We carried out a review of the data available to us about St Michaels House on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about St Michaels House, you can give feedback on this 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.
We found the following examples of good practice.
The home was closed to visitors and access into the home for health or social care professionals was managed safely. People were isolating in their own bedrooms and where people needed more space to support their mental health well-being this was done safely.
The provider ensured there were enough staff on duty to meet people’s needs safely.
The provider had developed policies, procedures and risks assessments for managing the service in relation to COVID-19.
Enhanced cleaning regimes were in place and staff followed these. The service was well ventilated and clean.
Staff were trained in how to use their PPE in line with national guidance. Testing for staff and people was well organised and regularly done.
¿ The service was clean and hygienic. The unit had not been used previously and was planned to open for people who were tested positive for COVID-19. To ensure the unit met the characteristics of a designated service the provider had to install a safety lock on a door leading to the main home. This was to ensure the unit could be isolated. We received confirmation from the provider that this work was being carried out.
¿ The environment was well organised with staff changing area, including laundry facilities. All bedrooms had fire doors opening to a patio area outside. This meant that people who were admitted could access their bedroom from outside without having to go into the unit. There was enough Personal Protective Equipment (PPE) and staff had training in Infection control and correct wear of PPE according to national guidance.
¿ The service was accepting professional visitors to the service with robust infection control procedures in place. Visitors could access the unit through a separate entrance.
¿ Risks to staff in relation to their health, safety and well-being had been thoroughly assessed. The registered manager told us when the unit opens individual risk assessments will be carried out for each person who was admitted.
¿ The provider had developed robust policies, procedures and guidance for the location which the registered manager and manager had successfully implemented at the location.
Further information is in the detailed findings below.
St Michaels House is a specialised short break service that provides respite care for adults with a learning disability and people with a 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.
The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.
People’s experience of using this service and what we found
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.
The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.
People told us they felt safe and were always looking forward to using the short break service. People’s medicines were managed safely, and staff knew how to mitigate risks to people. Staff received training in safeguarding and were confident in telling us how they would report their concerns internally and externally to safeguarding authorities.
Staff felt supported through training and supervision to carry out their roles effectively. People were happy with how staff met their needs and told us they were involved in planning the support they needed when using the service. People had been supported to eat and drink sufficient amounts. Staff knew when to involve health or social care professionals in people’s care.
People told us staff were kind and caring and showed them respect. People were involved in planning the support they needed when using the service or, when appropriate, their relatives.
Staff supported people to continue to attend their usual activities and offered people additional ones like outings. People’s communication needs were met and where needed, staff used aids like pictures or computer devices to support effective communication. The provider’s complaint procedure was shared with people and relatives to ensure they knew how to raise their concerns. End of life care was not provided at the service. However, there were plans in place to ensure staff had information available to them and they were trained in case there was a need to offer this service.
When things went wrong, the registered manager reported to safeguarding authorities; lessons were learn and actions taken to prevent reoccurrence. Various audits were carried out by the management of the service to monitor the quality of the care provided and actions were taken to improve where necessary.
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 01 August 2017).
Why we inspected
This was a planned inspection based on the previous rating.
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.
St Michaels House provides respite and enablement facilities in a short stay service for up to 12 adults who have a physical and or learning disability or sensory impairment. It does not provide nursing care. At the time of this inspection there were six people staying at St Michaels House
There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.
This was the first inspection since the service was reregistered in April 2016.
People told us they felt safe during their stay at St Michaels House and we observed staff supported people safely. Staff understood how to keep people safe and risks to people's safety and well-being were assessed and mitigated. People's medicines were managed safely by staff who had received training.
People had their needs met in a timely way and we observed there were sufficient numbers of staff who had the right skills and experience to support people safely. There was a robust recruitment process in place. This helped to ensure that staff who were employed at the service were suitable to work in this type of care setting.
Staff received regular support from their line managers which included attendance at team meetings along with regular one to one supervisions. Staff told us they felt well supported. People's consent was obtained and the service worked in line with Mental Capacity Act (MCA) principles. People were supported to eat and drink sufficient amounts to maintain their health and wellbeing. People were supported to access a range of health care professional and services when required.
People gave very positive feedback about the staff and management at the service, along with the facilities and ethos of the service. We observed staff to be kind and caring.
Staff were knowledgeable about people’s individual requirements in relation to their care and support needs and expectations. People had been involved in the planning of their care.
People were encouraged and supported to participate in activities which they had an interest in and were invited to join in events and celebrations which were organised throughout the year. There was a cheerful ambience around the communal areas of the service, including the outside areas.
There were arrangements in place to receive feedback from people who used the service. People were able to raise any concerns they had and were confident they would be listened to and any concerns raised would be addressed.
There were systems and processes in place to monitor the quality of the care and support provided for people who used the service. There was an open and inclusive ethos and people were central to everything the service offered.