This inspection took place on 17 September 2018 and was unannounced.

St Michaels House 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 House can accommodate 13 people in one adapted building. At the time of inspection, 9 people were living at the service.

Following our inspection in March 2018 the service was rated as ‘Inadequate’ due to serious concerns about the safety and well-being of the people who lived there, and ongoing breaches of regulation. The commission placed the service in special measures until they had improved the care provided. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the provider demonstrated to us that improvements have been made and it is no longer rated as inadequate overall or in any of the key questions. At the time of this inspection we found there had been improvements in the way that the home operated and in relation to the cleanliness of the environment and maintenance within the home. Therefore, this service is now out of Special Measures. However, the rating reflects that more time is required to evidence sustainability of the improvements made.

The service 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.

People told us they felt safe, and staff understood how to recognise abuse and the safeguarding procedures that should be followed to report abuse. People had risk assessments in place to cover any risks that were present within their lives, and actions were taken to reduce risk where possible. All the staff we spoke with were confident that any concerns they raised would be followed up appropriately by the registered manager.

Staffing levels were adequate to meet people's current needs, and rotas showed that staffing was consistent.

The staff recruitment procedures ensured that appropriate pre-employment checks were carried out to ensure only suitable staff worked at the service.

Staff attended mandatory training courses to ensure their knowledge was up to date. Staff were able to update their mandatory training with short refresher courses.

Staff supported people with the administration of medicines, however, there were improvements required in identifying risks and making sure people could take the medicines they required safely.

People were protected by the prevention and control of infection. The home had undergone decoration and renovation in many areas, and all areas were being regularly cleaned.

People's consent was gained before any care was provided and the requirements of the Mental Capacity Act 2005 were met. Consent forms were signed and within people’s files.

People were able to choose the food and drink they wanted and staff supported people with this, and people could be supported to access health professionals when required. All aspects of people’s health was documented within their files and updated regularly.

Care planning and risk assessments were personalised and mentioned the specific care each person required, including their likes and dislikes. Staff were aware of people’s preferences, and supported people in a person-centred manner.

People were involved in their own care planning as much as they could be, and were able to contribute to the way in which they were supported. People told us they felt in control of their care and were listened to by staff.

Staff treated people with kindness, dig

This unannounced inspection took place on 5, 6 and 12 March 2018.

St Michaels House 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 House can accommodate 13 people in one adapted building. At the time of inspection, 10 people were living at the service.

There was a registered manager in post who was also the provider 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.

St Michaels House was inspected in April 2017 and rated as inadequate and placed into special measures. In August 2017 we inspected again, and whilst some improvements had been made, we found ongoing breaches of regulation. The service was rated as requires improvement, and remained in special measures. During this inspection in March 2018, we found that the provider had implemented improvements in some areas however; they remained in ongoing breach of regulation . There remained a poor quality of cleanliness within the home, lack of oversight to monitor and improve the quality and cleanliness. This meant there was a risk of harm posed to people due to the lack of cleanliness of the home. We found that there was not enough improvement to take the provider out of special measures. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

The home was dirty and had continued to not be adequately cleaned. There were numerous areas throughout the home that posed a direct risk of harm through the allergens present in mould and the increased risk of infection associated with the ingrained dirt and general lack of cleanliness. This included the kitchen area and people’s bedrooms. The kitchen had many areas of ingrained mould and dirt, and food was being prepared in these areas. We found mould around several people’s basins, and serious damp and mould issues in one person’s bedroom. This was a risk to people’s health, including one person at a higher risk of developing respiratory infections due to a diagnosis of COPD.

We found that fire doors within the service had been propped open by chairs, thus creating a fire risk as the doors would not close in the event of a fire. People using the service smoked within their rooms. Risk assessments were in place to identify the potential risks of this behaviour, and people had signed agreements not to smoke in rooms. This did not stop people from smoking in their rooms, and no further actions had been taken by the service to address this.

