This inspection took place on 9 and 10 October 2018. The inspection was unannounced.

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

St. Michaels is a service for five people who have autism and learning disabilities. It is a specialist service for people that have anxious or emotional behaviour that has limited their quality of life and experiences. Each person lives in their own flat or a bungalow and the staff team and service provided is organised around their individual needs. There is an office building where the management team are based and large garden areas, including secluded areas and fenced areas for people who need more security. The service is comprised of four flats located in one building, together with a purpose built bungalow with enclosed garden area within the grounds. At the time of the inspection, there were four people using the service.

The care service has been developed and designed in line with the values that underpin the ‘Registering the Right Support’ and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

The service had a registered manager, however, although still registered at the time of our inspection, the registered manager had not been in post since July 2018. A peripatetic manager oversaw the day to day running of the service while the provider was in the process of recruiting a new 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.

St Michaels was last inspected on 26 and 27 April 2016. At that inspection the service was rated as Good overall and in each domain, with the exception of the Responsive domain, which was rated as outstanding.

At this inspection, the service had declined. There were not always enough staff to safely support people or consider potential risks to staff. Insufficient priority had been given to some repairs which potentially presented a risk of harm. Water safety management checks were not completed in line with policy or guidance and some cleaning tasks intended to reduce the risk of waterborne infection were not completed. Although most equipment had been serviced and inspected, the safety inspection of a large gas appliance in the basement of the main building had not been completed. There were appropriate processes in place for ordering, administration and storage of medicines. However, records of medicines staff took with them when they accompanied people in settings outside of the service were not always completed.

Some training, including safeguarding training, had not always been completed within timescale. Consequently, a safeguarding matter emerged during the inspection because of how a person told us a member of staff had spoken to them. People were not safeguarded from situations in which they may experience abuse. In addition, supervision meetings with staff had not always taken place when planned which, if completed, may have highlighted overdue training. Management of the service had failed to fully address some of these issues to ensure compliance.

The registered and peripatetic managers had quality audits in place. However, this was not comprehensive enough to enable the service to assess, monitor and improve quality and safety service. The service management were not aware of some of the concerns found during this inspection.

The Care Quality Commission is required by law to monitor the o

This inspection took place on 27 and 28 April 2016.

St. Michaels is a service for five people who have autism and learning disabilities. It is a specialist service for people that have anxious or emotional behaviour that has limited their quality of life and experiences. Each person lives in their own flat and the staff team and service provided is organised around their individual needs. There is an office building where the management team are based and large garden areas, including secluded areas and fenced areas for people who need more security. Four flats were in one building and one ground floor flat was purpose built in the grounds. All flats have been modified and furnished to suit the needs of each person. The alterations and furnishings in two flats were a work in progress because people’s needs had changed or they had moved in recently.

The management team based at the service was made up of a registered manager and two deputy managers. 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 provided was innovative and based around the needs of each individual. There was a ‘can do’ attitude in the culture of the staff team. Even in the most difficult circumstances, people were given opportunities to live as independently as possible and with as many opportunities for new and interesting experiences as possible.

Staff were dedicated and worked hard to get to know people so that they could provide a service tailored to each individual. They found ways to help people overcome the barriers to their relationships with other people, and that had limited their opportunities to go out and about and live an ordinary lifestyle. People were making evident progress with their social skills and awareness, managing their health and wellbeing and developing their daily living skills.

Before people moved in staff found out the best way to communicate and support communication with the person and what was important to them. A moving in plan was designed with the person to make sure they had all the preparation needed for them to move in and settle down.

The staffing levels and buildings were designed to maximise people’s opportunities to be as independent as possible whilst keeping them as safe possible. The staff team were motivated and spoke confidently about their roles and the people they supported. Staff said they felt well supported by the management team and had the training they needed to meet people’s needs.

People were involved in the recruitment of staff, including being part of the interview team where possible. Staffing levels were reviewed and changed in response to the needs of the people. One person needed the support of four staff when out in town or doing activities outside the service but their needs had changed and they now only required three staff at these times. When people were trying new activities the staffing level was assessed specifically for this and a higher level of staff was provided to make sure, as far as possible that the new experience was a success.

Staff and the management team had an excellent understanding of managing risks and had supported people that had previously challenged services to reach their full potential. People said or expressed that they felt safe in the service and staff had a very clear understanding of what constituted abuse. Staff spoke up for people if they thought there may be at risk of potential abuse.

Staff assumed people had capacity and respected the straightforward decisions they made on a day to day basis. When people needed help or could not make a particular decision on their own, staff supported them. Decisions were made in people's best interests. The Care Q

Most people were unable to directly discuss the care provided at the service due to their communication difficulties.

One person did speak to us with regard to his care. He said staff had discussed his support and preferred routines and felt that his views and opinions were considered and said that he was able to give consent with regard to the care he received. He added "I enjoy going out and like my key worker. I am able to choose my holiday" He spoke of his planned holiday to Devon and how he had been involved in making decisions around where he wanted to go and the hotel he wished to stay at.

We saw that people were treated with dignity and their privacy was respected. Staff were seen during the day offering people choices and being given time to make decisions. People who used the service had the opportunity to discuss and take part in all aspects of life within the service as they wished or their capacity allowed.

Through direct observation, discussions with staff and records viewed we could see that the service actively encouraged people to be members of the wider community. The service provided imaginative and varied opportunities for people to develop and maintain social, emotional, communication and independent living skills. The staff had a strong ethos and focused on involving people in all areas of their lives.

Most people were unable to directly discuss the care provided at the service due to their communication difficulties.

One person did say "The staff are very good; they make sure I am treated well and I have no worries". He said he enjoyed the various activities he participated in and like to do cooking.

We saw that people were treated with dignity and their privacy was respected. Staff were seen during the day offering people choices and being given time to make decisions. People who use services had the opportunity to be asked about and take part in all aspects of life within the service as they wished or their capacity allowed.

People were unable to directly discuss the care provided at the service due to their learning disability.