St. George's Nursing Home and Home Care

St Georges Nursing Home and Home Care is a residential care home providing personal and nursing care to 41 people aged 65 and over at the time of the inspection. The service can support up to 56 people in a part purpose built and partly converted premises.

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

People were safe at St George’s Nursing Home and significant improvements had been made to safety measures since we previously inspected the service. Staff had training in areas such as health and safety and safeguarding and knew what actions to take should there be an accident or suspicion of abuse.

Improvements had been made to the administration of medicines and an electronic system provided the clinical manager with daily reports to ensure clear oversight. Medicines were administered in a person-centred way by registered nurses and there were clear protocols in place for as and when required medicines.

The premises were extremely clean and throughout our inspection we saw housekeeping staff methodically cleaning the service. Staff wore appropriate PPE and measures had been taken to ensure they could socially distance during breaks.

People’s needs were assessed and care plans written and continually reviewed for the duration of their time at St George’s. Both needs and preferences were assessed and recorded to ensure people had positive experiences of care delivery.

Staff received training and updates to ensure they were current with good practice. Training had slipped slightly due to the pandemic but alternative courses including online training had been provided instead of face-to-face training.

Meals were provided according to people’s needs and preferences and relevant referrals were made should additional support be needed with nutrition.

The premises were bright and welcoming and designed to meet people’s needs. Themed wall art aided people to navigate the building.

The provider was compliant with their responsibilities under the MCA 2005. 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.

There was a supportive management team who had specific skills to provide clinical direction and leadership. An open door approach provided staff with opportunities to speak directly to management as they could when they worked alongside them on the floor.

Comprehensive audits and an EMAR system provided oversight of the service and positive links to health and social care professionals ensured provision of relevant and quality care.

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 6 December 2019) and there were two breaches 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 improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 3 October 2019. Breaches of legal requirements were 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 and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to good. 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 St Georges Nursing Home and Home Care on our website at www.cqc.org.uk.

Follow up

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.

St George’s Nursing Home and Home Care is a residential care home providing personal and nursing care to 50 people at the time of the inspection. The service can support up to 56 people, who may be living with dementia.

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

People did not always receive a safe or well-led service.

Air mattresses had not always been used in a safe way to reduce the potential risk of people’s pressure areas becoming sore. Medicines were not always managed safely.

Individual care plans were in place for each person which covered their care and support needs, but people may have benefitted from having more detailed care plans for their personal care needs. The registered manager had already acted to improve the care plans.

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 provider had policies and procedures in place designed to protect people from the risk of suffering harm and abuse. The provider had processes in place to reduce the risk of the spread of infection. Regular safety testing and maintenance had been completed.

People’s needs were assessed before moving into the home, so the registered manager could be assured their needs could be met. People’s needs were met by suitable numbers of staff. People were supported by staff who were trained and staff were supported through the use of supervision and an annual appraisal.

People felt cared for, were treated well and their privacy and dignity was respected. People were supported to eat and drink enough and had a choice of meals. People could choose where they ate their meals. People were supported to access healthcare professionals when necessary.

People and their relatives, when appropriate, were involved in planning their care. People enjoyed a range of activities. People’s end of life preferences and choices had been discussed with people and recorded in their care plans.

The registered manager investigated complaints and spoke to families about their concerns. Staff and the registered manager liaised with other agencies to ensure consistency of care. The provider and registered manager promoted a positive culture and were aware of the duty of candour requirements.

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 15 February 2017).

Why we inspected

This was a planned inspection based on the previous rating.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

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

Follow up

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.

There was 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 requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The service had a strong visible person centred culture with staff regularly going the extra mile to ensure people's wishes and goals were achieved. Relatives and healthcare professionals consistently told us staff provided outstanding care and were always compassionate during interactions with people.

Staff received a thorough induction before they started work.

People were supported by staff that had the skills and knowledge to meet their assessed needs.

The provider had employed skilled staff and took steps to make sure care was based on local and national best practice. Information regarding diagnosed conditions was documented in people’s files.

Recruitment practices were safe and relevant checks had been completed before staff commenced work. Staff worked within good practice guidelines to ensure people’s care, treatment and support promoted good quality of life.

The provider had appropriate arrangements in place to assess people’s capacity to make decisions about their care and treatment. Staff were knowledgeable about the requirements of the Mental Capacity Act 2005.

People who required assistance to eat and drink were supported effectively. Appropriate assessments had been conducted for anyone who had difficulty in swallowing their food. Interactions between staff and people during meal times were respectful and dignified.

Multi-disciplinary teams including mental health workers and occupational health were involved in reviewing and updating people’s risk management plans.

Medicines were managed safely. Any changes to people’s medicines were prescribed by the service’s GP and psychiatrist. People were involved before any intervention or changes to their care and treatment were carried out.

People had access to activities that were important and relevant to them. Records showed people’s hobbies and interests were documented and staff accurately described people’s preferred routines. There was a range of activities available within the home.

The provider actively sought, encouraged and supported people’s involvement in the improvement of the service. People’s care and welfare was monitored regularly to make sure their needs were met within a safe environment. The provider had systems in place to regularly assess and monitor the quality of the service provided.

People told us the staff were friendly and management were always visible and approachable. Staff were encouraged to contribute to the improvement of the service. Staff told us they would report any concerns to their manager and said the management and leadership of the service was good and very supportive.

During our visit we observed a lunch time sitting within the dining area. We observed people being treated in a dignified and respectful way. One person told us, "The food is really good here and if I don't like what's on the menu I can always ask for something else." People told us they enjoyed their meal. The mealtime was calm and people were treated politely and supportively.

The registered manager confirmed that all members of staff received training in safeguarding adults on commencement at the service and received refresher training annually. Care workers we spoke to were able to describe the main types of abuse and the actions they would take if abuse was suspected.

Appropriate checks were undertaken before care workers began work. The registered manager explained the recruitment process to us and gave us examples of what they had done when they had concerns, for example they requested more than two references.

There was a customer satisfaction survey that was carried out yearly and we noted that this was planned for December this year. The survey included relatives and other health and social care professionals. The last survey showed that people were positive about the care that they were receiving.

We looked at six care plans of people who lived at St George's and six care plans for people who received home care. The care plans contained an assessment of capability and need for all aspects of life such as personal care, sleeping, mobility, nutrition, pain and tissue viability. The care plans were very clear and reflected the needs of that person.

All medication administration records included a photograph of the person for whom the medication related to together with their room number. Records were kept when medicine was refused by people or not required, for example, when people said they didn't need pain relief.

The complaints procedure was on the information board at the entrance to the home and a copy of this was in the welcome pack given to people on admission to the home or before the home care service started. We saw a record of complaints and they had been responded to in a timely manner by the registered manager.