St George's Nursing Home

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

Well-led – this means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture.

At our last assessment we rated this key question requires improvement. At this assessment the rating has remained requires improvement.

This meant the management and leadership was inconsistent. Leaders and the culture they created did not always support the delivery of high-quality, person-centred care.

This service scored 46 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had not embedded a shared vision, strategy and culture based on transparency, equity, equality and human rights, diversity and inclusion, and engagement. They had not understood the challenges and the needs of people and their communities.

A culture that demonstrated a shared vision through transparency equity, inclusion had not been provided to people or staff. Managers since our previous inspection had failed to take decisive and timely action in response to those risks and concerns and additionally those identified at this inspection. The provider and managers had not prioritised or delivered high-quality care consistently and did not seek staff engagement to identify how to make those improvements to develop a culture focused on learning and improvement.

Learning and reflection as a team was not promoted across the service with learning from incidents, events or significant safeguarding concerns not evident. Staff meetings were not led in a manner where staff were supported to discuss and share ideas or reflections to help drive improvements in the service.

Following our feedback and meetings with the provider they implemented systems to help change practice and embed a strategy and culture which gave us assurances.

The provider and managers at all levels did not consistently demonstrate the context in which they delivered care, treatment and support, that embodied the culture and values of their workforce and organisation. Leaders did not have the skills, knowledge, experience and credibility to lead effectively, and they did not do so with integrity and openness.

We identified breaches of regulations and concerns in the areas of safeguarding, safe care, lessons learned, reporting and governance. At our last inspection we also raised concerns in relation to these areas. The management team had implemented new systems they felt would improve people’s lives and experiences. However, not enough had been done to improve those existing concerns prior to our inspection.

The provider's website gives their approach to leadership, which states, “Leadership Charter. Our leaders put residents first, are visible and approachable, lead by example, create open cultures, develop people, challenge poor practice, use learning and data to improve, and take accountability for quality and safety.” This inspection demonstrated clearly the processes needed to demonstrate that approach was not effectively implemented. People therefore experienced a culture that was closed and did not embody the culture and values published by the provider.

The provider was developing a culture where people felt they could speak up and their voice would be heard.

Most staff were positive about how the management team engaged with and involved them. A staff member said, “All the management changes has been challenging. [Manager] is available and always very helpful. They are very good at listening to new things to get better. They have an open-door policy and they act on it.”

There were staff meetings taking place and daily catch ups. A staff survey was due to be carried out by the provider.

Most relatives told us they had regular contact with staff and the manager during visits to the home.

However, we attempted to obtain more feedback and examples from staff and we had limited responses. Where they had raised points with the management team, there were limited actions taken to address them. This meant we were unable to test the effectiveness of the freedom to speak up culture as although staff said they were able to speak up, we were unable to find examples of when this had happened.

The provider valued diversity in their workforce. They worked towards an inclusive and fair culture by improving equality and equity for people who worked for them.

Staff felt supported and respected by the management team. A staff member said, “In meetings we discuss what help we may need, sometimes there have been staffing issues.”

Staff employed at the service reflected different backgrounds, age, gender and ethnicity which demonstrated an inclusive approach.

The provider did not have clear responsibilities, roles, systems of accountability and good governance. They did not act on the best information about risk, performance and outcomes, or share this securely with others when appropriate.

The provider had failed to ensure governance processes were effective. The systems in place had not resulted in the service being improved from our previous inspection or ensured care was delivered and maintained to a safe and appropriate standard.

The provider continued to operate ineffective processes or systems for the monitoring of the quality of care provided to drive improvements. The provider did not operate robust quality assurance systems and processes to support the delivery of safe, responsive and transparent care to people. For example, management of risks to people was poor, there was inconsistent oversight in relation to people’s food and fluid intake, repositioning and safety checks. We found a continued lack of analysis of incidents, and the subsequent lessons learnt were not in place. There continued to be key information missing in staff recruitment files which placed people at risk from staff with inappropriate employment checks.

The provider did not operate systems to assess the ongoing competence of staff to ensure staff practise met people’s needs adequately. Systems were not in place to check staff knowledge following training, particularly where refresher training was overdue, for example, annual refresher training in areas such as safeguarding and the Mental Capacity Act had not been completed within the required timescales. We identified ongoing concerns with those specific areas among others. This ineffective approach to monitoring staff competence meant the provider could not assure themselves their staff were skilled and had the necessary knowledge to undertake their job roles.

The provider had failed to ensure their safeguarding processes to identify when people were at risks of abuse were robust. Where safeguarding concerns had been identified, the correct actions were not always taken, and concerns were not always reported to CQC in line with the provider’s legal responsibilities. This also related to notifications of serious injury and death. The auditing of people’s care records did not identify this as a risk and further did not note the accompanying risk reviews had not been completed. People were at risk of harm or avoidable harm because the systems operated did not provide staff with information to safely support people.

The provider had not notified us of events they were required to do so. For example, injuries, allegations of abuse and deaths in the home.

Following our feedback the provider and manager were working to improve their systems to help ensure they improved people’s lives.

The provider did not always understand their duty to collaborate and work in partnership, so services worked seamlessly for people. They did not always share information and learning with partners or collaborate for improvement.

People and relatives told us they were supported to access health and social care professionals when needed. However, some visiting professionals told us advice and actions given by them was not always followed and this gave them concerns. These concerns were reviewed as part of this inspection and we found there to be shortfalls.

The management team told us about the agencies they worked with outside of the organisation, which included health and social care agencies. This included a care providers association to access training and updates, and other health and social care teams so health care and support were accessible. For example, the team were meeting with visiting health professionals regularly.

Following our feedback the provider was making stronger connections and working with external agencies, including the CQC, to improve the issues found in the home.

The provider did not always focus on continuous learning, innovation and improvement across the organisation and local system. They did not always encourage creative ways of delivering equality of experience, outcome and quality of life for people. They did not always actively contribute to safe, effective practice and research.

The new manager in post was introducing systems to help drive improvement. However, these had not yet been effective.

The provider had not embedded a practical and reflective culture of learning that directly transforms how staff think, feel, respond and behave when supporting people. St Georges Nursing Home supported some people living with complex dementia and associated distressed behaviours. Care records and staff training to meet the needs of people needed further development, so they better reflected current best practice guidance. Managers and staff did not assess and analyse the causes of people’s distress or anxiety. There had been 3 discharges from the home in the last 3 months due to failed admissions, some of which included situations where people became distressed and staff could not support that person expressing those feelings and behaviours. Staff had not been given an opportunity to talk through what worked or may have worked well in the reduction of such distress or what the triggers were. Managers had not supported staff to identify poor admission planning or discuss patterns, shared approaches to providing care or identifying potential indicators which could significantly improve the lives of people they supported.

Incidents related to unexplained injuries for example were not reviewed adequately, meaning patterns, trends and emerging risks were not identified or acted upon. We found a similar lack of learning with other areas, such as repositioning frequency, daily fluid consumed, daily nutrition and medicine management placed people at risk of harm.

Many of these areas had been raised at our last inspection and there had been limited learning, development and a lack of innovation since then.