George Potter House

George Potter House is a residential care home providing personal and nursing care to up to 69 people. At the time of our inspection there were 38 older people living at the care home. The care home accommodates people in 1 adapted building built over 2 floors, each with their own separate facilities.

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

The overwhelming number of people we spoke with talked positively about the care home. A person’s relative told us, “My [family member] is taken care of at George Potter House and I am sure she is happy living there.”

People were kept safe and were confident any concerns they raised would be listened to. Staff understood how to protect people from poor care and abuse. Staff received training on how to recognise and report abuse and knew how to apply this knowledge. Staff were aware of how to manage risks people they supported might face and how to keep them safe. Enough staff were deployed to meet people’s assessed needs whose suitability and fitness to work at the care home had been thoroughly assessed. The premises was kept clean and tidy and staff followed current best practice guidelines regarding the prevention and control of infection. People received their prescribed medicines as and when they should.

Staff had the right levels of training, support and experience to deliver effective care and meet the needs of people living at the care home. People had access to a wide variety of food and drink that met their dietary needs and wishes. Staff enabled people to access specialist health and social care support in the community. People lived in a safe, well-maintained and comfortable environment. 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.

The provider promoted an open and inclusive culture which sought the views of people living in the care home, their relatives, and staff working there. Staff knew and understood people, and responded well to people’s individual needs. The provider worked well with external health and social care agencies and professionals to plan and deliver people’s packages of care.

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 overall (published 6 June 2023). At our last inspection we recommended the provider consider current guidance on medicines recording and act to update their practice. At this inspection we found the provider had acted upon our recommendation and improved how they managed medicines records.

Why we inspected

We received concerns in relation to how the care home was being managed, specifically in relating to medicines, nutrition and record keeping. As a result, we undertook a focused inspection to review the key questions of safe, effective 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 and for both key questions safe and effective remains good, and the rating for the key question well-led remains requires improvement based on the findings of this inspection.

We found no evidence during this inspection that people were at risk of harm however, we have found evidence that the provider needs to make further improvements.

Please see the well-led section of this full report.

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

Enforcement and Recommendations

We have identified issues in relation to how the provider operates their governance systems and have made a recommendation about how they manage their oversight and scrutiny practices.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect. If we receive any concerning information, we may inspect sooner.

George Potter House is a care home that provides nursing and personal care to up to 69 older people. At the time of our inspection there were 49 people using the service including those living with dementia. The care home accommodates people in one adapted building.

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

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.

The service was able to demonstrate how they were meeting the underpinning principles of right support, right care, right culture.

The home was not always well-led. Audits were thorough and records kept up to date with the exception of the medicines administration records (MAR) on the ground floor which contained some gaps without explanation. This was acknowledged by the management team and immediately investigated. The home’s management and leadership was transparent with an open, honest and positive culture. The provider had a vision and values that were clearly set out, understood by staff and which they followed. A good service was maintained, regularly reviewed and areas of responsibility and accountability identified. Where possible community links and working partnerships were established and kept up to minimise social isolation. The provider met Care Quality Commission (CQC) registration requirements. Healthcare professionals told us that the service was reasonably well managed and met people’s needs in a professional, open and friendly way.

People and their relatives told us that the George Potter House was a safe place to live and staff said it was a safe place for them to work. Risks to people were regularly assessed and reviewed. This meant people were able to take acceptable risks, live safely and enjoy their lives. Accidents, incidents and safeguarding concerns were reported, investigated and recorded. There were sufficient, appropriately recruited staff to meet people’s needs. People said they 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 were up to date.

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 3 October 2018). The overall rating for the service remains good. This is based on the findings at this inspection.

Why we inspected

We undertook this inspection as part of a random selection of services rated Good and Outstanding.

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 effective, caring and responsive.

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

Recommendations

We have made a recommendation regarding the recording of medicines administered.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the Well-Led section of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for George Potter House 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.

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

Some areas of the home were in need of refurbishment. One unit of the building was closed and under refurbishment pending new admissions. However, the unit that was in use needed repairs. There was damp on some of the walls. Patch work had been undertaken and the building seemed to be in constant repair. They were signs of leaks on the roof and stains on several ceilings. We saw a window stained and dirty from bird droppings. The garden was not well maintained did not look pleasing to the eye. A water fountain was overgrown and covered with a mesh wire. The registered manager told us, and records confirmed the provider was aware of these maintenance issues and had an action plan to resolve them.

