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Inspection carried out on 11 April 2018

During a routine inspection

Georgiana 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.

Georgiana accommodates up to 72 people in one adapted building. The home provides support and personal care for people who may have a range of care needs, including physical disabilities and dementia.

At the last inspection, the service was rated good. At this inspection we found the service remained good.

People were safe because there were effective risk assessments in place, and systems to keep them safe from abuse or avoidable harm. There was sufficient numbers of staff to support people safely. Staff took appropriate precautions to ensure that people were protected from the risk of acquired infections. People's medicines were managed safely, and there was evidence of learning from incidents.

People's needs had been assessed regularly and they had care plans in place that took account of their individual needs, preferences, and choices. Staff had regular supervisions and they had been trained to meet people's individual needs effectively.

The requirements of the Mental Capacity Act 2005 were being met, and staff understood their roles and responsibilities to seek people's consent prior to care and support being provided. People had been supported to have enough to eat and drink to maintain their health and wellbeing.

People were supported by caring, friendly and respectful staff. They were supported to have maximum choice and control of their lives, and the policies and systems in the service supported this practice. Staff regularly reviewed the care provided and were guided through regular input by the person receiving care to ensure the care provided continued to meet their individual needs, in a person centred way.

The provider had an effective system to handle complaints and concerns. People on end of life care were supported by the home and staff to remain comfortable and have a dignified and pain-free end to their lives.

The service has a registered manager .The service was well managed and the provider's quality monitoring processes had been used effectively to drive continuous improvements. The registered manager provided stable leadership and effective support to the staff. They worked well with staff to promote a caring and inclusive culture within the service. Collaborative working with people, their relatives and other professionals resulted in positive care outcomes for people using the service.

Further information is in the detailed findings below.

Inspection carried out on 31 March 2016

During a routine inspection

We carried out an unannounced inspection on 31 March 2016.

The service provides care and support to people with a variety of care needs including those living with dementia, physical disabilities, mental health needs and chronic health conditions. On the day of our inspection, there were 53 people being supported by the service.

There was no registered manager in post. However, a new manager who had started in December 2015 was in the process of registering with the Care Quality Commission. 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 had effective systems in place and staff had been trained on how to safeguard people. There were individual risk assessments that gave guidance to staff on how risks to people could be minimised. People’s medicines had been managed safely and administered in a timely manner. The provider had effective recruitment processes in place and there was sufficient numbers of staff to support people safely.

Staff had received effective training, support and supervision that enabled them to provide appropriate care to people who used the service. The manager and staff understood their roles and responsibilities in ensuring that people consented to their care and that it was provided in accordance with the requirements of the Mental Capacity Act 2005 (MCA) and the associated Deprivation of Liberty Safeguards (DoLS). People had nutritious food and they were supported to have enough to eat and drink. They had access to other health and social care services when required in order to maintain their health and wellbeing.

Staff were kind and caring towards people they supported. They treated people with respect and supported them to maintain their independence as much as possible.

People’s needs had been assessed and they had care plans that took account of their individual needs, preferences and choices. Care plans had been recently reviewed and they now contained sufficient information to enable staff to support people well. Staff were responsive to people’s changing needs and where required, they sought appropriate support from other health care professionals. A variety of activities had been planned and provided to occupy people within the home, and trips organised to visit places of interest for people who used the service. The provider had a formal process for handling complaints and concerns.

The provider encouraged feedback from people or their representatives, and acted on the comments received to improve the quality of the service. Changes in managers had meant that quality monitoring processes had not always been used effectively to drive improvements. Any improvements made had not always been sustained and this put people at risk of not receiving good quality care. However, the manager had worked closely with the local authority to make the necessary improvements to the service, but a longer period of stability was required to ensure that these had been embedded in the culture of the service.

Inspection carried out on 22 December 2014

During a routine inspection

We carried out this inspection on 22 December 2014 and it was unannounced.

The service provides accommodation, care and support for up to 72 older people who may have a range of care needs including living with dementia, chronic conditions and physical disabilities. There were 54 people living at the home at the time of the inspection.