The environment continued to be poorly maintained. A redecoration plan was in place, but this had failed to take prompt action in improving the environment.

A robust and detailed system of quality assurance to monitor the environment and key aspects of people's care and support had not been implemented. This had resulted in the shortfalls that we identified during this inspection failing to be identified or addressed by the provider. As a result of the last inspection, we were receiving monthly updates from the provider regarding the cleaning that was taking place and the environmental audits. We found that these were ineffective and did not reflect the state of poor cleanliness within the home. The registered manager had not taken prompt action to identify and address the problems with the environment.

Staff supported people in a positive manner and were caring in their day-to-day interactions with people. However, the overall ethos within the service required improvement in this area, due to lack of a

This unannounced inspection took place on 22 and 29 August 2017. St Michaels House provides accommodation for up to 13 people living with mental health needs. At the time of our inspection there were 11 people living in the home

There was a registered manager in post who was also the provider 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.

Following the last inspection of St Michaels House in April 2017 the provider was rated as inadequate and placed into special measures. During this inspection we found that the provider had implemented improvements in a number of areas however, these improvements required further development to ensure that they were sufficiently embedded into practice. There was a lack of oversight of people’s care and support from the provider and an appropriate system to monitor and improve the quality and suitability of care and support that people received had not been implemented. This had resulted in ongoing breaches of regulation and a risk of harm posed to people due to the lack of cleanliness of the home. This inspection found that there was not enough improvement to take the provider out of special measures and that the well-led domain remained inadequate.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

The home was dirty and a number of areas on the ground floor including the laundry room were mouldy and posed a risk of harm to people. Throughout the home and in people’s bedrooms we found broken items of furniture that were in use, dirty carpets and the home was in need of redecoration and updating. The provider had submitted an action plan to CQC in August 2017 detailing the improvements that they intended to make to the environment however, appropriate and timely action had not been taken since our last inspection.

Although people’s care and support files contained assessments of their capacity showing that they lacked capacity to make decisions in relation to their care there was no evidence that people had been involved in these capacity assessments. Best interest checklists had not been completed and there was no evidence to show that the provider had explored less restrictive options when developing people’s plans of care.

A system of quality assurance to monitor the environment and key aspects of people’s care and support had not been implemented. This had resulted in the shortfalls that we identified during this inspection failing to be identified or addressed by the provider.

A programme of activities had been introduced to increase people’s sense of well-being. We have mad

This unannounced inspection took place over three days on the 31 March, 7 and 13 April 2017.

St Michaels House provides accommodation for up to 12 people living with mental health needs. At the time of our inspection there were 9 people living in the home

We inspected this service in May 2016 and found identified that there was a breach of two regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider was asked to submit an action plan to tell us how they would address these breaches however, did not submit this to us.

There was a registered manager in post who was also the provider 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 provider continued to fail to implement adequate quality assurances procedures since our last inspection. This had resulted in on going shortfalls in the service failing to be identified and resolved. We also found that the home had not been adequately maintained and the provider did not have plans in place to address the maintenance of St Micheals House.

The provider continued to fail to ensure that people received their prescribed medicines safely as there were insufficient processes in place to ensure that all prescribed medicines had been given..

People’s capacity to consent to their care and support had not consistently been considered by the provider. People were subject to some restrictions where their capacity to consent to the restrictions had not been assessed or processes followed to ensure that the restrictions were in their best interests.

People did not always experience positive interactions and relationships with staff. Staffing levels within the home were not always sufficient to facilitate activities or positive engagement with people.

Staff provided care that was based on mitigating known risks; however, this provided a negative culture as staff did not relate to people’s strengths, interests or implement proactive strategies to engage with people.

There was a breach of four regulations which included two continued breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The overall rating for this service is 'Inadequate' and the service is therefore in 'special measures'. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no l

This unannounced inspection took place over two days on the 19 and 20 May 2016.

