St. Michaels Lodge Also known as Shakthi Healthcare Limited

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Risk assessments did not provide clear guidance and support to staff to help reduce and mitigate risk. Specific details known by staff were not documented for reference and accessibility to risk assessments was limited. Staff had a training programme in place, but we were not assured this was effective as some training modules were rushed. We did not see how competency was checked by the registered manager after training had been completed. The above was a breach of Regulation 12 (Safe care and treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The home was clean and staff were responsible for cleaning. However, observation of staffing levels showed that this could be challenging in addition to supporting people with their health needs during each shift, in addition to managing people who had a health condition requiring extra cleaning throughout the home. Staff told us they felt supported and could speak with experienced staff or the registered manager if they required extra guidance. Staff had an understanding of safeguarding and told us they would report concerns to the registered manager. Information on who to whistleblow to had to be prompted. The safeguarding policy in place did not have information on who to contact outside of the home if a concern needed to be raised. We recommend the provider seeks safeguarding guidance. Accidents and incidents were recorded with actions taken post the event, information on learning from these incidents had not been evidenced. The registered manager told us they discussed this with staff.

This service scored 53 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Relatives told us they knew who to speak to if they needed to raise concerns about safety and felt the registered manager listened to them when it was brought to their attention.

Staff told us they discussed accidents and incidents that occurred across the service to help them learn from them with ways to deal with them for any future incidents. Staff told us they had daily discussions across the staff team to reduce the risk of any incidents or understanding when a person might become upset, distressed or agitated. A staff member said, “We do discuss [person] in our handovers and we try to understand and address any behaviours that might be challenging and how we can prevent any incidents.” We observed a handover at the service and this was verbal, we did not see that this had been documented for audit purposes or to review that what had been discussed was acted upon.

Staff accessed and completed their mandatory training online. We were not assured there were effective monitoring procedures in place to ensure staff completed training in a timely manner or oversight of learning. Records we viewed showed staff had completed some training modules after we had asked to see the records and the time to complete the course was only a few minutes. We informed the registered manager of this who told us they had noticed this and it would be discussed in a team meeting. We found systems were in place to record accidents and incidents and actions taken were recorded. However, information on how to prevent the incident was not documented as part of learning. Policies and procedures viewed were not up to date for example, the supervision policy was out of date as it did not reflect the current frequency for staff supervisions. The registered manager told us staff had read all policies and procedures, but we were not shown evidence of this. This meant we were not assured staff understood what the provider expected from them.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

People who wanted to speak to us told us they felt safe. One person said, “Yeah, I’m good.” One person expressed they did not feel safe due to their preferences not being respected when receiving personal care. We raised this with the registered manager, and they confirmed the preference was now respected. A relative told us their family member was kept safe within the home. A relative said, “Yes, but I do feel they [person] would benefit from a bit more attention."

Overall staff demonstrated an understanding of safeguarding procedures. However, we did have to prompt staff to explain how they would escalate concerns outside of the home while interviewing on site. Staff we could not speak with on-site sent us their responses to how they would whistleblow and report concerns about abuse if the registered manager did not take appropriate action. A member of staff said, “If I witnessed or suspected a service user was being abused, I would go straight to my manager and tell them of my suspicions. If the manager did not act accordingly I would feel obliged to contact the local authority (safeguarding).” Another member of staff said, “We have talked about the importance of whistleblowing to uphold integrity and transparency at work."

We observed staff ensure they were monitoring someone at risk of absconding while they were outside. This meant staff were aware of the risk potential harm someone could face if they did not always observe them.

A safeguarding and whistleblowing policy and procedure were made available to us. The safeguarding and whistleblowing policy and procedure did not contain the Care Quality Commission contact details if staff wished to raise concerns about alleged poor care directly with us. Deprivation of liberty safeguards [DoLS] applications had been made to the appropriate authorities for people where applicable and records confirmed these were up to date.

A relative told us risk could be managed better within the home and involve their family member more. They said, “[Person] would benefit from someone with them on a daily basis with personal care and with eating.” The same relative told us they saw the biggest improvement when there was someone always assigned to their family member.

Experienced staff were able to tell us how they protected people from their known risks and the importance, for example, of having medicines on time to maintain good mental health. Some staff confirmed specific information about risks was not written down and as staff could not access risk assessments at the time of our visits we were not assured staff were viewing up to date information. We were concerned if experienced staff were not on shift and accessibility to up to date risk assessments was limited, how were people kept safe from their known risks or changes to their care.