After the inspection, the registered manager advised us that there were contractors on site working on the roof. In addition, the maintenance team had started refurbishments that included repainting the walls. The overgrown garden had been cleared.

People told us they felt safe living at the home. Staff understood their responsibilities to protect people from the risk of harm. Staff were aware of the provider’s safeguarding procedures and followed these to raise concerns about people’s well-being. Risks to people were assessed and managed.

People received care from a sufficient number of staff.

People’s needs were assessed and managed. People received support in line with how they wanted their care delivered. Staff understood people's health conditions and knew how to deliver their care.

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 coronavirus and other infection outbreaks effectively.

Rating at last inspection

The service was registered with us on 20 January 2011.

The last rating for the service was good (published on 2 October 2018).

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

Why we inspected

We undertook this targeted inspection to check on a specific concerns we had about how the provider prevented and controlled infection and managed the risk of falls by people who use the service. The overall rating for the service has not changed following this targeted inspection and remains good.

CQC have introduced targeted inspections to check specific 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 have found evidence that the provider made improvements prior to our visit to mitigate risks against people having falls. We have found evidence that the provider needs to make improvements to the premises. Please see the safe section of this full report.

Follow up

We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The breaches of the regulations were regarding, the care and treatment of people, staffing, nutrition and hydration, person centred care, dignity and respect and systems and processes. We also recommended that the home sought guidance in respect of The Mental Capacity Act 2005 (MCA). This recommendation was followed.

For four of the breaches, we issued ‘Warning Notices’ against the service and required the provider to ensure the breaches were met by 27 August 2017. These breaches were regarding the care and treatment of people, staffing, nutrition and hydration and person-centred care. The provider sent us a report to say how they had met these breaches and we checked that they had followed their action plan. At this inspection we found that the terms of the ‘Warning Notices’ and the breaches of regulations identified in June 2017 were met.

George Potter House is a ‘care home’. People in care homes receive accommodation and nursing or 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. The home is located in Battersea, south London and registered to provide care and support for 69 people who require nursing or personal care support.

The home had a registered manager. 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 and associated Regulations about how the service is run.

People said they experienced a pleasant, friendly and relaxed atmosphere at the home. This was created by the staff and people and their relatives were also satisfied with the care and support provided. They thought there were enough staff who met people’s needs in a thoughtful, kind way.

The home’s recording, auditing and quality assurance systems were kept up to date and now monitored and assessed the quality of the service provided. The information was clearly recorded, easy to understand and reviewed regularly.

People had access to community based health care professionals as required. Staff also discussed health needs with people and provided them with balanced diets and protected them from risks regarding nutrition and hydration. The meals served addressed people’s likes, dislikes and preferences.

Most people said they enjoyed the meals, which were of good quality and there was a variety of choices provided. People were supported, by staff to eat their meals and drink at their own pace and enjoy the experience.

The home provided a safe environment for people to live and staff to work in. It was clean and well-maintained.

Staff knew the people they supported well and were appropriately skilled and trained to meet people’s needs. They also understood their responsibility to treat people equally, respect their diversity and human rights and recognise and respect people’s differences. People said they were fairly treated.

The Mental Capacity Act and DoLS required the provider to submit applications to a ‘Supervisory body’ for authority. Appropriate applications had been submitted by the provider and applications under DoLS been authorised, and the provider was complying with the conditions applied to the authorisation.

Staff said the registered manager and organisation provided good support and they had opportunities for career advancement.

People said the registered manager and staff were approachable, responded to them and asked their opinions.

We last carried out an unannounced inspection of this service on 10 May 2016. Breaches of legal requirements were found regarding the assessment and management of risks, cleanliness of the premises, person-centred care, dignity and respect, complaints and good governance. After the comprehensive inspection the provider wrote to us to say what they would do to meet legal requirements in relation to these breaches. On 13 December 2016 we carried out an unannounced focused inspection, where we found the provider was now meeting these requirements.

George Potter House is a care home that provides nursing care for up to 69 older people. At the time of our inspection there were 47 people using the service. The ground floor is called Primrose Unit and has a large kitchen and dining area, garden, courtyard and lounge which serves as an activities room. The first floor of the building, called Rainbow Unit, provides care to people living with dementia, and contains a lounge, dining room and sensory room.

