Georgina House

Georgina House is a residential care home providing personal care and accommodation to up to 4 people. The service provides support to autistic people and people with a learning disability. At the time of our inspection there were 4 people using the service.

Georgina House is a two storey house with a garden and communal spaces. There are two ensuite bedrooms downstairs and two bedrooms upstairs with a shared bathroom. There is a small open plan lounge and diner and a small kitchen. Laundry facilities are located in a shed in the garden and are shared by everyone living at the service.

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

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

Right Support:

The service (or staff) did not support people to have the maximum possible choice, control and independence be independent and they did not had control over their own lives. Some people had personal items locked away without any reasonable rationale for this. Staff used a stairgate for another person to block their access to the kitchen, this had not been reviewed to look at less restrictive options. People were unable to pursue choices for how they spent their time as there was not enough staff deployed to meet these preferences.

We have made a recommendation about the management of restrictive practices and consent.

Staff did not focus on people’s strengths or promote what they could do, so people did not have a fulfilling and meaningful everyday life. People were not encouraged to do things for themselves or learn new skills to empower them to have ownership over their home. This included areas such as cooking, cleaning and laundry.

People were not supported to identify their dreams and aspirations. People had no meaningful goals in place and goals that were in place showed no evidence of how they would be achieved or any progress and outcomes.

The service gave people care and support in a safe, clean and well-maintained environment. However, the environment size and layout meant people’s sensory needs were not always met. People personalised their rooms.

Staff enabled people to access specialist health and social care support in the community. Staff supported people with their medicines in a way that promoted their independence and achieved the best possible health outcome.

Right Care:

Staff did not promote equality and diversity in their support for people. They understood people’s cultural needs and provided culturally appropriate care. However, they did not understand how to safely and appropriately support people’s needs in relation to preferences about how people chose to express themselves sexually or in relationships.

People who had individual ways of communicating, such as, using body language, sounds, Makaton (a form of sign language), pictures and symbols could not interact comfortably with staff and others involved in their treatment/care and support because staff did not have the necessary skills to understand them.

People did not always receive kind and compassionate care. Staff did not always protect and respect people’s dignity. People unable to communicate easily were often ignored and one person was left wearing odd shoes.

Staff had training on how to recognise and report abuse and they knew how to apply it. However, staff struggled to recognise how poor practice could result in the less visible forms of abuse.

The service did not have enough appropriately skilled staff to meet people’s needs. People did not always receive care that supported their needs and aspirations, was focused on their quality of life, and followed best practice. The service did not give people opportunities to try new activities that enhanced and enriched their lives. People were not supported to take positive risks.

Right Culture:

People did not lead inclusive and empowered lives because of the ethos, values, attitudes and behaviours of staff. People did not always receive good quality care, support and treatment because staff did not have the right training and support to meet people’s needs and wishes.

People were supported by staff who did not understand best practice in relation to the wide range of strengths, impairments or sensitivities people with a learning disability and/or autistic people may have. This meant people did not always receive empowering care that was tailored to their needs.

People’s relatives were involved in planning their care. However, people who were unable to communicate easily were not involved in these reviews and did not have their views sought about the service generally.

Staff did not evaluate the quality of support provided to people, involving the person, their families and other professionals as appropriate. Staff and the provider had not ensured risks of a closed culture were minimised so people did not receive support based on transparency, respect and inclusivity.

The registered manager was new to post, had made some progress with improvements and had plans to improve the culture and ethos of practice further. The provider did not offer sufficient training and support to the registered manager and staff team to ensure they had the knowledge and skills to apply learning and promote a quality of life for people that empowered them and promoted valuing people and equality.

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 requires improvement (published 26 February 2021). The service remains rated requires improvement. This service has been rated requires improvement or inadequate for the last two consecutive inspections.

Why we inspected

This inspection was prompted by a review of the information we held about this service. 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.

Enforcement and Recommendations

We have identified breaches in relation to personalised care, the environment, upholding people’s dignity and respect, staff training and provider oversight at this inspection.

We have imposed conditions on the providers registration to ensure the provider makes the required improvements.

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.

We found the following examples of good practice.

¿ The home was clean and well ventilated. Key areas were cleaned several times a day. The communal bathroom was cleaned after each use.

¿ We observed staff wearing personal protective equipment (PPE) correctly. Staff received training in relation to PPE. People had been supported (where possible) to understand the importance of staff wearing this equipment.

