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St George's Nursing Home Requires improvement

Inspection Summary


Overall summary & rating

Requires improvement

Updated 27 January 2017

The inspection took place on 29 and 30 November 2016. The inspection visit was unannounced on 29 November 2016 and we informed the manager we would return on 30 November 2016.

St George's Nursing Home is registered to provide both nursing and residential care with accommodation for up 43 people. People who live at St George's Nursing Home all had needs relating to their health, and some people were also living with dementia. At the time of our inspection there were 11 people living at the home.

A registered manager was not in post at the time of our inspection. 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 provider had recruited to the role of home manager and this manager was in the process of registering with the Care Quality Commission [CQC].

At our previous inspection on 20 and 21 April 2016, we found five breaches in the legal requirements and regulations associated with the Health and Social Care Act 2008. These breaches were in relation to person centred care, safe care and treatment, premises, staffing and good governance. The home was placed in 'Special Measures.' The special measures framework is designed to ensure a timely and coordinated response where we judge the standard of care to be inadequate. Services in special measures are inspected again within six months.

We also took enforcement action by imposing a condition on the provider’s registration to restrict admissions to the home. This was because of the significant concerns about the safe care and treatment of people who lived at the home.

At this inspection we looked to see if the provider had responded to make the required improvements in the standard of care to meet the regulations. Whilst we found areas of improvement had been made to meet some of the regulations the provider continued to be in breach of the legal requirements and regulations associated with the Health and Social Care Act 2008. These were in relation to safe care and treatment and good governance.

The overall rating for this service is ‘Requires improvement’. However, we are placing the service in 'special measures'. We do this when services have been rated as 'Inadequate' in any key question over two consecutive comprehensive inspections. The ‘Inadequate’ rating does not need to be in the same question at each of these inspections for us to place services in special measures.

The provider had management procedures in place but these were not consistently effective. Where improvements were required these had not always been assessed for their effectiveness and sustainability. At this inspection we found there was a continued lack of a consistent strong vision and oversight of the service to support people in receiving safe, effective and responsive care which was well led.

We found there were inconsistencies in the provider's systems and staff practices to provide assurances that all risks to people were safely and effectively managed. We found the management oversight of incidents did not provide confidence in how these were consistently followed through. There were aspects of staff practices which did not assist in the prevention of reducing cross infections and accessible items could place people at risk of harm.

The provider had employed a maintenance person who had assisted in the improvements in the repairs within the home. Since our previous inspection work had been carried out on the water supply so the risks to people of scalding and/or their personal care needs neglected had been reduced. The temperature of the hot water supply had been regularly tested by the maintenance person.

People’s medicines were stored securely and made available to people as prescribed. Safety meas

Inspection areas

Safe

Requires improvement

Updated 27 January 2017

The service was not consistently safe.

Risks to people’s safety and wellbeing were not consistently managed to protect people from the risk of improper treatment.

People were supported by staff who were made available and met their needs in a timely way.

People’s medicines were made available to them at the specific times they were prescribed. Staff medicine administration practices needed to consistently reflect the provider’s medicine policies and procedures.

People were supported to feel safe and staff knew how to report potential abuse to the manager.

Effective

Requires improvement

Updated 27 January 2017

The service was not consistently effectively.

Staff did not consistently apply their training and knowledge to make sure their practices remained effective and safe.

People’s best interest decisions were not consistently followed through to show only people with the legal authority were included so people’s rights were protected. Staff sought people's consent before supporting them.

People received support from healthcare professionals which included assisting staff to meet their nutritional needs.

Caring

Requires improvement

Updated 27 January 2017

The service was not consistently caring.

People did not consistently benefit from living at home where they were always kept at the heart of the care practices to consistently enhance people’s quality of life.

People were supported by staff who were kind and respectful.

Responsive

Requires improvement

Updated 27 January 2017

The service was not consistently responsive.

People's care plans were being improved so they consistently held accurate details to support staff in providing care in accordance with people's needs and preferences.

People were supported to follow their interests and have fun things to do which was continuing to be developed to enhance people’s quality of life.

The complaints procedure was on display and people knew how to make a complaint.

Well-led

Inadequate

Updated 27 January 2017

The service was not well led.

The systems and processes in place did not assist in ensuring the services provided were consistently effective, sustained and well led.

There had been inconsistencies in the management of the service. The current manager was not registered with us which is a condition of the provider’s registration with us.

People who lived at the home, relatives and staff were hopeful the improvements being made would continue as there had been previous inconsistencies in the management of the home.