The service had a registered manager. 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 that the provider had taken steps to improve the overall quality of the premises; this included replacing carpets and furniture, decorating communal areas and refurbishing bathrooms and toilets. However, areas of the building remained dirty and we saw some hazards such as trailing wires and unsafe filing cabinets. The provider carried out regular checks of some areas of safety such as electricity, gas and window restrictors and had evacuation plans in place in the event of an emergency. There were also regular checks of their fire safety systems.

We saw many instances of good and respectful interactions between people and staff, but we also saw examples of poor care. This included people not being seen to promptly when they needed support to be changed, and people did not always receive showers or oral care in line with their care plans. Some people complained of being handled roughly by staff, and some people told us they were put to bed too early. We saw some examples of poor infection control practice. The provider had measures in place to assess people's capacity and demonstrate how they were working in people's best interests, but these were not always applied effectively.

There were measures in place to assess and mitigate risks to people. People were assessed by the provider for their risk of pressure sores. However, measures were not always followed to prevent these, which included pressure relieving mattresses being placed on the wrong setting for the person’s weight and turning charts not being correctly completed. We also found that staff carried out weekly audits of whether existing pressure sores were healing but did not always record appropriate measurements of wounds which would help to measure if this was taking place.

The provider carried out assessments of people’s nutritional needs and monitored people’s weights. However, dietitian referrals were not always followed up, and although many people received suitable support to eat, some people did not. We found that food and fluid charts for two people contained misleading information about what people had actually eaten.

The provider had measures that ensured staff were suitable for their roles, which included providing regular training and supervision and carrying out suitable pre-employment checks. However, we found that staffing levels were frequently far below what the provider told us were required; some people and relatives told us the service was short-staffed and that care workers were often rushed or unable to see to people’s needs promptly. Three people who used the service and two relatives said that staff did not have the time to talk to people, and three people felt they were not treated with dignity by care workers.

There was a programme of activities for people, which included activities in people’s rooms for those who were unable to participate. The activities programme of gardening and music was carried out in partnership with local schoolchildren.

Medicines were safely managed by staff with the correct training to do so, and regular checks took place of people’s medicines to ensure these were given correctly.

Managers had systems in place to monitor staff training, supervisions and meetings, and there was a detailed action plan for responding to the points raised at the previous comprehensive inspection. Audits were scheduled regularly of the service, but did not always detect areas of concern.

We have made a recommendation about how the provider ensures measures for obtaining consent to care are used effectively. We found breaches of regulations regarding safe care and treatment, person-centred care, nutrition and hydration, dignity and respect, staffing and good governance.

We issued warning notices against the provider with regards to person centred care, nutrition and hydration, staffing and safe care and treatment. You can see what action we told the provider to take at the back of the full version of this report.

We undertook this focused inspection on 13 December 2016 to check they had followed their plan and to confirm they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for George Potter House on our website at www.cqc.org.uk.

The service had a new manager who had applied to become the registered manager. 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.

At our previous inspection we found that building was unclean. We found that the provider had taken steps to improve the environment, including implementing a cleaning schedule and replacing old carpets and furniture. The environment was substantially improved since our last visit. We found that there were not suitable checks in place to address some safety hazards within the building.

At our previous inspection we found that risks to people around pressure care were not always suitably addressed and that care plans were not person-centred. In some cases plans were not in place for when people were dying. At this inspection we found that suitable measures were in place to address the risks of pressure sores and that care plans recorded people’s needs, life stories and wishes for the end of their lives were on people’s care plans.

At our last inspection we found that people were not always treated with dignity and respect and that there were not suitable activities in place for people. At this inspection we saw that people’s dignity was protected by staff and promoted by managers and we observed kind and friendly interactions with staff. Activities programmes had improved, but information about activities was not always accurate and some people were not always included in activities.

At our last inspection we found that complaints were not addressed by managers and that managers were not carrying out the right checks to ensure that staff received training and supervision. At this inspection we found that complaints were recorded and that these were appropriately investigated by managers and action taken in response. People told us that they could speak to the manager if they had a complaint or a concern, and they were approachable and helpful. Managers now had systems in place for monitoring staff training and checking the quality of the care people received. Staff received supervision which was used to improve standards of care.

Managers had a detailed plan in place for delivering improvements to the service, which was monitored and reviewed regularly. This had brought about significant improvements in the care that people received.

We have made two recommendations about how the service carries out checks of the safety of the building and how people are included in activities.