St Michaels House provides accommodation for up to 12 people living with mental health needs. At the time of our inspection there were 10 people living in the home.

There was a registered manager in post. 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.

At the last inspection in March 2015 we asked the provider to make improvements to the way in which people’s medicines were managed as at times people’s medicines were not managed safely. During this inspection we found that people continued not to always receive their medicines safely. We also found that records were not always completed to show what medicines people had been administered. This constituted a breach of the regulation of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

There were not effective systems in place to monitor and improve the quality of the service. Audits of the environment had not always identified areas that required improvements, and where they had been identified actions to improve the environment had not always been made. This constituted a breach of the regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

During our inspection in March 2015 we also asked the provider to make improvements to the way in which they supported people who did not have the capacity to consent to their care and support. At this inspection we found that these improvements had been made and staff and the manager understood their roles in supporting people who may lack the mental capacity to make decisions for them.

People felt safe and comfortable in the home and staff were clear about their roles and responsibilities to safeguard people from harm. People were protected from the risk of harm and staff understood how to recognise and respond to concerns. Risks associated with people's care needs were assessed and measures put in place to reduce the likelihood of harm occurring.

There were enough staff to meet people's needs in a timely manner. Staff were knowledgeable about people's needs and people told us staff cared for them in a kind and compassionate way.

Staff received regular training that equipped them with the skills and knowledge that they required to carry out their roles.

Staff worked closely with people’s allocated health professionals to ensure that they maintained good health. Where staff had identified that people were unwell they supported them to access appropriate healthcare services in a timely manner.

People were supported to eat and drink enough to maintain their health and well-being and were able to choose and participate in the preparation of their meals. People had individual plans of care in place that they had been involved in developing. People were involved in and supported to make decisions about their care and were supported to participate in a range of activities both with and outside of the home.

People had good relationships with staff within the home. Staff knew people well and were aware of how to support people to raise any concerns and complaints. People told us that the registered manager was visible within the home and that they felt able to approach her should they have any concerns.

This unannounced inspection took place on 10 March 2015.

St Michaels House provides accommodation for twelve people with mental health needs, at the time of our inspection there was twelve people living at the home.

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.

At the last inspection in September 2014 we asked the provider to make improvements in relation to staff supervision. At this inspection we found that these improvements had been completed.

People were cared for by a staff team that knew them well and understood their needs. There were robust and effective recruitment processes in place so that people were supported by staff of a suitable character. Staffing numbers were sufficient to meet the needs of the people who used the service and staff received regular training.

Care staff were knowledgeable about their roles and responsibilities and had the skills, knowledge and experience required to support people with their care and support needs. People generally received their medicines as prescribed however there was a need to tighten the record keeping systems in place.

People were actively involved in decisions about their care and support needs; however Mental Capacity assessments were not always reviewed in response to changing levels of understanding. Changing case law in relation to the deprivation of liberty safeguards had not consistently been taken in to account in relation to code pads on the front door and the care of people in bed. People received a detailed assessment of risk relating to their care and staff understood the measures they needed to take to manage and reduce the risks. People told us they felt safe and there were clear lines of reporting safeguarding concerns to appropriate agencies and staff were knowledgeable about safeguarding adults.

Care plans were in place detailing how people wished to be supported and people were involved in making decisions about their care. People participated in a range of activities both in the home and in the community and received the support they needed to help them do this. People were able to choose where they spent their time and what they did.

Staff had good relationships with the people who lived at the home. Staff were aware of how to support people to raise concerns and complaints and we saw the manager learnt from complaints and suggestions and made improvements to the service. The registered manager was visible and accessible. Staff and people living in the home were confident that issues would be addressed and that any concerns they had would be listened to.There were effective systems in place to monitor and improve the quality of the service provided.

