Georgian House Nursing Home

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

The provider did not always have effective systems in place to safeguard people from risks.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

We made a recommendation the provider consider current guidance and implementation of The Mental Capacity Act 2005 (MCA).

Meaningful recreational activities for people to help prevent social isolation were limited.

Care plans were not always personalised so staff knew how to respond to people’s individual needs appropriately, for example end of life care.

We recommended the provider seek and implement national guidance to make sure people have personalised plans around end of life care.

The provider had quality assurance systems in place to monitor and manage the quality of service delivery. However, these were not always effective as they had not identified the various areas we identified during our inspection that needed to improve.

Staff were recruited safely and supported to develop their skills through supervision and training to help them deliver appropriate care to people.

People were supported to access healthcare services. People and their relatives told us people were cared for by kind staff who knew the needs of the people they cared for.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 30 June 2021) and there was a breach of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found the provider remained in breach of regulations.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 11 March 2021. A breach of legal requirements was found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective, Responsive and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained requires improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Georgian House Nursing Home on our website at www.cqc.org.uk.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to person centred care, safe care and good governance.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Georgian House Nursing Home is a nursing home for up to 25 people aged 65 and over. Some people were living with the experience of dementia. At the time of our inspection, 22 people were living at the service, one of whom was in hospital.

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

Medicines were not always managed in a safe way. Whilst we did not find people were being harmed, there was an increased risk that they would not receive their medicines as prescribed because we found a number of discrepancies.

The provider had systems for monitoring and improving the quality of the service, and these were mostly operated effectively. However, these had not identified the issues we found during our inspection.

Following our inspection visit, the registered manager told us about improvements they were making based on our feedback.

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

The provider followed the principles of the Mental Capacity Act 2005 (MCA) and where people lacked capacity, they were deprived of their liberty lawfully.

The provider had made improvements to the environment and had developed this to suit the needs of the people who used the service, particularly those living with dementia.

People using the service were happy with the care they received. They told us staff were kind and met their needs. Feedback from relatives was positive, and indicated they were happy with the care their family members received.

People were assessed before using the service, and their care and support had been planned in line with their needs and choices. Staff knew people’s needs well and had assessed risks to their safety and well-being. Guidelines were in place to help minimise these risks. People had access to healthcare services when needed and the staff communicated well with healthcare professionals to meet people’s needs.

There was a range of different social activities being offered, and people were consulted in relation to activities they wanted to take part in. The home was clean and some improvements to the décor had taken place. Further improvements were planned. There were robust procedures for preventing and controlling infection, and the staff followed these.

There was enough suitable staff who were trained and supported so they knew how to care for people. The registered manager regularly assessed staff competencies and skills. Staff received regular supervision.

There were systems for identifying, investigating and responding to complaints, accidents, incidents and safeguarding alerts. We saw the provider learnt from these to make improvements to the service.

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 requires improvement (published 14 November 2019) and there was one breach of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection, we found that although improvements had been made in some areas, further improvements were required and the provider was still in breach of regulations.

The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

This was a planned inspection based on the concerns identified at our previous inspection of October 2019, and new recent concerns received about a person sustaining repeated falls.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection.

We have identified one breach in relation to safe care and treatment. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Georgian House Nursing Home is a nursing home providing personal and nursing care to 25 people aged 65 and over at the time of the inspection. Some people were living with dementia and two people were receiving end of life care. The service can support up to 26 people.

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

At our last inspection, we issued a recommendation because the environment was not developed to meet the needs of people who lived with dementia. Although the provider had taken some steps to improve the environment, such as painting some walls a different colour, they had not improved other areas and the environment still did not meet people’s needs.

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

Staff were responsive to people’s individual needs and knew them well. They supported each person by spending time with them and listening to them. They ensured that each person felt included and valued as an individual. People were supported to engage in activities organised at the home. They were consulted in all aspects of their care and support and were listened to.

People who used the service and their relatives were happy with the service they received. Their needs were met in a personalised way and they had been involved in planning and reviewing their care. People said the staff were kind, caring and respectful and they had developed good relationships with them.

The provider worked closely with other professionals to make sure people had access to health care services. People received their medicines safely and as prescribed. People’s nutritional needs were assessed and met.

People's needs were assessed before they started using the service and care plans were developed from initial assessments. People and those important to them were involved in reviewing care plans. Risks to their safety and wellbeing were appropriately assessed and mitigated. There were systems for monitoring the quality of the service, gathering feedback from others and making continuous improvements.

