This inspection was unannounced and took place over four days on 15 April, 20 April, 22 April and 23 April 2015.
St George’s Nursing Home is registered to provide personal and nursing care for up to 60 people. The home specialises in the care of older people with dementia. At the time of this inspection there were 31 people living in the home.
The manager had been in post since 23 February 2015; however they were not registered with the Care Quality Commission (CQC) They told us they were preparing the documentation to apply to be registered. 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.
This inspection was scheduled following concerns received regarding staff shortages, end of life care, infection control and the management of risk specific to falls.
Throughout the inspection there was a relaxed and cheerful atmosphere; people living in the home, relatives and staff were happy and at ease when they spoke with us.
The manager responded to concerns and complaints in line with the provider’s policy and procedure. We looked at one complaint in detail. The complaint was received by the provider at the beginning of April and at the time of our inspection had not been concluded. By the end of our inspection the manager had responded to the complaint but the response was defensive and did not address all the issues raised. We discussed the outcome of their investigation and they agreed there had been a breakdown in communication but this was not identified in the response and no apology had been made.
Medicines were not always handled safely. Nursing staff were assisted by care workers to administer medicines. They had not checked the practice of the care workers to ensure it was safe for them to assist them. The medicines charts for some as required medicines such as pain relief did not include information for ensuring they were given in a consistent way. This was addressed during the pharmacist’s inspection and guidance was in place for staff to follow. Medicines prescribed for end of life did not include what checks the nurse should carry out before administering. This had been addressed by the end of the inspection and very clear guidance and protocols were in place.
There were systems in place to monitor the care provided and people’s experiences. However they had failed to identify specific issues until they were bought to the manager’s attention either through a complaint or our discussions during the inspection. Some shortfalls had been identified and where this happened action plans were put in place to address the issues found.
A regular survey was carried out asking people and their relatives about the service provided by the home. Suggestions for change were listened to and actions taken to improve the service provided. All incidents and accidents were monitored, trends identified and learning shared with staff to put into practice.
During the inspection we saw there was adequate staff on duty to meet the needs of people during the day. However people who could comment, relatives and staff all told us there was not enough staff at night. We saw for 31 people, five of whom were residential not nursing, 11 people required two staff to support them; there was one qualified nurse and two care workers. The manager confirmed a twilight shift had been introduced about a year ago. This meant an extra care worker supported the night staff until 11.30 at night. However this did not provide adequate support during the early hours of the morning when some people liked to get up early. The manager agreed to look at ways of also providing extra support for people early morning.
The manager had looked at innovative ways of reducing staff shortages at the weekend. They rostered on more staff than was necessary. This meant if a staff member rang in sick people did not experience poor care due to lack of staff.
The home was in the process of introducing new electronic care plans. We saw one care plan contained conflicting information about the person’s wishes. Records showed people were involved in their care plans and consented to the care they received as far as possible. Family members were involved when necessary. We saw the lack of communication between qualified staff had resulted in one family’s wishes not being recorded. This meant they were not contacted when their relative’s health declined. We recommended the service explored guidance on ways to ensure all staff were kept aware of relatives wishes.
During the inspection we observed and monitored infection control. We found the home was clean, tidy and free from bad odours. We did not observe any dirty laundry or equipment left in the wrong place. However we did observe staff did not wear aprons when serving lunch. We bought this to the manager’s attention who said they would talk with staff about the importance of wearing aprons.
We asked the manager how they managed the risks to people who had been identified as at high risk of falls. They confirmed they carried out an audit of falls and incidents which helped identify trends such as time of day or the part of the home. They would assess the need for any equipment that would help prevent injury occurring from falls. People had risk assessments in place and where equipment had been identified this was in place. This included the use of crash mats, and pressure mats to inform staff when a person was moving and one to one support for one person with very high risk of falls due to their illness. The home did not restrain people from moving about which meant falls would happen. However they did attempt to minimise the risk of injury, although injuries did sometimes occur.
Staff had received training in identifying and reporting abuse. Staff were able to explain to us the signs of abuse and how they would report any concerns they had. They stated they were confident any concerns brought to the manager would be dealt with appropriately. There was a robust recruitment procedure in place which minimised the risks of abuse to people. People who could comment told us they felt safe in the home and they all knew who to talk to if they wanted to raise a concern or complaint.
People saw healthcare professionals such as the GP, district nurse, chiropodist and dentist. Staff supported people to attend appointments with specialist healthcare professionals in hospitals and clinics. Staff made sure when there were changes to people’s physical well- being, such as changes in weight or mobility, effective measures were put in place to address any issues.
Everybody spoken with told us they enjoyed the food, they all said the food was good. People were offered choices and the food was nutritious and well presented. People who needed assistance with eating were supported in a dignified and unhurried manner. Some people chose to eat in their room.
We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.
