This inspection was carried out on12 and 13 April 2018 and was unannounced.

Care service description

St Michael’s Nursing Home is 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. St Michael’s Nursing Home provides care for up to 65 older people who have nursing needs and who may also be living with dementia. The care home is based in a residential area of Westgate-on-Sea, with car parking on site, and public transport links close by. The service is arranged as two separate units over two floors of a detached building. There are communal lounges and dining areas. On the day of the inspection there were 53 people living at the service.

Rating at last inspection

At our last inspection we rated the service good. At this inspection we found overall the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. However, we did find an area, records that needed improvement. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection but one of the domains now requires improvement.

At this inspection we found the service remained Good.

Why the service is rated Good.

The service continues to be rated as good but some records needed improvement. Staff had not always completed some records accurately and concisely to show that people were getting the support and care that had been planned for them and for risks to be minimised. Records had been audited and checked but the inaccuracy of the records had not been identified as a shortfall. Other information in care plans and medicines records needed further details to make sure people were receiving consistent care from the staff in the way that suited them best. The registered manager took immediate action to address the issues.

People, staff and relatives told us that the service was well led and that the management team were supportive and approachable and that there was a culture of openness within the service. The registered manager was experienced and skilled in supporting people with complex health needs and continued to enhance their knowledge and skills. They had a clear vision for the service and this was shared by the staff. The registered manager worked with other professionals and outside agencies to ensure people had the support they needed. There were links with the local community. The registered manager had sought feedback from people, their relatives and staff about the service.

People felt safe in the service. Staff understood how to protect people from the risk of abuse and knew the action they needed to take to report any concerns in order to keep people safe. The management responded appropriately when concerns or complaints were made.

Staff understood people's specific needs and had good relationships with them. Throughout the inspection people were treated with dignity and kindness. People's privacy was respected. Staff were respectful and caring when they were supporting people. At the end of their lives people were supported to have a comfortable, dignified and pain –free death.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People were assessed before they came to live at the service. Care plans contained the detail needed to show how all aspects of people’s care was being provided in the way they preferred. Risks to people's health and safety were assessed and there was guidance for staff to mitigate risk and keep people as independent as possible. There was a wide range of activities provided for people to

The inspection visit was carried out on 25 January 2016 and was unannounced.

St Michael’s Nursing Home is a privately owned care home providing nursing care and support to up to 73 adults who have nursing needs and who may also be living with dementia. The care home is based in a residential area of Westgate-on-Sea, with car parking on site, and public transport links close by. The service is arranged over 2 floors of a detached building. On the day of the inspection there were 52 people living at the service.

There was a registered manager working at 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 and associated Regulations about how the service is run.

There were risk assessments in place, including environmental risk assessments, to minimise risks and ensure that people remained safe. Systems were in place to make sure that the registered manager and staff learned from events such as accidents and incidents.

Health and safety audits of the environment and equipment were carried out regularly to make sure people were safe in the service. People each had a personal emergency evacuation plan, which detailed how they could be safely evacuated from the service in the event of an emergency.

All staff had completed safeguarding training and they knew what action to take in the event of any suspicion of abuse, and who to report to both internally or externally, such as the local authority safeguarding team. Staff knew about the whistle blowing policy, and were confident they could raise any concerns with the registered manager, who would take appropriate action.

People had their needs met by sufficient numbers of staff on duty. Staff were checked before they started to work at the service and regularly received training to ensure they had the skills and competencies to provide safe care. New staff received induction training and shadowed established staff before they started to work on their own. Staff met with the registered manager to discuss their role and practice, and had an annual appraisal to discuss their training and development needs.

Medicines were stored and administered safely. People had the support they needed to remain healthy and well. Staff responded to any changes in people’s health needs; people and relatives told us that staff always called their doctor if they felt unwell. Nursing staff ensured that medicines were managed and administered safely.

People’s care plans contained clear information about people’s care needs. They were reviewed regularly and updated so that staff were aware of people’s current needs. People or relatives had signed the plans to confirm they had agreed with the care to be provided. Records about people’s end of life care were not always completed fully and in some cases there was a lack of people’s personal histories to ensure that staff would know what was important to them. Some plans lacked detail on how people preferred to receive their care and support. This was an area for improvement.

The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS). At the time of the inspection the registered manager had applied for a DoLS authorisation 15 people who were at risk of having their liberty restricted. At the time of this inspe

People who used the service told us they were satisfied with the service they received. We found that staff took time to explain where possible the options available and supported people to make choices. People told us that they were asked for consent before any care or treatment took place and their wishes respected.

People's needs were assessed before and when they first started to use the service. We found that people’s health care needs were monitored and community health professionals were involved to provide advice and support when needed. We found that appropriate arrangements were in place for the safe handling, storing, disposal and giving of medicines.

People told us that the staff were nice, friendly and there was always enough staff to help them. We found that there was sufficient suitably qualified, skilled staff available throughout the home to meet people's needs.

Systems were in place to monitor the service that people received to ensure that the service was satisfactory and safe. People told us they did not have any complaints but would not hesitate to speak to the manger or staff if they had any concerns.

We spoke with people who use the service, the manager, staff members and visitors. There were 51 people using the service. We met and spoke with some of them and everyone we spoke to said that they were happy living at St Michael’s Nursing Home. One person told us, “I like it here, I’m very happy”.

People looked relaxed, comfortable and at ease with each other and staff. One person said, "The staff help me when I need it. They come quickly if I ring the bell".

Everyone said that the food was 'good' and that they always had a choice. We saw that meals were nicely presented and peoples dietary needs were catered for.

We spent time with people and observed interactions between the people and the staff.

The staff we spoke with had knowledge and understanding of people's needs and knew people's routines and how they liked to be supported. We found evidnece that staff had the skills and the knowledge to meet the needs of people using the service and were supported by colleagues and managers.

People told us they felt confident to make a complaint and were happy with the outcome of complaints that they had made.

We found that the service was clean and odour free. The provider had processes in place to minimise the risk to people from the building, including fire.

We observed care that was given to some people, and found that people engaged with staff at the home, and we noticed that some people joked and laughed with their carers. We noted that staff members addressed people by name and greeted them politely, and that people appeared relaxed and content.

We spoke to three residents and four relatives of residents, some of whom told us that they thought the staff were “lovely”, although others we spoke to said that “although the care was good, the personal touch was sometimes lacking”. One resident we spoke to said all the staff were good to her.