We reviewed a care plan where someone was to use a walker frame around the home to support them with their mobility. We did not observe this being done during our visit. Where people smoked, we observed staff provide them with their cigarettes in line with their risk assessment. Staff were extremely busy during our visit and this highlighted whether there were enough staff to manage risks within the home.

Access to risk assessments was restricted. On the first day of our visit staff told us the registered manager had the risk assessments and care plans. Risks to people had not always been assessed with clear risk management plans developed or with clear accompanying guidance for staff to follow. For example, where someone had the condition polydipsia (over drinking of fluid). The risk assessment did not provide information on what staff should do to manage and reduce this risk. Specific details to manage risk were not documented for review, this posed a risk if staff with the knowledge were not to work and potential new staff were to work with people at the service. There was no evidence from risk assessments to show that people had been involved in the discussions about their care and how to manage identified risk with them. Risk assessment documentation had not been signed by people living at the service or the staff member assessing the risk. There was a section on the risk assessment asking for people to sign if they had agreed to what had been discussed and if not staff were to comment. This section was also blank.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

A relative told us they believed their family member would benefit from 1 to 1 support within the home. They said, “At times I only see 2 care workers, feel they need more.” The same relative told us the registered manager did ensure their family member was taken for haircuts, trips home and for shopping by staff. People within the home commented on the number of staff and those who required support to leave the home confirmed an extra member of staff came to do this. One person said, “Sometimes there are so many missing (staff) sometimes 3 and sometimes only 2.” Another person said, “There are only 2 (staff) today.”

Staff told us at times they felt staffing levels impacted their ability to meet people’s needs, which was consistent with our observations during the inspection. On the first day of our inspection, there were only 2 staff members present, when it should have been 3. A staff member said, “Usually there are 3 of us, but the senior has called in sick today and we don’t have a replacement.” They further added some tasks, such as cleaning, could not be completed. Staff also provided inconsistent feedback about the number of staff on duty at night. During our site visit on the 20 March 2024, 3 staff members told us there were always 2 staff present at night. However, records confirmed only 1 staff member was on shift. We discussed this with the registered manager who told us there used to be 2 staff, but it had been reduced. They were not able to explain how this decision had been made or assessed. Staff were positive about the training and support that they received to help them carry out their role and meet people’s needs. Staff confirmed this included shadowing senior staff when they first started and seeking guidance from the registered manager. Where we identified some gaps in training, the registered manager told us this was something that they had already identified and were planning to discuss this at a team meeting but this had not been carried out yet.

During our visits we observed only 2 staff were at the home and the third staff member attended where they were required to support people to attend their chosen activities or health appointments. This was clearly planned in advance and staff knew when they would be expected to be there for extra support. It was very busy for staff with different needs to attend to f There was no capacity tool to explain how the service decided how many staff were required on each shift. The registered manager told us they were present to support the staff team when needed.

We were not assured the provider was ensuring their staff kept up to date with training. Staff were registered with a training provider to complete their mandatory training and mental health training online. Records viewed showed that staff had completed training courses a day before we had requested them. We were also not assured staff had effectively completed training as they had completed courses within a few minutes. We raised this with the registered manager and they advised this had been noticed and they would speak with staff.

Relatives told us they found the home clean and tidy. A relative said, “it is maintained well, always has been clean and hygienic. No issues with the room always kept and his room as well - we pay attention to this and no concerns.”

Staff told us they were responsible for cleaning. A member of staff told us they were all responsible for cleaning the home in addition to their other duties to keep people safe. They said, “We have asked about help for this and they are looking for new staff for this.”

Upon entering the home we found it to be clean, we did notice areas that needed cleaning due to a persons behaviour, staff informed they had not been able to get that as yet. Staff were wearing personal protective equipment (PPE). This included gloves, apron and mask. Staff were responsible for the cleaning and observations showed this could be challenging if they had to tend to a number of people’s needs at the same time. Where people’s behaviours posed an infection risk this required staff to be continually cleaning after them and we were not assured this was easily managed. A communal bathroom had not been cleaned, we showed this to staff and they confirmed this was due to staff shortages on the day of the visit.

Staff completed infection control training. We noted this had been completed shortly after our first site visit in a very short amount of time, this meant we were not assured staff were keeping up to date with their required skills in reducing the risk and spread of infection. For example, a staff member had completed an infection control course in 3 minutes and 20 seconds. An infection prevention control audit carried out by a clinical nurse in May 2023. We asked the registered manager if they had completed an infection control audit since then and they told us they did not have this. We recommend the provider seek infection control guidance.

We did not look at Medicines optimisation during this assessment. The score for this quality statement is based on the previous rating for Safe.