At the last inspection on 6 November 2014, we had told the provider to make improvements to so that people lived in clean premises and they were protected from the risk associated with inadequate infection control measures. They sent us an action plan telling us that they would meet the requirements by December 2014 and we found that all the improvements had been made during this inspection.

The service is required 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. 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 registered manager was not available at the time of the inspection and the provider’s area manager was supporting the deputy manager in the day to day management of the service.

People’s needs had been assessed, and care plans took account of people’s individual needs, preferences, and choices. People were supported to have sufficient food and drinks in a caring and respectful manner. They were supported to access other health and social care services when required.

There were risk assessments in place that gave guidance to the staff on how risks could be minimised. There were systems in place to safeguard people from harm and medicines were managed safely.

The provider had effective recruitment processes in place and there were sufficient staff to support people safely and effectively. Staff had appropriate training, supervision and support, and they also understood their roles and responsibilities in relation to the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).

The provider had a formal process for handling complaints and concerns. They encouraged feedback from people and acted on the comments received to improve the quality of the service.

The changes in the managers had not provided stable leadership. The provider’s quality monitoring processes were not always used effectively to drive improvements.

Inspection carried out on 6 November 2014

During an inspection to make sure that the improvements required had been made

During this inspection we did not speak with any people who lived at the home. We carried out this inspection to check whether the provider had carried out improvements to address areas where the required standards of cleanliness and infection control had not been met. We found that the provider had addressed the areas that we had previously identified.

However, during this inspection we found that there were other areas within the home where acceptable standards of cleanliness and infection control had not been maintained. We found that chairs in the lounge areas and some bedrooms were dirty. We saw that some floors and doors were damaged and could not be cleaned effectively. In addition, we found that the surfaces of some furniture around the home had been damaged and this also could not be cleaned effectively. This meant that people were not cared for in a clean, hygienic environment.

Inspection carried out on 9 September 2014

During an inspection to make sure that the improvements required had been made

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a registered manager on our register at the time.

We had previously inspected Georgiana Care Home and found that they were not meeting the regulations in relation to infection control and the keeping of accurate records. We told the provider they must make improvements. They sent us a plan of action telling us that they would be complaint by 22 August 2014.

An inspector from the Care Quality Commission (CQC) returned to the home on 09 September 2014. We found that the provider had made some improvements, however we had continued concerns regarding infection control practices. Some areas of the home were not clean and did not protect people who used the service against the risk of harm and injury or infection. Furthermore members of the public were also at risk because the home’s clinical waste bins were found to be unlocked and located next to a public footpath.

We looked at five care records and spoke with three people who used the service. We also spoke with relatives that were visiting the home and four staff. We observed the care that was being provided to people around the home. We reviewed cleanliness throughout the home.

We considered our inspection findings to answer questions we always ask;

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well-led?

This is a summary of what we found.

Is the service safe?

People had up to date risk assessments in place to enable them to be as independent as possible and these were reviewed regularly by staff to ensure that they correctly reflected the needs of the person.

Most areas of the home were clean. However we noted that in the two communal bathrooms for the home, razors had been left either inside or around the bath. We also noted that the level of cleanliness within these bathrooms did not meet the regulations. This meant that people were not always being cared for in a safe environment. Hazardous waste was also kept in bins which had not been secured and meant that the public could gain access to them.

Is the service effective?

People's care needs were assessed before they came to live at the care home and these were reviewed regularly to ensure that any changes in a person’s individual needs were identified. We observed that people had their personal care needs met and that they were free to move around the home, although most people had chosen to go into either of the two communal lounges. Although we were told that people were provided with activities during the day, we did not see evidence of this. We noted that for most of the time during our inspection, although some people were attending the hair dressing salon, most were left sitting in the lounge areas with no stimulation and were noted to be asleep in their chairs. .

Is the service caring?

We observed that staff were caring and compassionate towards people. One person told us, “The staff are nice." We saw that when one person entered the room, staff greeted them and said, "Good morning, how are you today? I have a lovely cup of tea waiting for you." We observed that staff were chatting with the person and the person seemed happy and comfortable talking and laughing with the staff.

