St Georges Nursing Home

St Georges Nursing Home is a care home that provides nursing and personal care for up to 28 older people. At the time of our inspection visit there were 14 people using the service including those living with dementia. As of 23 October 2023, the last person using the service had moved out and the service became dormant, pending the provider’s application to cancel their registration. The care home accommodates people in three period town houses across five storeys, with a day room and two dining areas in the basement.

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

The home was not always safe for people to live in. The registered manager, deputy and staff assessed and reviewed risks to people daily. There were sufficient, appropriately trained staff to meet people’s needs safely, on a basic level. People received their medicines at the correct time. The medicines were administered by trained staff. The home used Personal Protection Equipment (PPE), as required effectively and safely and the infection prevention and control policy was in line with current guidance.

The home was not always effective. Whilst people received care and support that met their basic needs, due to limited staff numbers, people did not receive care above this. Instead of having meals in dining areas as previously happened, they now had their meals in their rooms. Staff protected people from nutrition and hydration risks, and they were encouraged to choose healthy and balanced diets that also met their likes, dislikes, and preferences. However, the system had changed from having a chef to meals being delivered that were then oven heated, although still nutritious and people still had choices. People were not subject to discrimination and their equality and diversity needs were met. Staff were well trained and supervised by the registered manager and deputy. People were encouraged by staff to discuss their health needs, and any changes to them or concerns were passed on to the registered manager and appropriate health care professionals. This was also being done as part of the structured transitioning to other services, as the home was closing imminently. The home was kept adequately clean by the care staff, as there were no cleaners employed at the time of the inspection.

The home was not always well-led. Although the home was well-led by the registered manager and deputy, there was a complete breakdown in communication from an operational and senior management level, particularly regarding purchasing resources and securing agency staff cover. Staff told us the home’s senior management and leadership had not been transparent, open, and honest with them about the imminent closure of the home. Staff wages had been delayed for September and staff were not confident if or when they would receive their October payments. They were also unsure about the arrangements regarding redundancies. As a result, what had previously been a positive culture was now the reverse. Positive working partnerships were established between the registered manager and placing authorities to make the transitions to new accommodation as smooth as possible for people. Healthcare professionals told us that the service was well managed by the registered manager and met people’s basic needs in a professional, open, and friendly way.

Although people were mostly being cared for in their rooms, they were still supported to have as much choice and control of their lives as possible. Staff supported people in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

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 30 June 2023). The overall rating for the service remains Requires improvement. This is based on the findings at this inspection.

Why we inspected

We received concerns in relation to the home no longer being financially viable to remain open. Because of this, we were concerned about people's overall safety and wellbeing; whether there were sufficient appropriately skilled staff to continue supporting people day and night; if people were provided with sufficient food and drink and whether daily costs were being met for the running of the home. We were also concerned about future financial viability if the provider decided to remain open. As a result, we undertook a focused inspection to review the key questions of safe, effective, and well-led.

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.

We did not inspect the key questions of caring, and responsive.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

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

Enforcement We have identified a continued breach of regulation in relation to good governance. Please see the action we have told the provider to take at the end of this report.

Follow up

We will continue to monitor information we receive about the service closure.

St Georges Nursing Home is a residential care home providing nursing and personal care for older people. At the time of our inspection 15 people were living at the service, some of whom were living with the experience of dementia. The service is registered to support up to 28 people. This is a family run business and this is their only registered care home.

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

Improvements had been made across the home since the last inspection in January 2023 to ensure people received a more person-centred approach to their care and support.

Positive examples were seen where the culture of the home was changing which encouraged people to be supported out of their bedrooms and be more involved in activities and social engagement within communal areas.

Issues related to the safety of the building had been addressed and staff had been reminded about their responsibilities related to fire safety. Areas where ongoing building works were taking place had been secured to ensure people and staff had no access.

Feedback from staff continued to be positive about the changes that were being made by the registered manager, who was further supported by the recent appointment of a new deputy manager to work through the improvement plan.

Health and social care professionals were confident the work that was being done by the registered manager was driving improvement across the home and ensuring better outcomes for people.

The management team were confident they were moving in the right direction and monthly audits were identifying where improvements were needed. These were discussed with staff during daily handovers.

The provider acknowledged the areas they needed to focus on and continued to make progress to ensure people were receiving safe care and support.

The provider continued to be committed to make ongoing improvements and had worked closely with the local authority to address the concerns.