¿ New staff received PPE training swiftly when they started at the home. Staff were observed to maintain good social distancing during the inspection.

¿ Staff received regular COVID-19 tests in line with the current government guidance.

¿ The registered manager was monitoring key aspects of infection protection control (IPC) to promote people’s safety. The home had not had any cases of COVID-19 so far during the pandemic.

People’s experience of using this service: The people who could communicate with us in ways which we could understand spoke positively about the staff who supported them and the new manager. One person said, “It’s good I have a key worker, [name of member of staff] has helped me.” One person spoke positively about their room. We saw other people engage well with the staff, they looked happy and at ease with the staff around them.

When we inspected the service last time we found many issues which led to multiple breaches of the Health and Social Care Act 2008 and the service was placed in Special Measures. At this inspection we found improvements had been made.

Plans had been made to help staff manage some of the key risks which people faced. People were being supported to access health support or seek professional advice about their needs. Improvements had been made to promote people’s safety in the home when they accessed the kitchen.

Staff now supported people to have their medicines in a safe way. Improvements had been made in terms of keeping the home clean, but we still found issues relating to infection control risks at the home. The manager did start to act to address these issues.

The provider had now had completed full employment checks to ensure people were safe around new members of staff. The staff we spoke with had a good and complete knowledge about how to protect people from potential abuse. They also knew how to promote people’s rights in terms of experiencing discrimination.

Plans were in place to ensure staff had competency checks so the manager could address shortfalls in their knowledge and be assured if staff were competent in their work. We saw that staff knowledge and practice had improved, but this was still a working progress, to ensure all staff were effective in their roles.

Progress had been made to enable people to have choice with their food and drinks and promote healthy options. We saw staff encouraging people to go out for walks and plans had started to be made to support people to eat healthier food.

Staff and the manager were making efforts to help people who could not communicate easily, to have a voice. Referrals to specialist health professionals had been made and care plans were updated so staff knew how to meet people’s needs.

Improvements had been made in terms of supporting people to consider goals but further work was needed to fully explore people’s interests, ambitions, and improve their environment and experiences.

There was now a management structure in place which had good oversight about the previous issues and what they needed to do to make improvements. There was now a better culture at the home. Further work was needed to make these improvements and show these had been sustained.

The home had not previously been fully developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen. Further work was needed to fully meet these values.

Rating at last inspection: Inadequate the report was published on 26 September 2018.

Why we inspected: This inspection was planned based on the previous rating.

Follow up: We will inspect the service again to check improvements have been made and in the mean time we will monitor the service.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

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

Georgina House provides personal care and accommodation for people who have a range of learning disabilities. Georgina House can provide care for up to four adults. At the time of the inspection three people were living at the home. Georgina House comprises of accommodation over two floors.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.” Registering the Right Support CQC policy

There was not a registered manager in place when we inspected the home. 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. An application had been submitted to the CQC by the current manager at the home.

The leadership and the provider of the service were not taking timely action to ensure people were safe. Insufficient action was taken to respond to the health needs of a person who had become unwell early this year. No meaningful review had been completed to improve the person’s wellbeing. We needed to discuss these concerns further with the provider after our inspection.

We found issues with staff practice which had the potential to put people at risk of harm. These included poor infection control practices. One person’s bathroom had mould growing in their shower and a dirty extractor fan. We also observed unsafe staff practices when administering people their medicines and with the storage of people’s prescribed creams.

Staff recruitment checks were not thoroughly completed to ensure people were safe around staff. The provider and leadership of the service were not monitoring or checking the competency of staff. The provider did not have strong assurances that staff were effective in their work. Staff had not received suitable support and leadership from the management of the home.

People were not being supported to have real choice with what they ate. People were not always being involved in planning what they ate or the preparation of their food. Healthy alternatives were not being promoted at the home. The meal time was not a social experience. People’s cultural dietary needs were not being met by staff.

People’s health needs were not always being responded to in a timely way. People’s rights and interests in this area were not being promoted and championed by the service.

The service was not compliant with the Mental Capacity Act 2005 (MCA). This provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. People’s relatives and professionals were not being consulted with when people could not make certain decisions themselves.

When people’s freedom of movement was restricted, there was no checking if these met the requirements of the Deprivation of Liberty Safeguards (DoLS).