Our inspection team was made up of one inspector. There were 12 people using the service on the day of our visit. We spoke with six people who used the service and three members of staff. They helped answer our five questions which are set out below.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People told us they felt safe. Safeguarding procedures were robust and staff understood how to safeguard the people they supported. People’s ability to manage their finances had been assessed and appropriate arrangements put in place.

No person in the home was subject to Deprivation of Liberty Safeguards. We saw no restrictions on people’s liberty. Specific training on the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards had been provided for staff. The Mental Capacity Act and Deprivation of Liberty Safeguards is legislation used to protect people who might not be able to make informed decisions on their own about the care they receive.

Improvements were needed in supporting staff through a structure of regular supervision and a system of appraisal.

Is the service effective?

All people we spoke to told us the care and support provided was good and they got on well with staff. They said staff cared for them well and listened to them. One person told us, “Staff are nice here – they all help us”. Another said, “I like it here – it is the best home I’ve been in, everyone is very helpful”.

People’s needs were assessed and care and support was planned and delivered in line with their individual care plans. Care plans considered all aspects of the person's circumstances and were centred on them as an individual. Information was given on how best to provide different aspects of a person’s care. This helped staff provide care and support according to the person’s needs and choices.

Is the service caring?

We observed effective communication and good relationships between the staff on duty and the people living in the home. Staff made sure they gave individual time to those people who needed this. This helped to make sure people felt listened to and their needs were met.

Is the service responsive?

People told us they were encouraged and supported by staff to take part in relevant daytime activities both in the home and in the community. This meant that the provider was promoting the wellbeing of people who used the service by taking account of all their needs.

Information on how to make a complaint was available in the home and in the information pack given to people who used the service and their representatives. There had been no recent complaints.

Is the service well-led?

The service had a quality assurance system. We found that a range of internal quality checks were carried out to assess and monitor the quality of service that people received. Any action needed to improve the service was identified and followed up.

People who used the service were asked for their views about the quality of care and support being provided. This meant that the care and service provided was informed by the comments made by people who used the service.

Improvements had been made in the maintenance of accurate and appropriate records since our last inspection.

We spoke with four people who lived at St Michaels House. Some people told us that they had lived at the home for a number of years. They all told us that they liked living at the home and that they got on well with the staff .One person told us “I keep busy and I have some jobs around the home which I enjoy”. Another person told us “I know all the staff and they know me well”. We spoke with a visiting healthcare professional who told us that they were pleased with the care that people had received from staff.

We found that improvements had been made in the standard of cleanliness, and that refurbishment had taken place in parts of the home.

We found that people were well cared for and we saw that staff interacted well with people in a way that demonstrated that they were knowledgeable about their individual requirements.

We were concerned that weekly fire alarm tests and some care records had not been completed in a timely way. One care record had not been completed which would outline the steps for staff to take in order to keep people safe.

We spoke with four people who used services. They told us they felt they were cared for and supported appropriately by staff. One person told us: “They look after me well." Another person told us: "They have respect for me and I have respect for them." One person told us how much they had enjoyed a trip to Wickstead Park. We saw people vacuuming and tidying their bedrooms and one person baking cakes with staff as part of a regular Wednesday activity. We saw people using services and staff dancing to music in the dining room and having fun. People who lived at St Michael's House told us they were well cared for and supported by staff. They told us they knew staff well and staff promoted their independence and involvement in the community. One person had an interest in books and was being encouraged to attend a book reading group. People said staff were patient and they felt confident to talk to them if they were unhappy.

People said they got all the support they needed at St Michael’s House. They told us they felt safe and liked the friendly attitude of the staff. They also said that the staff and Manager always have time for them, especially if they are “having a bad day” and need to talk to staff.

People told us they liked being able to have their bedrooms they way they liked them. They said it was their home and the staff respected their choices.

Comments included, for example:

• “I enjoy having a smoke in the garden. They have made it really nice for us.”

• “Food is good. Plenty of it.”

• “I can go out when I want as long as I let them know when I’ll be back.”