Background to this inspection
Updated
18 April 2018
‘We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.’
The inspection took place on 8 March, and was unannounced. This meant the provider did not know we were coming.
The inspection was carried out by two adult social care inspectors. A specialist advisor who is a Nurse with knowledge and experience of supporting people with dementia within the NHS (National Health Service) and an expert by experience who spoke to people and relatives to gain their opinions and views of the service. An expert by experience is a person who had personal experience of using or caring for someone who used this type of service.
Before the inspection we reviewed other information we held about the service and the provider. This included statutory notifications we had received from the provider. Notifications are changes, event or incidents the provider is legally obliged to send to CQC within required timescales. We used information the provider sent us in the Provider Information Return. This is information we require providers to send us at least once annually to give some key information about the service, what the service does well and improvements they plan to make.
We also contacted the local Healthwatch, the local authority commissioners for the service, the local authority safeguarding team and the clinical commissioning group (CCG). Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England.
During our inspection we spoke with eight people who lived at St Georges Hall and Lodge. We spoke with the regional manager, acting manager, one nurse, the administrator, the activity coordinator and 4 care workers. We also spoke with four relatives of people who used the service and one visiting health care professional.
We looked around the home and viewed a range of records about people’s care and how the home was managed. These included the care records of five people, 29 medicine administration records (MAR). We reviewed five staff recruitment files, training records, and records in relation to the management of the service.
Updated
18 April 2018
The inspection took place 8 March 2018 and was unannounced. This meant the provider and staff did not know we were coming.
St Georges Hall and Lodge 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.
We inspected St George’s Hall and Lodge in December 2016 and found the provider was not meeting one of Regulations of the Health and Social Care Act 2008 (Regulated Activities) relating to staffing. At this inspection we found the provider had taken action and staff had received regular supervision.
St Georges Hall and Lodge is registered to provide accommodation for up to 83 people. At the time of the inspection the service was providing care to 29 people living with dementia.
The service did not have a registered manager. The acting manager had applied to be the registered manager and was waiting for their fit person’s interview with the Care Quality Commission.
‘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.’
People and their relatives felt the service was safe. Policies and procedures were in place to keep people safe such as safeguarding and whistleblowing policies. Staff had received training in safeguarding and knew how to report concerns.
Staff recruitment procedures were robust and included Disclosure and Barring Service checks and references. Staffing levels were appropriate to the needs of the people using the service.
Risk assessments were detailed, person-centred, and gave staff clear guidance about how to help keep people safe. People had personal emergency evacuation plans in place in case of an emergency.
Staff were trained in a range of subjects such as health and safety, first aid and fire safety. Staff had also received training to support them to meet the needs of people who used the service, such as dementia training.
Staff received regular supervisions and an annual appraisal which covered their personal development. Staff felt they were well supported by the manager.
People had access to a range of healthcare, such as GPs, occupational therapy and dentistry. Nutritional needs were assessed and people enjoyed a health varied diet.
The premises were well suited to people’s needs, with ample dining and lounge space. Bathrooms were designed to incorporate needs of the people living at the home. The corridors and reception area were spacious for people using mobility equipment. Signage was available to support with orientation around the home.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.
The atmosphere at the home was warm and welcoming with ample communal space. Relatives and friends felt welcome when visiting with staff offering refreshments and the opportunity to eat with their loved one. People were encouraged to make choices in everyday decisions. Staff were described as kind and caring. Staff provided support and care in a dignified manner, ensuring privacy when necessary.
Care plans were in place but these were not always personalised. Reviews of care plans did not always capture whether the plan was meeting the person’s needs.
We made a recommendation about the providers approach to care records.
People enjoyed a range of planned activities. The service had positive links with the community.
The provider had a complaints process in place which was accessible to people and relatives. The manager responded to all complaints and concerns.
Staff were extremely positive about the manager. They confirmed they felt supported and were able to raise concerns. We observed the manager was visible in the service and found people interacted with them in an open manner.
The quality assurance process included audits of medicines, care plans, quality surveys and health and safety checks. Where necessary actions were set following audits and these were linked with the development plans for the service.