St Georges Ltd

This service is a domiciliary care agency based in Witham. It provides personal care to 30 people living in their own houses and flats. It mainly provides a service to older adults but also to adults with other support needs.

People’s experience of using this service:

When we last inspected the service we found staff were caring but rated the service requires improvement because we had concerns about how the service was assessing need and managing risk. We found the service was in breach of regulation as improvements were needed in the management of risks associated with people's specific health conditions, daily living and administration of medicines. At this inspection we found the registered manager had made significant changes and people received safe and person-centred care from skilled staff who knew them well.

The registered manager was passionate about the service and introduced innovative and practical solutions which made a difference to the support people received. The new deputy manager worked well the registered manager and we receive feedback from people, families and staff that the service had improved since our last visit.

Feedback from key professionals about how the service worked with them was not consistently positive. The registered manager did not always respond openly and effectively when they received feedback from external organisations. They had also not notified CQC following a safeguarding incident, as required. We made recommendations about improving how the service communicated following mistakes and how they responded to stakeholder feedback.

The registered manager had implemented a new electronic system which they used effectively to improve all areas of the service. Senior staff could check what support staff provided and the system highlighted any concerns around late visits or delayed medication.

There had been improvement in the safeguarding processes at the service. Staff knew what to do when they had concerns about a person’s safety. There were enough well-deployed staff to meet people’s needs.

Senior staff had revised care plans to ensure they were more detailed and person-centred. The improvements since our last inspection meant people now received their medicines safely. Staff had detailed guidance about individual needs and knew how to minimise risk to people’s safety.

The registered manager had adapted the new electronic system creatively to ensure it was tailored around people’s personalised needs. Staff provided support flexibly and adapted it when peoples’ needs changed. Staff supported people holistically and promoted their physical and emotional wellbeing. People received support to eat and drink in line with their preferences and needs. Staff were alert to any changes in people’s health and circumstances and referred people to professionals for support as required.

Staff were caring and attentive to the needs of the people they supported. People received dignified respectful care and were encouraged to remain independent. At the time of our inspection all the people at the service had capacity to make decisions. Staff supported them to make choices about the care they received.

People had access to a complaints process and office staff communicated well with people and their families and usually resolved concerns informally and promptly.

Staff were enthusiastic and told us they were well supported. They benefitted from the improved communication and morale was good. Senior staff ensured care staff had the skills to meet the needs of the people they supported. Training was varied, and senior staff provided additional guidance when there were gaps in staff skills.

Rating at last inspection: Requires improvement (Last report published 1 March 2018)

Why we inspected: This was a planned inspection based on previous rating.

Follow up: We will continue to check St Georges Ltd to ensure people receive care which meets their needs. We plan our inspections based on existing ratings and on any new information which we receive about each service.

The provider was given 48 hours' notice of our inspection because the location provides a domiciliary care service and we needed to know that someone would be available.

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 our last inspection in July 2017, we found the registered provider was in breach of six regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We asked the provider to submit an action plan to tell us how they intended to make the required improvements. At this inspection, we checked whether these improvements had been made and found the provider continued to be in breach of one of these regulations. Progress had been made in meeting the requirements of the other regulations previously breached. However, further improvements were still required in some areas.

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

Improvements were still needed in how the service assessed and recorded risks relating to people’s specific health conditions and daily living. This included risks associated with the administration of people’s medicines.

Despite the lack of information in people’s records relating to management of risk, people indicated they felt safe with the staff providing their care and support. Staff were provided with training and guidance in how to keep people safe and what they should do if they were concerned a person was at risk or was being abused. Concerns and complaints were responded to appropriately.

Care plans had been updated and better reflected peoples support needs. However, further work was needed to ensure all aspects of peoples care and support were considered and that care plans were consistent and accurate. Despite some shortfalls in the care records, people and their families told us they received personalised care that was responsive to their needs and their views were listened to and acted on.

People were positive and complimentary about the care they received. They were treated with dignity and respect and independence was encouraged. People received support from regular carers and staff arrived when they expected them. There had been improvements in staff training. and people were confident in the ability of the staff.

Staffs understanding of the mental capacity act had improved and they understood the importance of gaining people’s consent to the support they were providing. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. However, mental capacity assessments required additional work to ensure they were specific to individual’s needs.

Guidance was available to staff regarding the support people required with their nutritional needs. People were supported to access services from health care professionals such as the community nursing team and GP’s.

New quality assurance systems were not yet completely effective at identifying where improvements were needed. The provider lacked oversight and there was not a consistent and planned approach to monitoring the service provision. Opportunities to improve records and therefore improve the provision of care had been missed. However, people, relatives and staff fed back that there was an open culture at the service and could see improvements had been made since out last inspection. They were confident these improvements would continue.

There is a Registered Manager at this location. 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.

During the inspection, we identified a number of concerns about the care, safety, and welfare of people who received care from the provider. We found a number of breaches 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.

The provider did not have fully developed systems to make sure that people were supported safely when taking their medicines. The provider did not follow their medicine policy and clear records were not available for staff. Records did not show what action the care worker should take or record the way in which the medicines should be managed for an individual.

The provider had not ensured people were protected from the risk of unsafe care because people’s needs had not been appropriately assessed and reviewed. Care plans did not contain enough detail to enable staff to meet the individual needs. Some care plans were not accurate in all areas and did not ensure all relevant risks were identified. Where risks were documented, some people’s care plans did not state actions to reduce risk. This meant the provider could not be assured that care staff had the correct information and guidance about how to care for people based on their current needs.

When it had been identified that people needed support to have a specific diet, detailed guidance was not available for staff. Care plans lacked guidance about what action should be taken if concerns arise.

The principles of the Mental Capacity Act 2005 (MCA) had not been properly followed. When people required assessments to include mental capacity, care plans were not in place. This meant that staff might not always have the correct information needed to carry out their role effectively. Staff were not familiar with Mental Capacity Act 2005, and told us that they had not received training in this area.

Staff told us they felt supported in their role, but that some additional training would assist them to carry out their role better. On the day of our inspection, we found that most staff were administering some form of medicine and had not been trained to do so. We also noted that competency assessments were not carried out. This meant that the registered manager could not assure us that staff responsible for administering medicines to people was competent to do so.

Whilst the registered manager undertook an annual customer, satisfaction survey and analysed the information. There was no evidence that action had been taken in response to improvement suggestions. Systems and processes were not in place to monitor, and improve the quality of the service. Staff meetings did not take place.

When people had a diagnosis of dementia, there were no records explaining to staff about how to manage the condition. This meant that staff may not have guidance available to them to know how best to respond to a person changing needs and behaviour.

The provider had a robust selection and recruitment process and employed care staff only when they had obtained all relevant information to make sure they were suitable to provide care and support to vulnerable people. Staff had regular supervision and had annual appraisals carried out.

Complaints and concerns raised by people were reviewed and registered manager responded to complaints in a timely manner.

Positive relationships had been developed between care staff and people. People told us that they thought most of the care staff were kind, caring and respectful.