St Georges Residential Care Home

About the service

St Georges Residential Care Home is a small family run service providing accommodation and personal care for two people living with a learning disability.

People’s experience of using this service and what we found

Right support: Model of care and setting maximises people’s choice, control and Independence;

People were kept safe from avoidable harm because the provider knew them well and understood how to protect them from abuse. One person was able to tell us they felt safe living there and enjoyed helping out with daily domestic tasks.

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

There were risk assessments in place covering the support provided, including safe access to the community.

Medicines were managed appropriately. Infection control measures were in place. Health and social care professionals were involved in people’s care to ensure they received the care and treatment which was right for them.

There was a stable staff team consisting of the provider and their family who had supported both people for many years.

Right care: Care is person-centred and promotes people’s dignity, privacy and human rights;

Staff relationships with people were caring and supportive, which one person confirmed. The stable staff team and people had formed close relationships over many years.

Right culture: Ethos, values, attitudes and behaviours of leaders and care staff ensure people using services lead confident, inclusive, and empowered lives;

People’s equality, diversity and human rights were respected. The service’s vision and values centred around the people they supported.

Regular checks helped to ensure the quality and safety of the service people received. The service made improvements as 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 29 October 2018).

Why we inspected

This inspection was prompted by a review of the information we held about this service and length of time since the last inspection. 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.

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

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice:

The provider understood and was meeting Covid-19 visitor vaccination requirements. This includes checking vaccination and Covid-19 status of relevant visitors (those not exempt from requirements) entering the home (fully vaccinated or exempt). The provider had personal protective equipment (PPE), specifically face masks and hand gel, at the entrance to the home for visitor use. The provider ensured that any visitors to the home had a negative lateral flow test prior to entry and wore PPE and sanitised their hands. The provider facilitated outside visits for residents to family and had a procedure where residents would be monitored on their return for signs of Covid-19 as residents were not compliant with Covid-19 testing. The provider had liaised with the local authority about not being able to complete Covid-19 testing on residents. Alternative forms of maintaining social contact were used for friends and relatives, for example, keeping in touch by the telephone. Remote considerations were considered by other visitors such as professionals and clinical consultations.

The provider told us about a process which would be followed if a resident contracted Covid-19. The provider would isolate the resident and would notify the GP, local authority and the resident’s family. If a member of staff tested positive, they would isolate on the top floor of the premises and arrangements for alternative staffing would be made. The provider had not had any positive Covid-19 cases for residents or staff.

The provider had not admitted any residents during the Covid-19 pandemic. The residents at the home had been there since 2010 and the provider told us that they were like part of the family. The provider told us that if a resident were to be admitted, it would check with the hospital that the person had a negative PCR and lateral flow test prior to discharge.

Environmental measures such as effective ventilation had been implemented. All areas were uncluttered so cleaning could take place effectively. The provider did not have cleaning schedules but told us that the premises was cleaned every morning, with bathrooms cleaned twice a day and surfaces cleaned two to three times a day. We saw evidence of monthly infection prevention and control audits which had been completed.

Staff members had undertaken infection prevention and control and Covid-19 training. The provider understood and had met Covid-19 staff vaccination requirements.

We were somewhat assured that this service met good infection prevention and control guidelines as a designated care setting.

Further information is in the detailed findings below.

This inspection took place on 16 and 22 August 2017. Our first visit was unannounced. At the previous inspection in November 2016 the service was not meeting all the regulations we inspected.

At our inspection in November 2016, we found that medicines management was not always safe as we could not always confirm people were receiving their medicines as prescribed. This was a breach of the regulation relating to safe care and treatment and we issued a warning notice to the registered provider following our inspection.

At this inspection we found that improvements had been made and medicines were now being managed safely. Medicines were being supplied in sealed blister packs by the pharmacist and records showed that people were receiving their medicines as prescribed.

At our last inspection we observed that staff sometimes did not refer to people in an age-appropriate manner, use their preferred names or keep them informed about what they were doing. During this inspection we saw that staff knew people using the service well, were aware of their likes and dislikes and treated them respectfully.

The service understood and complied with the requirements of the Mental Capacity Act (MCA) 2005. One person using the service had a Deprivation of Liberty Safeguards (DoLS) authorisation in place for their safety. The provider had applied for authorisations for two other people and these were awaiting assessment from the local authority.

The provider and staff were aware of safeguarding procedures. Any risks associated with people’s care, daily routines and activities were identified with action taken to minimise these. Care plans addressed the support people required with personal care, maintaining their health and their activities of daily living. There were enough staff on duty to support people safely.

The provider understood their role and responsibilities. There were systems in place to help ensure the safety and quality of the service provided.

St Georges Residential Care Home provides accommodation and personal care for up to three adults with learning disabilities. At the time of our inspection there were three people using the service. The manager of the service was also the owner and sole provider and so did not need to have a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service.