George Potter House is a care home with nursing which provides accommodation for up to 64 older people, including people with nursing needs and dementia. At the time of our inspection there were 57 people living in the service. The building was divided into two units, with the first floor providing care to people with dementia. Each floor had a dining room and lounge, and the first floor had communal bathrooms, whilst rooms on the ground floor had en suite bathrooms.

The service had a registered manager. 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 that the building did not meet the needs of people with dementia and was in need of redecoration. Chairs in particular were dirty and urine stained, and in some cases bin liners had been used to protect furniture. There was a pervasive odour of urine throughout the service, audits had identified this but no action had been taken to improve the environment. Many people told us that call bells were not responded to in a timely fashion, and we found that several bells were broken at the time of our inspection. Risks to people were not always adequately assessed, for example with regards to pressure area care, although when people had pressure sores, measures were in place to treat these.

Staffing levels were adequate to meet people’s needs and were regularly reviewed. The provider followed safer recruitment measures to ensure that staff were suitable for their roles. However, we did not always see positive interactions between staff and people who used the service, and did not find that there was a culture of protecting and promoting people’s dignity. The two units in the service were known as “Elderly Mentally Infirm (EMI)” and “Elderly Frail Unit (EFU)”, even though it was noted at our last inspection that these were outdated and needed to change.

Staff did not receive enough supervision from managers, staff training was not well recorded and in some cases staff had not received essential training. People’s nutritional needs were assessed and people were monitored for weight loss, however there was limited choice with food and the support people received to eat was not always appropriate.

Medicines were safely stored and administered by staff with the correct skills to do this. The provider had carried out suitable checks on the safety of the building and equipment. However, we noted that the front door was at times left open and unattended, which could compromise the safety of people who use the service and staff. Care plans adequately described people’s care needs and these were regularly reviewed, however they did not give detailed information on people’s wishes and preferences. In some cases people did not have care plans in place to meet their needs at the end of their lives. We saw that there were good links with a hospice that provided this support. Activities were limited and not always suitable for people with dementia, there was limited evidence of community involvement.

Quality assurance measures were in place, however these did not always identify concerns or take adequate steps to address these. The service did not adequately monitor and respond to complaints.

We have made two recommendations concerning providing suitable person-centred activities and the suitability of the premises for people with dementia. We found a number of breaches of regulations relating to the assessment and management of risks, the cleanliness of the premises, person-centred care, dignity and respect, complaints and good governance. You can see what action we have told the provider to take at the back of the full version of this report.

Overall comments about George Potter House from people staying there included 'I like it here, it's quite nice and the nurses are very friendly', 'I like it here very much, especially after the hospital, they are all so friendly' and 'I can't live at home so it's good to be here'. Relatives or friends told us "'I think they look after her very well as she likes to look good all the time' and 'the staff are very caring'. One person said 'our relative was here for respite and liked it so much we decided to let them be here'.

Feedback about the staff included "very polite and caring", "good, they pop in and check on you", 'the staff do all sorts, we would not cope without them' and 'they have been good to me and I appreciate that'.

Most people spoken to said they were happy with the food provided saying 'the food is OK but I am not a big eater', 'they do me a tomato soup if I don't fancy the meal', 'the food is quite nice, but if I don't like anything, they give me a choice' and "the food is good".

Further work could take place to enhance the first floor environment for people living with dementia and provide more opportunities for meaningful interaction and engagement. Activities could also be reviewed on this floor to further develop this provision. The manager told us that plans were already in place to improve the signage and to introduce the Namaste program which is designed to improve the quality of life for people with advanced dementia.

All of the people who use the service spoken to said that they were treated with dignity and respect. Feedback about the staff included 'they are very good people', 'not bad' and 'very good staff'. One person told us 'they're a nice bunch, you would like them'.

Feedback from visitors and family members included 'very nice staff, you've only got to call and they will come', 'terrific', 'they have what they want here', 'the staff are very friendly' and 'they love them here'.

People who use the service told us that enjoyed the food provided to them. Comments included 'the food is excellent', 'I like it', 'good food' and 'I'm happy'.

An acting manager was in charge at the time of this inspection. We were informed that a new manager had been recruited and was expected to commence work in January 2013.

Overall we noted the improvements that had been made by the service since our last visit in February 2012. One person using the service told us 'it has got better here, slowly and surely' and a staff member reported 'it's getting better here - we are doing well'.