Archived: St Georges Nursing Care Home

At the last inspection, carried out on 22 February 2016 the service was rated Good. At this inspection we found the evidence continued to support the rating of Good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

People who lived at the home told us they were happy, felt safe and were treated with kindness at all times.

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

People’s care and support had been planned with them. They told us they had been consulted and listened to about how their care would be delivered.

Care plans were organised and had identified care and support people required. We found they were informative about care people had received.

The service had systems in place to record safeguarding concerns, accidents and incidents and take necessary action as required. Staff had received safeguarding training and understood their responsibilities to report unsafe care or abusive practices.

Risk assessments had been developed to minimise the potential risk of harm to people during the delivery of their care. These had been kept under review and were relevant to the care provided.

Staff had been recruited safely, appropriately trained and supported. They had skills, knowledge and experience required to support people with their care and social needs.

Staff responsible for assisting people with their medicines had received training to ensure they had the competency and skills required. People told us they received their medicines at times they needed them.

We saw there was an emphasis on promoting dignity, respect and independence for people supported by the service. They told us they were treated as individuals and received person centred care.

We looked around the building and found it had been maintained, was clean and hygienic and a safe place to live. We found equipment had been serviced and maintained as required.

The service had safe infection control procedures in place. People who lived at the home told us they were happy with the standard of hygiene in place.

People told us they were happy with the variety and choice of meals available to them. We saw regular snacks and drinks were provided between meals to ensure people received adequate nutrition and hydration.

People were supported to have access to healthcare professionals and their healthcare needs had been met. A visiting healthcare professional spoke highly about the care provided by the manager and her staff.

People told us staff were caring towards them. Staff we spoke with understood the importance of high standards of care to give people meaningful lives. They told us staff who supported them treated them with respect and dignity.

The service had information with regards to support from an external advocate should this be required by people they supported.

People who lived at the home told us they enjoyed a variety of activities and trips out which were organised for their entertainment.

The service had a complaints procedure which was on display in the hallway for people’s attention. The people we spoke with told us they were happy with the service and had no complaints.

The service used a variety of methods to assess and monitor the quality of the service. These included regular audits, resident meetings and satisfaction surveys to seek their views about the service provided.

Further information is in the detailed findings below.

The home did not have a registered manager. 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 previous registered manager left the employment of the home at the start of 2016. The acting manager has applied to be registered with CQC, and her application was being processed at the time of our inspection visit.

There were systems in place to ensure people's needs were assessed, and their care plan for. Improvements in the way in which the care records are set out would make the information more accessible. The addition of one page profiles relating to each individual living at the home would allow staff to quickly see what people's needs were, the risks related to their care and what their interests were. Activities linked to people's assessed needs, abilities and interests were available.

People were able to express their choice in relation to meals and how they spent their time. The menu offered people a choice of meals and their nutritional requirements were met. People knew how to access the complaints process, and know who to talk to if they wanted to raise a concern. People who lived and worked at the home were fully aware of the lines of accountability at the home. Staff spoken with felt well supported by the management team. The systems operated within the home relating to how information was processed and how systems were audited was satisfactory. The systems assisted staff to identify areas of service delivery that required improvement and to mitigate risks. People were treated in a kind, caring and respectful way.

The home was involved in a new scheme to undertake speech and language (SALT) assessments using new technology such as Skype (internet based communication software). SALT assessments are used to assess and treat speech, language, swallowing and communication problems.to help them eat and communicate effectively. People who needed to have a SALT assessment were supported to use a computer connected to Skype so that they could have a private consultation with a speech and language therapist based at the local hospital.

There were systems in place to ensure people were involved in their own care planning and support. The training records showed that staff had received awareness training on the subject of end of life care. If people were found to be in need of end of life care, there were systems in place to support this. Staff had access to on-going training and supervision to meet the individual needs of the people they supported. We found that measures were in place to ensure staff received update training and we saw documentary evidence to support this. We saw written evidence that staff supervision was taking place and we were satisfied that appropriate measures were in place to support the staff team.

Management review meetings were held to analyse the performance of the service and review its objectives. There was a wide range of policies and procedures in place which provided staff with clear information about current legislation and good practice guidelines. This meant staff had clear information to guide them on good practice in relation to people’s care. We found written evidence to show that the acting manager had an appropriate system in place used to assess and monitor the quality of the service. Surveys were sent out to all the people who received a service, and other stakeholders on an annual basis. The feedback contained within the surveys showed that the service was consistently meeting its objectives. Any issues raised via the surveys had been addressed via an action plan.

The service had policies in place in relation to the Mental Capacity Act 2005 (MCA) and depriving people’s liberty, and these were put into practice. The building was found to be in a good state of repair, and the environment was found to be fit for purpose. The service had procedures in place for dealing with allegations of abuse. Staff were able to describe to us what constituted abuse and the action they would take to escalate concerns.

Employees were asked to undertake checks prior to employment to ensure that they were not a risk to vulnerable people; the records relating to these checks were complete. Risks associated with medicines management, infection control and cleanliness, and environment factors were assessed. Satisfactory control measures were in place.

People spoke positively about the meals that were offered with regard to quality, choice, presentation and portion size. Care plans included consideration of people's nutritional needs.

The provider worked cooperatively with other healthcare professionals. We saw that appropriate information was shared when people were admitted to hospital.

One person living there said the home was 'better than a hotel' and their room had 'marvellous views'. They told us that the availability of a call bell gave them great peace of mind and staff responded very quickly if they needed to use it.

One person said they had 'every confidence' in the staff. The provider had arrangements in place for on-going training, supervision and appraisal of staff.

We looked at three people's care records. They were well organised and provided clear, concise instructions to staff on how to meet all aspects of people's care and support needs.

Some people living at the home had a range of conditions which affected their ability to communicate with us. For this reason we spent time with individual residents in their rooms and a communal area. This meant we could observe how staff communicated and assisted people.

People we spoke with told us they liked living there. Comments included, "We like having this room, it's a home from home and staff always knock before they are asked to come in.' Also, 'The staff have been very supportive to our relative. They always keep us updated.'

Throughout the inspection we saw staff talking with people in a respectful manner. We saw staff spent time with people on an individual basis. One staff member told us, 'Residents like us to have a chat with them. I always try and take time to do that.'