Is the service responsive?

The service was responsive to people’s needs as we found that they kept accurate records that reflected the care people required to maintain their health, safety and well-being.

Is the service well led?

The service had a new manager in place. We were told that the new manager was experienced and had worked for the provider’s other homes. They had recently moved to the Georgiana to aid with improvements. We also saw that the regional manager was available in the home. Staff we spoke with told us that the management of the service was 'good' although they found it too early to comment about the new manager, they told us that the regional manager was 'very good' and was 'always approachable'.

Inspection carried out on 31 July 2014

During an inspection in response to concerns

Before this inspection we, the Care Quality Commission, received some information of concern relating to a person living at the Georgiana Care Home. We were told that the person’s bedroom was not clean and that there were not enough staff employed to clean the whole home properly on a daily basis. Concerns were also raised about whether the person had enough to drink.

The purpose of this inspection was to follow up on those concerns. We gathered evidence against the outcomes we inspected to help answer our five key questions: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

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 our full report.

Is the service safe?

The Georgiana Care Home is a large home for up to 72 people. In addition to people’s bedrooms, the accommodation includes a significant amount of communal rooms, bathrooms, corridors and stairways.

We spent time walking round the building and checking a number of rooms, including bedrooms, to see how clean they were. It was clear from our observations and from speaking with a number of staff working in the home, that the cleaning staff did not have enough time to maintain required standards of cleanliness in all parts of the home. We saw dust and / or evidence of liquid spillages in many areas including communal corridors and people’s bedrooms. In one person’s room we found two arm chairs that were significantly stained, the lounge carpet in one area of the home was heavily soiled with food debris and we found two bedrooms with offensive odours coming from the mattresses. This was a concern because some infections have the capacity to spread within environments where susceptible people share eating and living accommodation.

Following feedback to a senior member of staff during this inspection, we were told that arrangements were being made to address the concerns we had found by bringing in additional domestic staff. Although this was positive and showed that the provider had taken our concerns seriously, we were concerned that this had not been put in place prior to our inspection. This showed that improvements are required to ensure adequate systems are in place to consistently provide a clean and safe environment for people living, working and visiting the Georgiana Care Home.

We have asked the provider to tell us how they will make improvements and meet the requirements of the law in relation to providing a safe, clean environment for people to live and work in.

Is the service effective?

During the inspection, we found evidence that another person had raised concerns about records maintained by staff because they were not detailed enough to show how much their relative had been given to eat and drink.

We checked a number of people’s care charts and found that entries had been made in respect of people’s fluid and food intake during the day on a regular basis. However, we found a small number that raised concerns about whether people were being provided with enough to drink during the evening and night.

We spoke to someone living in the home who asked for a drink. They were confused about when they had last had a drink, which demonstrated the importance of maintaining accurate records. A hot drink was provided as requested, but we observed a member of staff completing the person’s care records at that point, to record that the person had drunk 180 mls of tea. We spoke with the member of staff who told us the person liked their drinks and was likely to drink it all. However, this raised concerns about the accuracy of the records being maintained, if they are completed in advance. This meant that care records could not be relied upon to establish how much people living in the home had actually had to eat or drink in a day.

We have asked the provider to tell us how they will make improvements and meet the requirements of the law to ensure records maintained by the home are accurate and fit for purpose.

Is the service caring?

We observed some positive interactions between staff and people living in the home and it was clear that staff knew the people they were providing care and support to.

Is the service responsive?

We observed that one person could not reach their call bell to summon assistance. We rang their call bell for them because they wanted a drink. It took 18 minutes for a member of staff to arrive. We brought this to the attention of a senior member of staff before we left the building.

Is the service well-led?

We were told that since our last inspection in May 2014, a new manager had started, but had since resigned and was no longer working there. Although there was evidence that the provider had arranged for managerial oversight of the home during this period, and another new manager was due to start the following week, it was clear from speaking with staff that the home had been without consistent managerial direction for some time.

Inspection carried out on 15 May 2014

During a routine inspection

The inspection team was made up of one inspector. We set out to answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led? Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with people using the service, their relatives, the staff supporting them and looking at records.

