St George's Nursing Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm.

At our last assessment we rated this key question requires improvement. At this assessment the rating has remained requires improvement.

This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

This service scored 59 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had a system that collated incidents and accidents and these were discussed at staff meetings. However, some improvements were needed where a person had unexplained bruising and where people raised incidents that could have possibly been avoided.

Incidents and accidents were reviewed by the registered manager and senior managers as required. However, during the inspection we observed 1 person who had bruising to their arm, which had not been raised or reviewed prior to our inspection. Some people and their families raised with us about incidents that had occurred. We discussed this with the registered manager who confirmed actions they had taken following incidents occurring and what actions they had taken following reviewing the bruising to 1 person and their arm. Although they provided a response to actions now taken there had been occasions when incidents and altercations had occurred that might have been avoided if there was staff intervention.

The provider following our inspection confirmed actions being taken. This included requesting staff complete sufficient documentation where people had unexplained bruising. They also provided assurance they had reviewed any unexplained bruising and ensured documentation was in place. Although we found during our inspection some improvements were still required.

Referrals were made to health and social care professionals for example, when people were experiencing frequent falls, this was confirmed within people’s care plans including any outcome.

The provider’s senior management team were responsible for monitoring any concerns or action needed following incidents and accidents. Notifications were being made to (CQC), Care Quality Commission as required.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

The registered manager confirmed they gathered information to support people prior to their admission to the service. They liaised with health and social care professionals as needed and worked in partnership to support people’s continuity of care, for example when people went into hospital. Discussions were held with the local GP practice if required and people were supported with weekly visits should they need this and referrals were made to other professionals as required. People’s care plans contained information to support staff where people had any health conditions.

The provider worked with people and healthcare partners to understand what being safe meant to them. Although we found some improvements were needed to ensure people did not experience incidents from others who lived within the service.

For example, during our inspection some people raised with us where they had experienced incidents within the service. The registered manager confirmed actions taken and any involvements with health and social care professionals and referrals made to safeguarding. Although they had taken action following an incident it was not clear if these incidents could have been prevented, for example if there had been more staff available to support people. We raised this with the registered manager as part of our inspection feedback and more information is within the quality statement of safe and effective staffing.

Staff received training in safeguarding adults, and all felt able to raise any concerns with senior managers and the management of the service if needed. The provider used a quality assurance system to review safeguarding concerns along with what actions were being taken including referrals and notifications made. The provider following our inspection confirmed staff were provided with information on safeguarding and who to contact should they need to.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making decisions on behalf of people who may lack the capacity to do so for themselves. Any decisions made on their behalf must be in their best interests. People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. In care homes, and some hospitals, this is usually through MCA application procedures called the Deprivation of Liberty Safeguards (DoLS).

People’s care plans contained important information such as if the person had capacity. Supporting information was within people’s care plans any mental capacity assessment and best interest decisions and if there was a Deprivation of Liberty Safeguard in place.

People were supported by staff with their individual needs. Although we found improvements were needed to some people’s care planning information to ensure care was provided as needed and documented contemporaneously.

For example, where people had been assessed as needing repositioning their care documentation did not confirm they were being repositioned in line with their assessed needs. This documentation also confirmed care was provided to people at the same time which was likely when staff were documenting the care rather than when it had been provided. One person’s care plan lacked guidance for staff on what equipment staff were to use and how to support them with this and their moving and handling needs. Improvements were also needed where 2 people needed support and assistance with their diabetes care and where people needed support with their catheter care, including hygiene procedures. We raised this with the registered manager during our inspection so they could review the care planning information and associated documentation for these 2 people. They confirmed following our inspection they were taking action to improve people’s care planning information.

People’s care plans contained risk assessments for example, where people were at risk of falls and choking.

During the inspection people provided us with mixed feedback about the care and support provided to them. Some felt care provided was good and others felt there could be improvements to the support provided to them. Where people were happy for us to share this with the registered manager we provided them with this feedback.

The provider following our inspection confirmed monthly wound audits were in place to identify any concerns relating to the management of wounds and people’s care and support.

The provider detected and controlled potential risks in the care environment although some improvements were needed to people’s equipment.

