Archived: St George's House

During our inspection on 12 August 2015 we found that systems in place for storing and administration of medicines were not appropriate to ensure safety and effectiveness. Support plans were not always personalised or reviewed regularly. Regular checks and audits of service quality and delivery were not being carried out effectively. The home was in breach of Regulation 9, 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

St George's House provides residential care for men and women with mental health issues. The service focuses on a three phase rehabilitation programme to support people to move to more independent accommodation. There were 23 beds, and 9 people were staying at the home during the inspection.

The service had a registered manager. 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 legal requirements in the Health and Social Care Act 2008 and the associated regulations on how the service is run.

Staff were trained in safeguarding adults and had a good understanding in keeping people safe. They knew how to recognise abuse and who to report to and understood how to whistle blow. Whistleblowing is when someone who works for an employer raises a concern about harm, or a risk of harm, to people who use the service. There were policies and procedures in place for staff to follow.

There was enough staff to support people safely and to meet their individual needs.

Assessments were undertaken to assess any risks to people living at the home and steps were taken to minimise potential risks and to safeguard people from harm.

Medicines were stored, administered and recorded correctly.

Safe recruitment procedures were in place that ensured staff were suitable to work with people, as staff had undergone the required checks before starting to work at the service.

Care plans were personalised to the people using the service. People were involved in planning of care and the care plans were then signed by people to ensure they were happy with the care and support listed on the care plan.

People had access to healthcare services such as the GP and dentists.

Systems were in place to ensure staff received regular supervision and appraisal. Staff received induction training and also received regular training to ensure that people were safe and the care provided was effective.

Complaints were managed appropriately and people were aware on how to make complaints.

People participated in a number of activities such as DVD nights, gardening and cooking workshops.

People's privacy and dignity was maintained. People were independent and we saw people moving freely around the house and were able to go to their rooms and outside without interruption.

Systems were in place for quality assurance. Regular audits were being carried out by the management team with actions listed for improvement.

Questionnaires were completed by people about the service. Outcomes were generally positive and covered important aspects on staff, safety, complaints and dignity.

Is the service safe?

People told us they felt safe and secure. The staff we spoke with understood the procedures they needed to follow to ensure people were safe.

We inspected staff rotas and spoke with people who received services who told us there were sufficient staff on duty to meet people's needs throughout the day. People received a consistent and safe level of support.

People were protected against the risks associated with medicines and we saw the provider had appropriate arrangements in place to manage medicines

Procedures for dealing with emergencies were in place and staff were able to describe these to us.

The provider and staff understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). Although no DoLS applications had been made, staff were able to describe the circumstances when an application should be made and knew how to submit one.

The premises were not fully suitable for people living there. Visitors and people themselves were able to enter and leave the premises without staff knowing. Issues of fire-doors being opened by people were not being clearly addressed. We saw some equipment was broken on our visit and staff were unaware of this. Fixtures and fittings were worn.

Is the service effective?

People all had an individual care plan which set out their care needs. People told us they had been fully involved in the assessment of their health and care needs and had contributed to developing their care plan.

People had access to a range of health care professionals, some of whom visited the home. People told us staff escorted them to healthcare appointments if needed.

Is the service caring?

People were supported by kind and attentive staff. We saw care workers showed patience and gave encouragement when supporting people. People told us "the staff are friendly", "they're fantastic", "they're really nice to me" and "they're flexible and always there when I need them".

Staff were aware of people's preferences, interests, aspirations and diverse needs. Our observations of the care provided, discussions with people and records we looked at showed us individual wishes for care and support were taken into account and respected.

Is the service responsive?

People told us they were able to participate in a range of activities both in the home and in the local community. The activities provided included ones people could enjoy as a group and others that meet their individual interests. People told us they were involved in reviewing their plans of care when their needs changed.

People knew how to make a complaint if they were unhappy. People told us the service took complaints seriously and looked into them quickly.

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a 'joined-up' way. The way the service was run had been regularly reviewed. Staff felt supported by their manager.

Records were kept in both paper files and electronically. Although people's personal care records and other records kept in the home were accurate, those entered electronically were not always complete.

Staff felt supported by the provider to keep updated, but no audit of individual or team training needs had been carried out and staff were unable to access a complete record of their own training to demonstrate what training they had received.

We found that people experienced care and support that met their needs, and that their views and experiences were taken into account in the way the service was provided and delivered in relation to their care.

People who use the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. Staff were supported to deliver care safely and to an appropriate standard.

The provider had an effective system to regularly assess and monitor the quality of service that people receive. Overall, people were cared for in a clean, hygienic environment. However, the provider may wish to note that some people who use the service commented that some kitchens and bathrooms were not always clean.