This inspection was unannounced and took place over four days on 15 April, 20 April, 22 April and 23 April 2015.
St George’s Nursing Home is registered to provide personal and nursing care for up to 60 people. The home specialises in the care of older people with dementia. At the time of this inspection there were 31 people living in the home.
The manager had been in post since 23 February 2015; however they were not registered with the Care Quality Commission (CQC) They told us they were preparing the documentation to apply to be registered. 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.
This inspection was scheduled following concerns received regarding staff shortages, end of life care, infection control and the management of risk specific to falls.
Throughout the inspection there was a relaxed and cheerful atmosphere; people living in the home, relatives and staff were happy and at ease when they spoke with us.
The manager responded to concerns and complaints in line with the provider’s policy and procedure. We looked at one complaint in detail. The complaint was received by the provider at the beginning of April and at the time of our inspection had not been concluded. By the end of our inspection the manager had responded to the complaint but the response was defensive and did not address all the issues raised. We discussed the outcome of their investigation and they agreed there had been a breakdown in communication but this was not identified in the response and no apology had been made.
Medicines were not always handled safely. Nursing staff were assisted by care workers to administer medicines. They had not checked the practice of the care workers to ensure it was safe for them to assist them. The medicines charts for some as required medicines such as pain relief did not include information for ensuring they were given in a consistent way. This was addressed during the pharmacist’s inspection and guidance was in place for staff to follow. Medicines prescribed for end of life did not include what checks the nurse should carry out before administering. This had been addressed by the end of the inspection and very clear guidance and protocols were in place.
There were systems in place to monitor the care provided and people’s experiences. However they had failed to identify specific issues until they were bought to the manager’s attention either through a complaint or our discussions during the inspection. Some shortfalls had been identified and where this happened action plans were put in place to address the issues found.
A regular survey was carried out asking people and their relatives about the service provided by the home. Suggestions for change were listened to and actions taken to improve the service provided. All incidents and accidents were monitored, trends identified and learning shared with staff to put into practice.
During the inspection we saw there was adequate staff on duty to meet the needs of people during the day. However people who could comment, relatives and staff all told us there was not enough staff at night. We saw for 31 people, five of whom were residential not nursing, 11 people required two staff to support them; there was one qualified nurse and two care workers. The manager confirmed a twilight shift had been introduced about a year ago. This meant an extra care worker supported the night staff until 11.30 at night. However this did not provide adequate support during the early hours of the morning when some people liked to get up early. The manager agreed to look at ways of also providing extra support for people early morning.
The manager had looked at innovative ways of reducing staff shortages at the weekend. They rostered on more staff than was necessary. This meant if a staff member rang in sick people did not experience poor care due to lack of staff.
The home was in the process of introducing new electronic care plans. We saw one care plan contained conflicting information about the person’s wishes. Records showed people were involved in their care plans and consented to the care they received as far as possible. Family members were involved when necessary. We saw the lack of communication between qualified staff had resulted in one family’s wishes not being recorded. This meant they were not contacted when their relative’s health declined. We recommended the service explored guidance on ways to ensure all staff were kept aware of relatives wishes.
During the inspection we observed and monitored infection control. We found the home was clean, tidy and free from bad odours. We did not observe any dirty laundry or equipment left in the wrong place. However we did observe staff did not wear aprons when serving lunch. We bought this to the manager’s attention who said they would talk with staff about the importance of wearing aprons.
We asked the manager how they managed the risks to people who had been identified as at high risk of falls. They confirmed they carried out an audit of falls and incidents which helped identify trends such as time of day or the part of the home. They would assess the need for any equipment that would help prevent injury occurring from falls. People had risk assessments in place and where equipment had been identified this was in place. This included the use of crash mats, and pressure mats to inform staff when a person was moving and one to one support for one person with very high risk of falls due to their illness. The home did not restrain people from moving about which meant falls would happen. However they did attempt to minimise the risk of injury, although injuries did sometimes occur.
Staff had received training in identifying and reporting abuse. Staff were able to explain to us the signs of abuse and how they would report any concerns they had. They stated they were confident any concerns brought to the manager would be dealt with appropriately. There was a robust recruitment procedure in place which minimised the risks of abuse to people. People who could comment told us they felt safe in the home and they all knew who to talk to if they wanted to raise a concern or complaint.
People saw healthcare professionals such as the GP, district nurse, chiropodist and dentist. Staff supported people to attend appointments with specialist healthcare professionals in hospitals and clinics. Staff made sure when there were changes to people’s physical well- being, such as changes in weight or mobility, effective measures were put in place to address any issues.
Everybody spoken with told us they enjoyed the food, they all said the food was good. People were offered choices and the food was nutritious and well presented. People who needed assistance with eating were supported in a dignified and unhurried manner. Some people chose to eat in their room.
We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.