For example, we observed during the inspection improvements needed to some people’s walking equipment as they required rubber replacements that were worn and posed a risk of slipping. We raised this with the registered manager who took action during our inspection to order replacements to ensure they were safe for them to use.

The service was observed to be clean and tidy with no odours. There were communal areas where people could sit and relax and various communal lounges and dining areas. Local artwork and pictures were on the walls within the service. People could access information via a notice board along with what activities were planned and what activities people had participated in. Improvements were being made throughout the service to soft furnishings, flooring and decor and the registered manager confirmed people’s views were sought on how communal areas might be painted. People and their families were free to use the café area to make themselves drinks and use the outside garden area. We observed these areas being used during our inspection.

People had personal evacuation plans in place and the provider completed fire safety checks and a fire risk assessment in the event of an emergency. The service had building safety checks for water, gas and electricity. The provider completed monthly safety checks within people’s rooms; this was an opportunity to identify any problems with furniture, furnishings and items that were broken or needed replacing.

The provider ensured staff were qualified, skilled and experienced although we had mixed feedback regarding if there were always enough staff to safely care for people. Staff felt supported through meetings, supervision and an annual appraisal.

People, relatives and staff gave mixed feedback regarding if there were always enough staff to adequately support people when they needed this. People were also being supported by agency staff. One person told, “They do have a lot of agency staff, there are people at night who wander into people’s rooms”. One relative told us, “I don’t think that there are enough staff”.

Staff told us, “There’s enough staff”. Another member of staff when asked if there were enough staff told us, “Sometimes”. During the inspection we observed 1 person who needed assistance from staff. There was no staff within close proximity to support the person as they were supporting other people. The registered manager confirmed they reviewed when people used their call bells and this was an opportunity to ensure there was enough staff. We shared our feedback with the registered manager and the provider’s management team during our inspection so they could review the staffing arrangements for people to ensure there is enough staff available to assist people when they need it.

Staff felt supported by the registered manager, nursing staff and the clinical lead. Staff received supervisions and an appraisal, regular daily meetings, clinical meetings and staff meetings. Staff told us, “Both the registered manager and clinical lead are approachable, available, they are really good” and “Really good support”.

Staff completed training in moving and handling, safeguarding, mental capacity, medicines management and training was also provided to support people with their individual needs such as with their skin care, palliative care, oral care and dementia care. The registered manager ensured staff had refresher training when required. The provider was exploring supporting staff with different levels of training and competency checks which could enable them to achieve their maximum potential, future aspirations and be recognised for this.

The provider ensured safe recruitment procedures were completed for new staff. This included the right to work in the UK and pre-employment checks such as a (DBS) Disclosure and Barring Service check and ensuring identification checks were in place and references were completed.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

The home was clean, well maintained and free from unpleasant odours. We observed staff using personal protective equipment (PPE) and washing their hands when needed. Staff had a good understanding of when to use PPE and how to dispose of this and they were provided with PPE training. Staff completed infection control training and food hygiene training.

The provider was not always ensuring improvements were being managed when shortfalls were identified and that medicines administration documentation was of a good standard.

For example, during our inspection we found improvements were needed to the documentation where people were prescribed topical creams. Topical medicines administration charts did not always confirm people were being administered their medicines as prescribed and documentation within care records did not always confirm where staff were to apply people’s topical medicines. We raised this with the registered manager who took action to address this shortfall during the inspection.

During our inspection we found improvements needed to ensure medicines were being managed safely. This included where medicines needed disposing of, confirmation of when they were opened and adequate guidance was available for staff on how to check and use medical equipment and that any other associated documentation was completed as required. We raised these shortfalls with the registered manager and deputy who started to take action during our inspection to address these shortfalls.

People were supported by care staff who administered topical medicines to them. Nursing staff administered all other medicines. Medicines were stored securely and any allergies were documented. The service had risk assessments for flammable emollients. During the inspection we observed staff administering medicines to people safely. However, on 1 occasion we observed a nurse leaving medicines for 1 person to take. This could pose a risk of the person not taking their medicines as required and the member of staff not knowing this. We raised this with the registered manager and the provider’s senior manager during the inspection.