Medicines were still not managed safely. People did not always receive their medicines in line with instructions from the doctor or pharmacist. Medicines were not always signed for at the time when they were administered, increasing the risk of errors. There were not clear records to show how much medicine should be in stock and staff were unable to account for some missing tablets. Some unsafe practices were being followed, such as splitting tablets in half with a kitchen knife and storing them in unsealed packaging. The provider’s audits and quality monitoring systems were not sufficiently robust to identify or rectify these problems and medicines audits had not been completed for the last two months. The provider was in breach of the regulations relating to safe care and treatment, notification of incidents and good governance. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

Staff sometimes did not refer to people in an age-appropriate manner, use their preferred names or keep them informed about what they were doing. However, at other times staff treated people with respect, were sensitive to their emotional needs and knew how to communicate with them effectively so they had the information they needed to make choices about their care. Staff promoted people’s independence by giving them opportunities to do as much for themselves as possible.

The home environment was safe because the provider had measures in place to store chemicals safely, maintain fire safety and otherwise ensure the safety of the environment. People had individual risk assessments and risk management plans that were tailored to their needs. There were arrangements in place to safeguard people from harm and abuse. There were enough staff to keep people safe.

People were able to choose from a variety of nutritious, high quality home-cooked food that met their nutritional and cultural needs. People enjoyed the food supplied by the service and staff provided the support people needed to eat their meals and drink enough fluids. Staff monitored people’s weight and food intake to ensure they maintained a healthy body weight. People received the support they needed to maintain their health and attend healthcare appointments.

The manager and staff understood their requirements under the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS). DoLS provides a process to make sure that people are only deprived of their liberty when this is necessary to keep them safe and in a way that ensures their rights are upheld. The provider ensured the relevant processes were in place and appropriate people were involved in any decisions about people’s care that were made when they did not have the mental capacity to make the decisions for themselves.

Staff were provided with enough training and support to enable them to carry out their roles effectively. The provider was able to access guidance on good practice to inform their work at the service.

Staff knew people well and were familiar with their likes, dislikes, preferences and needs. People had comprehensive care plans that instructed staff what support they needed with personal care, completing tasks, maintaining their health and other aspects of their care. Care planning took into consideration people’s preferences, routines and cultural and religious needs. People received support to maintain contact with families and loved ones and to access their local community. There were not many structured activities available but the provider was looking into this.

The provider spent time at the home and monitored the quality of the service through observation, speaking with people and by using a range of checklists. Although these had not identified the problems we found in relation to medicines management, they were effective in assuring other aspects of the safety and quality of the service.

People benefitted from a small and well-established team of staff, because this meant they were familiar with how the service operated. People, relatives and staff gave us positive feedback about the manager. There were appropriate cover arrangements in place in case the manager was absent.

The service provides personal care and support to people within a small care home setting. It specialises in providing care to people who have a learning disability and a range of communication needs. There were three people using the service at the time of our inspection.

There was no registered manager in post because the service was owned by an individual who was also the manager 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.

During this inspection we found that the manager had not sufficiently improved medicines management. This was because the service was repackaging people’s medicines in pill dispensing boxes which is classed as ‘double dispensing’. Double dispensing introduces a risk as only specific professionals such as pharmacists and chemists are able to dispense medicines as they have been specially trained to do so. Other staff administering the medicines cannot also be sure people are receiving the right dose of medicine at the right time, as prescribed, because they do not have the medicines original packaging with pharmacy label to double check as they administer to people.

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

We considered our inspection findings to answer five questions we always ask:

' Is the service safe?

' Is the service caring?

' Is the service responsive?

' Is the service effective?

' Is the service well led?

Is the service safe?

The manager and staff had received training in the Deprivation of Liberty Safeguards (DoLs) and understood when an application should be made.

We saw that the home was well maintained with various health and safety checks carried out regularly. People had safe access to a well-kept garden. Procedures in relation to fire safety were in place.

There were enough suitably competent staff employed to meet the needs of the people who lived at the home. Staff recruitment procedures were robust to ensure that only suitable people were employed. People's personal records, and other records relevant to the management of the service, were accurate and fit for purpose.

Is the service caring?

We saw that people working at the home were caring. Also the feedback we received from people who used the service, their relatives and visiting professionals was positive about the standards of care and support provided at the home.

Is the service responsive?

We saw that the home regularly sought the views of people using the service, staff and relatives. We found that the home had responded positively to suggestions that had been made.

The way in which care should be provided was set out clearly in care plans. We saw that care was delivered in line with this.

Is the service effective?

People were protected from the risks of inadequate nutrition and hydration. Also, people told us that they liked the food they were provided with and we saw that it met their cultural needs.

People's needs were regularly assessed. Care plans were 'person-centred' focusing on people's individual needs. We found that care was delivered in line with these care plans.

Is the service well-led?

The provider had regard to the views of people using the service and relatives. Systems were in place to effectively assess and manage risks in relation to people's health, safety and welfare.

We saw that people and their family were involved in making decisions about their care and treatment. Their needs were assessed and care was delivered in line with their individual care plan.

We found the provider worked in co-operation with other professionals to support people with their health and welfare needs. Medicines were prescribed and given to people appropriately.

We saw that people's personal records were accurate and fit for purpose and were kept securely.

We found that staf had received training in relation to safeguarding vulnerable adults and knew what to look out for and how to report such matters should they arise.

People who used the service and their families were supported to raise any concerns. We saw that concerns were dealt with effectively and in a timely way.