographical area including Watford, Enfield and Ilford.

The service provides care and support to people living in six ‘supported living’ settings, so that they can live in their own home as independently as possible. People’s care and housing are provided under separate contractual agreements. The Care Quality Commission (CQC) does not regulate premises used for supported living; this inspection looked at people’s personal care and support.

CQC only inspects the service being received by people provided with ‘personal care’, which is help with tasks related to personal hygiene and eating, including the prompting support needed where someone may not undertake those tasks without being prompted. For these people we also take into account any wider social care provided. There were 30 people using the service in this way at the time of our inspection visits.

The service had a registered manager. This 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 present during the inspection visits, but in their new role as a locality manager. The service’s new manager (the ‘DCA manager’) was also present during the inspection and had applied to the Care Quality Commission to become the registered manager.

People using the service were positive about it, telling us for example, “I think that this is a really good service” and “It’s one of the better places I’ve been.” Most people felt able to recommend it. Community healthcare professionals also spoke positively about the service. Staff said they would recommend the service.

However, we found service quality varied between schemes. At one Enfield scheme there was too much focus on supporting people’s autonomy regardless of the impact on them. Some people were therefore not getting the support they needed to address cleanliness and food hygiene matters in their flats, and personal hygiene matters. The tone of some care records was disrespectful, adding judgements instead of reporting the facts of what occurred. Occasionally reports were not made where incidents occurred.

Where there was doubt that a person had capacity to consent to aspects of the care and support the service proposed to provide them, the service did not always assess the person’s capacity. In one instance, where someone withdrew consent, it was not listened to, which caused them unnecessary anxiety. The provider was not therefore ensuring the service followed the requirements of the Mental Capacity Act 2005.

We found the service had not been deploying sufficient numbers of suitable staff to support people at the Enfield schemes to stay safe and meet their needs. There had been a reliance on the scheme manager to cover vacant support hours, meaning they had not been able to manage the schemes effectively. We believe this contributed to the concerns we found at the Enfield schemes.

Systems of supporting people to take their prescribed medicines were not entirely robust across the service. Medicines stock checks were either sometimes inaccurate or people had not been supported to take their medicines as prescribed. The specific medicines training one person needed their staff to have in respect of their epilepsy had not been provided, leaving them at unnecessary safety risk should they have a seizure.

There were a number of governance systems embedded at the service, which helped to promote a positive and inclusive culture that achieved good outcomes for many people. However, they had not been effective at addressing the concerns we found.

The service supported people to express their views and make their own decisions about their care and support. Staff had built good relationships with most people and communicated well with them. Most people were given emotional support when needed. This had helped some people’s recovery and development. It was seen as an achievement when people developed enough to move on from the service.

An Ilford scheme had recently made the final of the supported living section of a national award. This was primarily for helping people to live as independently as possible in the community and significantly reduce behaviours that challenged the service.

The service’s systems, processes and practices safeguarded people from abuse and ensured appropriate action occurred when safeguarding concerns were raised. This was particularly evident at the Watford scheme, where responses to incidents and safeguarding matters included increasing staffing levels and installing CCTV at the scheme entrances.

The service supported people to follow their interests and access the local community when requested. It helped people to develop, re-establish or maintain relationships that mattered to them.

People were supported to maintain good health and nutrition, and to access appropriate healthcare services, both for physical and mental health. The service worked in co-operation with other organisations to deliver effective care and support. This included for assessing the needs of new people to make sure the service could meet their needs and wishes.

The service generally made sure staff had the skills, knowledge and experience to deliver effective care and support. Staff received good overall support for their roles in working with people. Robust staff recruitment procedures were followed to minimise the risk of unsuitable people being employed.

The provider engaged with and involved people using the service and staff in the development of the service. People’s concerns and complaints were listened to, and used to improve the quality of care.

This is the first time this service has been rated Requires Improvement. We found four 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.