Georgian House

Updated 28 October 2022

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection team consisted of two adult social care inspectors, a medicines inspector and two Experts by Experience who had consent to gain feedback on the care provided by the service from people and their relatives. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

Georgian 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.

Georgian House is also registered to provide personal care to people in their own homes. At the time of the inspection, there was no one receiving care in their own home, so this activity was not included in this inspection.

Registered Manager

This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

At the time of our inspection there was a registered manager in post.

Notice of inspection

The first day of this inspection was unannounced.

What we did before the inspection

We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make.

We used information gathered as part of monitoring activity that took place on 28 June 2022 to help plan the inspection and inform our judgements. We reviewed the information we held about the service, including notifications we had received. Notifications are changes, events or incidents the provider is legally required to tell us about within required timescales. We sought feedback from the local authority. We used this information to plan the inspection.

During the inspection

We spent time with and spoke with 11 people living at the service, nine relatives, 12 members of staff, the registered manager and the providers/owners of Georgian House. To help us assess and understand how people's care needs were being met we reviewed seven people's care records. We also reviewed a number of records relating to the running of the service. These included staff recruitment and training records, medicine records and records associated with the provider's quality assurance systems. We also spoke with and received feedback from partner agencies.

After the inspection

We continued to seek clarification from the provider to validate evidence found. We looked at training data, quality assurance records, policies and procedures and we spoke with a representative from the local authority.

Updated 28 October 2022

About the service

Georgian House is registered to provide personal care and accommodation for up to 43 people who may have needs associated with their physical and/or mental health. At the time of the inspection, there were 33 people living at the home. Georgian House is also registered to provide personal care to people in their own homes. At the time of the inspection, there was no one receiving care in their own home, so this activity was not included in this inspection.

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

The majority of people told us they were safe, happy, liked living at Georgian House and were well cared for by kind and caring staff. We received mixed feedback from relatives regarding people’s experiences. Most relatives told us they did not have any concerns for their loved one’s safety. However, two relatives told us they did not have confidence in the care people were receiving or the management team. These concerns are being dealt with under formal complaints and safeguarding procedures and CQC will be informed of the outcome.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

We found the service was not always operating in accordance with the regulations and best practice guidance. Some systems were either not in place or had not been undertaken robustly to identify and monitor the quality of the service and drive improvements. This meant some systems operated by the provider had failed to identify concerns and shortfalls we found during this inspection and could not be relied upon as a source to measure quality and risk.

Safeguarding systems were established and the provider had clear policies and procedures in relation to safeguarding adults. However, we found safeguarding processes did not always operate effectively.

People were not always protected from the risk of avoidable harm. We found where some risks had been identified, enough action had not always been taken to mitigate those risks and keep people safe.

People were not always supported to have maximum choice and control of their lives and staff were not always supporting people in the least restrictive way possible. The service could not always demonstrate they were acting in people’s best interests.

Most medicines were given safely and correctly. Some improvements were needed and these were being implemented.

People did not always receive their commissioned individual support hours.

People were mostly supported by staff who had the skills and experience to meet their needs. However, we found there were gaps in training and some staff had not completed a full induction.

People’s needs were assessed prior to admission.

Staff knew people well and understood how to communicate effectively with people and spoke about people in a dignified and respectful way.

The registered manager was keen to put processes in place to address any areas of concern or improve practice. The provider had identified particular areas such as compliance, staff welfare, learning and development as areas they needed to focus on.

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 27 September 2019).

Why we inspected

This inspection was prompted by a review of the information we held about this service. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

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.

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 has changed from good to requires improvement based on the findings of this inspection.

You can see what action we have asked the provider to take at the end of this full report.

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

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to safeguarding, safe care and treatment, staffing, the need for consent, notifications and governance at this inspection. We have also made recommendations in relation to Fire safety and person-centred care.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.