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 31 March 2023) and there were multiple 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 the provider was making a range of improvements across the service. However, the provider remained in breach of regulation.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

We carried out an unannounced comprehensive inspection of this service on 31 January 2023 and 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 areas related to safe care and treatment, person-centred care, staffing and good governance.

We undertook this targeted 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 specific areas related to breaches within the Key Questions of Safe, Effective and Responsive.

We use targeted inspections to check concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

We also inspected the full Key Question of Well-led. For those key questions not fully inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has not changed following this inspection and remains requires improvement.

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 on our website at www.cqc.org.uk.

Enforcement

We have identified a continued breach of regulation in relation to 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.

St Georges Nursing Home is a residential care home providing nursing and personal care for older people. At the time of our inspection 16 people were living at the service, some of whom were living with the experience of dementia. The service is registered to support up to 28 people. This is a family run business and this is their only registered care home.

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

There had been improvements since the last inspection. The provider had taken prompt action to address building issues and had started a programme of building repairs. They did not have a robust risk assessment in place to assess the potential risk as a result of the refurbishment programme. There had been some improvements to safety checks, but staff did not know what action to take in the event of a fire.

Medicines were not always managed safely. The provider had reduced staffing levels but there was no formal process in place for how the new staffing figure was reached.

There had been improvements to the governance systems since the last inspection however there was a lack of information recorded on how changes were made.

The service was clean, and the manager was introducing systems to ensure equipment was safe and in good working order.

Staff supervision was carried out by the manager and there was a daily handover which staff told us was very helpful.

Peoples care plans had been updated however there were large parts of information which was still not available. The manager was aware of this and was working with staff to ensure all care plans were updated. People’s communication and end of life wishes were recorded.

Where things went wrong, the manager had taken action to reduce the risk of reoccurrence.

The provider had demonstrated a willingness to make ongoing improvements and have continued to engage with the local authority to address the concerns.

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.

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 rating at the last inspection (published 16 June 2022) was inadequate and there were multiple 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 some improvements had been made. However, we identified further improvements were needed in respect of assessing risk, premises and equipment, managing medicines, personalised care and governance.

This service has been in Special Measures since 16 June 2022. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

We undertook this comprehensive inspection to check the provider had followed their action plan and to follow up on breaches of relation to person-centred care, dignity and respect, safe care and treatment, premises and equipment, staffing and good governance.

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 on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches of regulations in relation to person-centred care, safe care and treatment, premises and equipment, 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.

St Georges Nursing Home is a residential care home providing nursing and personal care. At the time of our inspection 24 people were living at the service. The service is registered to support up to 28 people. This is a family run business and this is their only registered care home.

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

There was an increased risk to people's safety and wellbeing because there were significant building and maintenance issues which had not been addressed within the home. The provider did not have effective measures in place in the event of a fire.

The provider did not have quality assurance processes in place which meant there was no formal system to identify concerns within the home and to agree what action needed to be taken. We were not assured that people were protected from the risk of abuse and harm. There was not always enough staff to care for people in a safe way.

The home was not following their infection control policy which meant people were at risk. Risks to people had not always been assessed and planned for. Risk assessments did not always provide staff with adequate information to care for people. We were not assured people’s needs were fully assessed before they moved into the home.

People were not happy with the food they received. We made a recommendation to the provider to consider people's preferences and needs at mealtimes to ensure a better mealtime experience. Staff were not receiving supervision and appraisals in line with the providers policy.

People's care plans did not always record people's wishes and preferences in how they would like to receive their care and support. People’s end of life wishes were not recorded. The provider could not evidence that they were following their complaints policy.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. We made a recommendation to the provider to review their practice to ensure they were working within the principles of the MCA.

Despite the concerns we found at the inspection, we did observe some good care and support. We saw individual care staff providing support in a respectful manner to people. Medicines were administered safely.

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 St George’s Nursing Home under the previous provider at the same premises was requires improvement (published on 18 May 2021). Whilst the home had reregistered, this service has been operating for many years with the same management structure and staff.

Why we inspected

This inspection was prompted due to concerns that we received about potential fire risks and concerns over maintenance issues not been addressed. A decision was made for us to inspect and examine those risks.

We looked at infection and prevention 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.

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 of regulations in relation to person-centred care, dignity and respect, safe care and treatment, premises and equipment, complaints, staffing and good governance.

Full information about CQC's regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

The overall rating for this service is 'Inadequate' and the service is therefore in 'special measures'. This means we will keep the service under review and, if we do not propose to cancel the provider's registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.