Staff were happy and felt well supported. They enjoyed their work and spoke positively about the people they cared for. They received the training, support and information they needed to provide effective care. The provider had robust procedures for recruiting and inducting staff to help ensure only suitable staff were employed.

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 6 April 2017).

Why we inspected

This was a planned inspection based on the previous rating.

We have found evidence that the provider needs to make improvement.

Enforcement

We have identified a breach in relation to person-centred care.

Please see the action we have told the provider to take at the end of this report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Georgian House Nursing Home on our website at www.cqc.org.uk.

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Georgian House Nursing Home is a care home providing personal and nursing care to up to 26 older people. There were 22 people living at the service at the time of our visit. Some people were living with the experience of dementia and one person was being cared for at the end of their life. 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 and associated Regulations about how the service is run.

A range of activities were organised by staff. However there was a lack of person centred activities, and the environment had not been developed to meet the needs of people who were living with the experience of dementia.

The provider had taken some steps to protect people in the event of a fire and there was a policy and procedure in place. The provider carried out regular fire checks and fire drills. However, people using the service did not have personal emergency evacuation plans (PEEPs) in place. There was a fire risk assessment in place but this had not been reviewed and updated since March 2011.

The temperatures of fridges used to store medicines were not consistently recorded, and where temperatures were out of the safe range, there was no evidence of any actions taken. There was a procedure for the recording, storing and administering people’s medicines and the staff were aware of this. Staff received regular training in the administration of medicines.

We have made recommendations in relation to the provision of person-centred activities, the environment, fire safety and medicines management.

The risks to people’s safety were identified and managed appropriately. The provider had processes in place for the recording and investigation of incidents and accidents.

The provider had put systems in place to ensure people lived in a safe environment. We saw a variety of health and safety checks were conducted on a regular basis by staff and external agencies.

There were appropriate recruitment procedures and systems were in place to ensure that only suitable staff were appointed to work with people who used the service.

There were enough staff on duty to keep people safe and meet their needs, and there were contingency plans in place in the event of staff absence.

There were appropriate procedures in place for the safeguarding of vulnerable people and these were being followed.

The provider was aware of their responsibilities and had acted in accordance with the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). People’s capacity was assessed and they consented to their care and support.

People were cared for by staff who were suitably trained, supervised and appraised.

Staff treated people with kindness and dignity and took into account their human rights and diverse needs.

People’s nutritional and healthcare needs had been assessed and were being met.

Assessments were carried out before people were admitted to the service to ensure the service could provide appropriate care. Care plans were developed from the assessments and reviewed regularly.

There was a complaints procedure in place and people and their relatives knew how to make a complaint. They felt confident that their concerns would be addressed. People and their relatives were sent questionnaires to gain their feedback on the quality of the care provided.

There were regular staff meetings, and these were recorded. Staff told us that communication was good and they had regular handover meetings.

People, relatives and professionals we spoke with thought the home was well-led and the staff and senior team were approachable and worked well as a team. The staff told us they felt supported by the provider and there was a culture of openness and transparency within the service.

People told us they were happy with the care and support they received. One person told us 'I'm very happy here, it's the happiest I've been.' Another person said 'I'm very well looked after, it's perfect here.' A visitor told us 'the staff are amazing, they are so caring.'

We saw that people were consulted about the care and treatment they received and these were delivered in line with their care plan.

People's medication was well managed and the provider had systems in place to make sure people received the medication they needed.

Appropriate pre-employment checks were carried out to make sure staff were suitable to work with people using the service.

Arrangements were in place to investigate and resolve, if possible, complaints from people using the service or their representatives.

We saw that staff supported people in a professional and friendly way. People using the service were offered choices with regard to the food provided at lunchtime and activities in the afternoon. People using the service also told us that they were involved in making decisions. One person told us "I can get up when I like and go to bed when I like." Another person said "there's always a choice of food at meal times. If I don't like what's offered, the staff will get me something else."

We spoke with six people working at Georgian House, including the home's manager. Staff were able to tell us about how they maintained people's dignity, respected their privacy and gave them choices throughout the day. Staff also told us they felt supported and well trained. Staff comments included "it's a good team, we work well together to make sure people are happy and safe" and "this is a good place to work, we have done all the mandatory training and we are offered other training if it's needed." The staff we spoke with were aware of the risk of abuse and gave appropriate answers when asked about how they would respond if they had concerns about a person using the service.