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

Is the service safe?

People were protected by effective staff recruitment systems. Records showed that staff had received Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS) training. This meant that staff were provided with the information that they needed to ensure that people were safeguarded.

Is the service effective?

People were satisfied with the care and support they received. No one raised any concerns with us. This was consistent with the positive feedback received from people as reported in the provider's own quality assurance survey. All of the staff we spoke with were knowledgeable about individual people's care needs, and this knowledge was consistent with the care plans in place.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. We spoke with four people who used the service. People commented, “I never feel rushed by the staff that help me, they don’t do everything for me and help me to do things for myself”. One person said to us, "I am very happy here. Everyone is very kind." Another person said, "The staff are very helpful and this is a beautiful place to live." We observed the care and attention people received from staff. All interactions we saw were appropriate, respectful and friendly and there was a relaxed atmosphere throughout the home.

Is the service responsive?

We saw that care plans and risk assessments were informative, up to date and regularly reviewed. The registered manager responded in an open, thorough and timely manner to complaints. This meant that people could be assured that complaints were investigated and action was taken as necessary. Staff told us the manager was approachable and they would have no difficulty speaking to them if they had any concerns about the home.

Is the service well led?

Staff said that they felt well supported by the manager, the team worked well together, and they were able do their jobs safely. The provider had a range of quality monitoring systems in place to ensure that care was being delivered appropriately by staff.

Inspection carried out on 5 November 2013

During a routine inspection

When we inspected Georgiana Care Home we saw that people were happy and at ease, living in a calm and relaxed atmosphere. We spoke with five people who used the service, two visiting professionals, four visiting relatives, and six staff including the registered manager.

Records we looked at reflected that the home worked in collaboration with other professionals and providers. One visiting relative said, “I’m always kept informed, staff are really lovely, it’s very reassuring.”

We noted that the older part of the building was being redecorated and found that the building as a whole was safe and adequately maintained. One visiting relative said, “It’s nice to see they are doing something about the décor.”

Regular safety checks were carried out and recorded in relation to the building, including fire evacuation procedures.

Staff were supported to gain further qualifications from time to time and records maintained by the home were securely stored and accurate.

Inspection carried out on 30 November 2012

During a routine inspection

When we visited Georgiana Care Home on 30 November 2012, we found people were very satisfied with the care and support they received. They told us they felt safe and the staff were friendly and looked after them well. One person said "I feel safe and well supported here."

We observed that people were offered care and support at a level which encouraged independence and ensured their individual needs were met. There was a relaxed atmosphere in the home, staff were friendly and courteous in their approach to people and interacted confidently with them. We spoke with ten people who lived at the Georgiana Care Home, and the relatives of four others. All commented positively about the quality of care and the conduct of the staff. One said, "... is fantatically happy here, I'm over the moon. Number one is the staff."

We noted people were encouraged to express their views and were involved in planning their care and making choices and decisions about their care and support and how they spent their time. One person said “I have my paper every morning, I get my specialist magazine too as I’ve ordered it.”

Within the care files we saw care documentation had been signed, or was ready to be signed, by the individual or their representative to confirm their involvement and agreement with their particular care needs. Someone told us “They involve the whole family and me in my care.”

There were robust systems in place to promote quality assurance in this home.

Inspection carried out on 28 November 2011

During a routine inspection

We visited The Georgiana on 29 November 2011. At this time there were 54 people living in the home. Some of the people that we met during our visit had problems communicating verbally; so we spent time observing how care was provided to them and how they were involved in that care.

We spoke to people who told us that they were able to make choices about how their care was provided. This was confirmed by our observation of people having their breakfast at various times throughout the morning.

People looked clean, comfortable and well cared for, and where people needed assistance with personal care this was done in the privacy of their room to protect their dignity. One person said to us, “It is lovely here, I wouldn’t want to be anywhere else.

Everyone we spoke with was complimentary about the staff and many people were observed to have a good rapport with the staff team. We heard call bells being answered in an acceptable timescale.

Reports under our old system of regulation (including those from before CQC was created)