People were not always treated in a kind, caring and respectful way. We observed people being spoken at times in a dictatorial and authoritarian tone.

The leadership of the home and the provider were not ensuring that people received person centred care. People’s rooms were not always personalised and the parts of the home that people shared were also not personalised. There were some social activities taking place. However, plans regarding some social events and activities were not always being made, with actions taken. People’s social day to day needs were not being met at the home. People’s cultural needs were also not being met by the service.

Some people could not communicate with others in ways which they could understand. No timely and meaningful work had been completed in this area so that the service understood people’s wishes and requests better.

There was a lack of leadership and a poor culture at the home. We identified institutionalised practices which were in place to benefit staff. Provider and internal audits were either not taking place or they were ineffective. Incidents were not responded to and the provider was not supporting the service to improve. The provider lacked insight into the issues which we had identified.

Risk assessments were taking place but these were not always updated. There was no evidence to show staff looked at these documents and were aware of people’s needs.

People’s confidential information was not being stored in a way which ensured it was secure.

Some of these issues constituted breaches in the legal requirements of the law. There were eight breaches of Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we asked the provider to take at the back of the full version of the report.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action.

Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

When we visited Georgina House on the 17 April 2014, we gathered evidence to help us answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

We always ask the following five questions of services.

Is the service safe?

We observed people were treated with respect and dignity and there were good interactions between people and staff. People looked relaxed and comfortable in the company of staff. We saw staff demonstrated genuine warmth, care and concern for people.

The home had a system in place to ensure that people's risk assessments were kept under regular review. Arrangements were in place to monitor accidents and incidents that occurred. This meant that measures were put in place to prevent a recurrence.

Staff spoken with said that there was no one at the home on the day of our inspection whose liberty was being deprived. We saw evidence which confirmed that staff had been provided with training on the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). Staff were able to describe what measures the home had in place to promote people's safety and how they would protect people if they felt their human rights were being breached.

The home had infection control processes in place to ensure that it was clean and hygienic. People were protected against the risk of acquiring infections.

Is the service effective?

Staff told us that people had access to an advocate if required. There was a notice displayed in the home to remind staff how to access the local advocacy service. This meant that if required people could access additional support.

We found that people's care plans provided detailed information on how they wished to be supported with their care needs. Health action plans had been developed for people. These were appropriately maintained to ensure if required, a new member of staff or agency worker would be able to deliver care safely and effectively.

We found that people's health care needs were kept under regular review. They had access to health care professionals such as the GP, dentist, optician and district nurse. This meant that people were supported to keep healthy and well.

The home had an effective recruitment and selection procedure in place. This meant that people's health and welfare needs were looked after by staff who were fit and appropriately qualified to undertake their job.

Is the service caring?

We observed staff talking to people in a kind and respectful manner. Staff demonstrated genuine warmth, care and concern to people. Staff spoken with were knowledgeable about people's care needs. It was evident that staff responded to people in a caring manner.

Is the service responsive?

We found that people were supported to express their views and be actively involved in making decisions about their care treatment and support. We found where people did not have the capacity to make decisions, best interest meetings were held involving the GP, an advocate and the home's staff.

We saw evidence that regular care plan reviews took place. This meant that people's care needs were current and kept under regular review.

We found that where appropriate staff enabled people to have access to outside activities that were important and relevant to them. It was evident that people were protected from becoming isolated and were provided with activities to meet their diverse needs.

Is the service well led?

Staff spoken with said that they felt supported by the interim manager and were provided with regular staff meetings. At these meetings they were able to raise questions and make suggestions relating to the provision of care. This meant that staff felt supported and well-led.

The home ensured that the complaints procedure was available in a suitable format to meet people's diverse needs. Arrangements were in place to monitor complaints, accidents and incidents. This meant that lessons were learnt from mistakes, incidents and complaints investigations to ensure improvements with the service delivery.

A person who was able to communicate with us said, 'I like living here, the staff are kind to me'. The person also said, 'I make my own breakfast and I help staff with washing the dishes. Staff take me shopping and I choose what food I like to eat'.

We found people were provided with sufficient food and drink to meet their needs. Where possible staff enabled people to maintain their independence and to prepare their own meals. People lived in premises that were adequately maintained. We found the garden was overgrown and staff supervision and appraisal was not consistent. Records relating to people's safety and the environment were appropriately maintained.