St Georges Residential Home

St Georges Residential Home is a residential care home providing personal care to up to 38 people. The service provides support to older people, some of whom were living with dementia. At the time of our inspection there were 36 people using the service.

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

People, relatives and staff gave positive feedback about the care provided. Staff felt people were safe and were confident to raise concerns, if required.

The provider investigated safeguarding concerns, incidents and accidents and acted to help keep people safe. Staff regularly carried out health and safety checks and risk assessments. The home was clean throughout. There were enough staff to meet people's needs and medicines were managed safely.

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 structured approach to quality assurance which had been effective in identifying and addressing issues. People, relatives and staff had opportunities to give feedback.

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 1 February 2018).

Why we inspected

This inspection was prompted by a review of the information we held about this service. The inspection was also prompted in part due to concerns received about staffing levels impacting on people receiving timely care. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service remains good based on the findings of this inspection.

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

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice:

• Appropriate measures were in place at the entrance and inside the home to prevent visitors from spreading infection. All visitors were required to wear appropriate personal protective equipment (PPE) and follow good hand hygiene practices.

• PPE was safely stored and used. Staff had received training in infection prevention and control.

• The environment was clean, with enhanced cleaning taking place of frequently touched surfaces.

• The provider was following national guidance for anyone moving into the home and admissions were carried out safely.

• People were supported to keep in touch with their family members via video or telephone calls. The provider had developed ways to safely support visits in line with the latest guidance.

• Social distancing rules were being complied with. Some minor changes had been made to the layout of furniture to encourage and support social distancing.

At our last inspection in November 2016 the service received an overall rating of good. The domain responsive was rated as requires improvement. At this inspection we found improvements had been consistently maintained with regard to record keeping and the rating for the responsive domain has now improved to good. We found the evidence continued to support an overall rating of good.

St Georges is a ‘care home’. People in care homes receive accommodation and personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

St Georges accommodates a maximum of 38 older people, including people who live with dementia or a dementia related condition, in one adapted building. At the time of inspection 36 people were using the service.

A manager was in post. They had applied but were not yet registered 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.

There was no evidence or information from our inspection and on-going 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 said they felt safe and they could speak to staff as they were approachable. We considered however that staff deployment needed to be kept under review. We have made a recommendation about ensuring staff are appropriately deployed to meet people’s needs. We observed activities were not always available to keep some people engaged and stimulated in some areas of the home where staff were not always available.

Staff knew about safeguarding vulnerable adults procedures. Staff were subject to robust recruitment checks. Risk assessments were in place and they accurately identified current risks to the person as well as ways for staff to minimise or appropriately manage those risks. A system was not in place to look at trends and patterns where several incidents such as falls occurred.

People had access to health care professionals to make sure they received appropriate care and treatment. Staff followed advice given by professionals to make sure people received the care they needed. People received a varied and balanced diet to meet their nutritional needs. Systems were in place for people to receive their medicines. However, we have made a recommendation about the management of medicines.

Appropriate training was provided and staff were supervised and supported. Staff had a good understanding of the Mental Capacity Act 2005 and best interest decision making, when people were unable to make decisions themselves. 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.

Detailed records reflected the care provided by staff. Care was provided with kindness and people’s privacy and dignity were respected. Communication was effective to ensure staff and relatives were kept up to date about any changes in people’s care and support needs and the running of the service.

A complaints procedure was available. People told us they would feel confident to speak to staff about any concerns if they needed to. The provider undertook a range of audits to check on the quality of care provided.

People had the opportunity to give their views about the service. There was regular consultation with people and family members and their views were used to improve the service. People had access to an advocate if required.

Changes were planned to the environment as a programme of refurbishment was to take place. The home promoted the orientation and independence of people who lived with dementia.

Further information is in the detailed findings below.

St Georges Nursing Home is a care home without nursing and provides accommodation and support for up to 38 people. Of the 38 single bedrooms, 24 had en-suite facilities and there were several accessible toilets and bathrooms on each of the two floors. At the time of the inspection there were 32 people using the service, some of whom were living with dementia.

The manager was not registered with the Care Quality Commission at the time of the inspection. The current manager had come into post on 31 October 2016 and had begun the application process to be registered with the 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.

We found the quality and detail in care plans had improved. Detailed records of monthly evaluations of care plans were completed which evidenced the appropriateness and relevance of care plans. The manager was very clear that care plans should be re-written in response to any change in need.

