St Michaels House

Updated 18 August 2021

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was made up of one inspector.

Service and service type

St Michaels House a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

This inspection was unannounced.

What we did before inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report. We used all of this information to plan our inspection.

During the inspection

We spoke with two people who used the service and four relatives about their experience of the care provided. We spoke with eight members of staff including the registered manager, assistant manager, senior care workers, care workers and the nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider. We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

We reviewed a range of records. This included four people’s care records and multiple medication records. We looked at three staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.

After the inspection

We continued to seek clarification from the provider to validate evidence found. We looked at training data and quality assurance records. We spoke with two professionals who regularly visit the service.

Updated 18 August 2021

About the service

St Michaels House is a specialised short break service that provides respite care for people with a learning disability and/or physical disability. Hertfordshire County Council is registered to provide accommodation and care at St Michaels House for up to 12 people at any one time. At the time of the inspection there were six people using the service.

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

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.

Based on our review of safe and well-led the service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture. Staff did not have specific training to support people with learning disability and autism. We observed a staff member speaking to people that did not promote dignity and respect. Care plans identified peoples support needs and were being developed to ensure they maximised people’s choice and control. The registered manager acknowledged this and was putting actions into place to educate staff.

Staff received training that covered mandatory training, however, did not receive training that was required for people’s specific support needs. This was actioned immediately following the inspection. And staff had their competency assessed. Staff had received training in infection control practices and personal protective equipment was provided for them.

People and their relatives felt the care provided was safe and risks were managed appropriately. This was because staff knew people well, and systems were in place to report any concerns. Risks to people's health, safety and well-being were assessed. People's medicines were managed safely. People were supported by a staff team, who had been safely recruited.

Systems were in place for reporting and responding to accidents and incidents. Incidents were followed up and prompt action taken to ensure people were safe and to prevent reoccurrence.

People and their relatives praised the staff team. Staff had a good understanding of the people they supported. They took the time to get to know people's individual likes and dislikes. People and their relatives told us they would be confident to raise any concerns with the management team.

People, their relatives and staff members and professionals spoke highly of the registered manager and told us that they were available and supportive. The registered manager had a good understanding of their responsibilities towards the people they supported and was dedicated to continuing to improve the service. A governance system was established, which included various audits and the monitoring of safeguarding concerns, complaints, accidents and incidences. Formal action plans however had not been developed for ongoing monitoring.

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 March 2020).

Why we inspected

We undertook this targeted inspection to follow up on specific concerns which we had received about the service. The inspection was prompted in part due to concerns received about staff skills, training and the culture of the service. A decision was made for us to inspect and examine those risks.

We inspected and found there was a concern staff skills and training, so we widened the scope of the inspection to become a focused inspection which included the key questions of safe and well-led.

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.

We have found evidence that the provider needs to make improvement. Please see the well-led section of this full report.

We asked the provider to ensure there was immediate action to mitigate the risk where staff needed specialist training. The registered manager ensured that staff had training the next working day.

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

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.