St. Michaels Lodge Also known as Shakthi Healthcare Limited

St Michael’s Lodge is a residential care home providing personal and nursing care to nine people with mental health needs aged 25 and over at the time of the inspection. St Michael’s Lodge can accommodate up to 10 people in one adapted building.

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

We found improvements were required to the management of the service. The registered manager had failed to notify us of two notifiable serious incidents in August 2018. Staffing levels were not always adequate to meet people’s needs.

People told us they felt safe and staff treated them well. Staff understood their responsibilities for reporting any suspicions of abuse.

People’s risks were assessed, and guidance provided to reduce these. However, the fire risk assessment did not take account of people smoking inside the house. Systems were in place to safely manage medicines. Lessons were learnt when things went wrong, however follow up information was not always documented.

People were cared for by staff who received appropriate training to effectively carry out their role. Staff worked with professionals to support people’s care needs.

People were asked for their consent before care was provided. 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.

People’s nutrition and hydration needs were met.

Care plans documented people’s preferences, likes and dislikes. People’s communication needs were documented in their care plan. Staff were caring and kind and spoke attentively to people.

People were supported by staff who knew people well. People were supported to maintain their independence and their dignity was valued and respected. People were encouraged to make daily living decisions and staff supported them to make their own choices.

People were supported to participate in activities and follow their own interests. People knew how to raise a concern if they were unhappy about the service they received.

There were systems in place for monitoring the quality of the service, however, we found management presence at the service was not enough to ensure the smooth running of the service. The provider knew what was expected of them in terms of Duty of Candour, they had spoken with the local authority and relatives concerning incidents at the home.

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 15 March 2017).

Why we inspected

This was a planned inspection based on the previous rating.

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

Enforcement

We have identified breaches in relation to staffing levels, recruitment, governance and notification of other incidents.

Please see the action we have told the provider to take at the end of this report.

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.

After the last inspection the provider wrote to us to say what they would do to meet legal requirements in relation to care plans being person centred and providing care in line with the Mental Capacity Act 2005.

St. Michaels Lodge is situated in a quiet residential road and provides accommodation and 24 hour support for up to 10 people with mental health needs. At the time of our inspection nine people were using the service. Five rooms had an en-suite bathroom for added privacy and the provider was in the process of renovating the downstairs bathroom.

St Michaels Lodge had a registered 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.

Staff knew how to escalate safeguarding concerns where they thought someone was at risk of abuse which involved speaking to the registered manager and where necessary forwarding concerns to outside agencies such as the CQC, social services or the police.

Medicines were managed safely and staff completed training before being authorised to administer medication to people. The registered manager audited medicines to ensure staff were recording them correctly and to see that people received medicines on time.

Risk assessments were in place and covered aspects of people’s daily lives to protect them from harm. Staff had guidance on how to identify and minimise the risk if it presented itself. Risks such as going into the community were minimised so that people could have their freedom and be safe in public by informing staff where they were going and when they had left the service.

Staff were recruited safely and criminal records checks were performed in a timely manner to ensure staff were of good character to work with people in a care setting.

Staff were supported to be competent in their role and received training, supervision and an appraisal to review their work.

People were supported to make their own decisions about their care and permission to give care was sought in line with the principles of the Mental Capacity Act 2005. Where people were deprived of their liberty this was done lawfully and staff were fully aware of who was subject to this.

Staff were kind and patient with people and positive interactions were observed between staff and people. Staff knew people at the service well and spent time getting to know people in order to understand their lives so far and pastimes they enjoyed.

Care plans were personalised and now met people’s individual needs. There was a clearer focus on meeting the needs of the person and what they would like to do.

Activities at the service were minimal and the registered manager was working to resolve this issue. However people who wanted to, took part in a number of activities outside of the service.

The registered manager was available however some people felt they could be on site more often.

Staff said the registered manager was approachable and they could speak to them about concerns or the work at any time.

Quality assurance processes identified where improvements were needed and feedback from people and relatives was listened to.

We have made two recommendations in relation to providing in service activities and seeking staff feedback.

The service provides accommodation and 24 hour support for up to 10 people with mental health needs. At the time of our inspection five people were using the service.

Two bedrooms on the ground floor had en suite bathrooms and the other eight bedrooms had a sink and people shared bathroom facilities.

There was a registered manager of 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 service did not always keep people safe. Staff had been trained in safeguarding but were not always recruited safely. People and their relatives said they felt safe and that staff protected them in the service. There were enough staff at the service delivering care and support and they had been trained to provide support to people.

The systems to ensure staff were of good character were insufficient. We have recommended that the service consider reviewing best practice for ensuring that staff are of good character.

People were supported to receive their medicines in a safe way and received their medicine from people who had been trained. The manager audited medicines internally and recently introduced a new system to monitor medicines.

The service was not meeting the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLs). We found that staff had been trained but did not understand the principles of the MCA or DoLs. The service may be depriving someone of their liberty without the proper authorisation and the policy on DoLs did not provide information in line with the code of practice. There was also no policy on the MCA so staff had no guidance to support them in their responsibilities for DoLs.

Staff were observed being kind to people at the service and people said that they liked the staff and spoke positively about living at the service.

Care plans and risk assessments were in place and had been updated. However care was not always person centred and staff were not aware that they had become regimented to people’s routines. We observed that people were not always supported to leave the service of their own choice.

People were involved in their care at the service and the manager and staff encouraged people to feel part of the service by helping with tasks and keeping them informed of health appointments that they were due to attend.

The manager checked the quality of the service by asking people how they felt but they did not ask staff or relatives for feedback. The manager did however carry out regular meetings with staff and discussed how the service performed.

Relatives spoke well of the manager and commented on how efficient they were and that they could easily contact them if they needed to discuss the relatives care.

We found two breaches of the regulations. You can see what action we told the provider to take at the back of the full version of this report.

' Is the service caring?

' Is the service responsive?

' Is the service safe?

' Is the service effective?

' Is the service well led?

This is a summary of what we found-

Is the service safe?

People who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. People we spoke with told us they felt safe living at the home. One person told us 'I'm safe here.' However, people's personal records and other records relevant to the management of the services were not accurate and fit for purpose.

Is the service effective?

People told us they were satisfied with the care and support provided by the service. One person told us "the staff are very efficient.' We observed staff supporting people in line with their stated wished and assessed needs. Staff were aware of people's needs and preferences and the support each person using the service required.

Is the service caring?

People were supported by caring and attentive staff. We saw that care workers had an understanding of people's needs. One person said, "the staff look after me." Another person nodded when we asked them if they thought that the staff were caring.

Is the service responsive?

The service carried out assessments of people's needs before they began to provide support in most cases. However, one person on respite had not been assessed before providing support. Assessments included information about people's likes and preferences. The service involved others such as opticians and chiropodists where there was a need.

Is the service well-led?

The service had a registered manager in place and clear management structure. Staff said they found the manager to be approachable and they were able to discuss any relevant issues with them. Various quality assurance and monitoring systems