St Georges Nursing Home is a care home without nursing and provides accommodation and support for up to 38 people. Since the last inspection the service is no longer providing nursing care but it retains the name St Georges Nursing Home. Of the 38 single bedrooms, 24 had en-suite facilities and there were several accessible toilets and bathrooms on each of the two floors. At the time of the inspection there were 31 people using the service, some of whom were living with dementia.

The service had a registered manager who had been in post since September 2015 and who has been registered with the Commission since December 2015.

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.

Care plans were in place and evaluated on a monthly basis. Changes in people’s needs which had been identified in the evaluations were not always updated in care plans so people may not have been receiving care that met their needs. Care plans did not always contain specific guidance for staff to follow, such as how to use the hoist when supporting a person with mobility needs. Detailed guidance on how to support people who were disoriented, distressed or confused was not always evident.

The registered manager was aware that care plans needed to be improved and this had been recognised in an action plan but there was no timeframe for completion. This meant there was an ongoing risk that people may receive inconsistent or inappropriate care.

Staff knew how to safeguard people from harm and abuse and how to report any concerns. They were confident that the registered manager would take action as required.

Accidents and incidents were recorded and action taken to minimise risks. Risk assessments were completed on a monthly basis and identified control measures to manage situations.

Risk assessments and contingency plans were in place in relation to the premises. Health and safety checks were completed and service contracts and maintenance plans were in place.

The registered manager had recently recruited a deputy manager and was waiting for pre-employment checks to be completed. These included references and a Disclosure and Barring Service check so they could be confident the person was suitable for the post. There were enough staff to meet people’s needs but recruitment was ongoing for additional care staff.

Medicines were stored, administered and managed in a safe way. The staff who were responsible for administering medicines were trained and completed a competency check on a six monthly basis.

Other training included mental capacity, safeguarding, dignity, dementia and person centred care. Staff champions were being identified so they could receive additional training and act as a point of contact for any queries. Training was discussed in each staff member’s supervision and in the team meetings. Staff said they felt well supported and well trained.

Authorised Deprivation of Liberty Safeguards were in place, and the registered manager and staff understood mental capacity principles. Staff included people in decision making at every opportunity.

People had access to health care services, with one relative saying, “They are very responsive to people’s health needs.” Where required people had been referred to the falls team and speech and language therapist, as well as having regular appointments for medicines reviews and sight check-ups.

People told us, “The food is lovely.” Staff were knowledgeable about people’s dietary requirements and ensured people were well supported. If people declined support with meals staff respected their wishes but remained observant in case the person changed their mind or was seen to be struggling.

Staff engaged with people in a warm and compassionate way, asking their permission and explaining what they were doing. Staff took time to answer people’s questions and did not rush them in any way. Staff were respectful and treated people with dignity. One staff member said, “I treat people how I would want to be treated.”

Activities were varied and, where possible, family members were invited to join in with bingo evenings and themed events such as pub lunches. The home was involved with the church next door and people could attend services at the church as well as services being held in the home. There were links with the local schools and amateur dramatics groups.

Staff were proactive in ensuring people maintained contact with family members and one person had recently used Skype to see and talk with their family who lived in Australia.

The registered manager had been in post since September 2015 and relatives and staff were very positive about the impact they were having on the service. Comments included, “The best manager I’ve had,” “They’ve made some really positive changes,” “They are always on the floor and know people really well.”

A range of audits were in place and there was a culture of working together to drive improvement.

You can see what action we told the provider to take at the back of the full version of the report.

We spoke with a number of people throughout the day and they told us of St Georges 'A1,' 'No complaints at all,' 'Lovely food.'

We saw on the day of our visit, there were sufficient qualified, skilled and experienced staff to meet people's needs.

Care records had enough information so staff would be able to know how to support each person in the right way.

Care plans were written in a clear and easy to understand way and people's personal preferences were clearly recorded. There were sufficient staff on duty to support people for their care needs.

We looked at how the service recruited staff by checking five staff files. These showed that the appropriate checks and procedures were being followed.

Comments from people who live at St George's Nursing home included "The food is lovely." and "The staff are always there for me."

Comments from relatives included "My ... is happy so I am happy". "Staff are always at hand for a chat".

We found people who used the service understood the care and treatment choices available to them. People's needs were assessed, and the planning and delivery of care and treatment met their needs and protected their rights.

The provider had an effective system to regularly assess and monitor the quality of service that people received. They also had an effective system in place to identify, assess and manage risks to the health, safety and welfare of people who used the service.