• Care Home
  • Care home

Archived: St Georges Hall and Lodge

Overall: Good read more about inspection ratings

Middle St George Hospital Site, Middle St George, Darlington, North Yorkshire, DL2 1TS (01325) 335425

Provided and run by:
Orchard Care Homes.Com (4) Limited

All Inspections

8 March 2018

During a routine inspection

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.

6 December 2016

During a routine inspection

The inspection took place on 6, 7 December 2016. The inspection was unannounced which meant the provider did not know we would be inspecting.

St Georges Hall and Lodge is a care home that provides accommodation for people who require personal or nursing care. The home is based on the outskirts of Middleton St George near Darlington County Durham and provides care for older people and people living with dementia. The home is registered to provide accommodation for up to 83 people. On the day of our inspection there were 50 people using the service.

The home did not have a registered manager in place managing the service. 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.

We spoke with a range of different team members; the area manager, the manager, care staff, kitchen staff, domestics and the hair dresser who gave positive reviews about the management of the service.

We found the environment to be clean and infection control measured in place however we found several areas where mal odour was present and addressed this with the provider.

From looking at people’s care plans we saw they held peoples personal history and described individuals’ care, treatment, wellbeing and support needs. They detailed care required and were written in plain English and in a ‘person centred way.’ Person centred care is an approach that aims to see the person as an individual, rather than focusing on their illness or disability.

During the inspection no activities were planned for people and there were little or no activities on offer for people to take part in.

Individual care plans contained personalised risk assessments. These risk assessments identified risks and were in place to enable people to take risks safely.

On the day of our inspection people who used the service were supported by sufficient numbers of staff to meet their needs. We could see that there had been previous staffing issues and this had improved since our last inspection and people who used the service were supported by enough people to meet their needs.

When we looked at the staff training records they showed us that staff were supported to maintain and develop their skills through training and development opportunities. We found that training was up to date and current.

When we looked at supervision and appraisal records we saw that these had not been carried out with all staff.

Staff recruitment records that we looked at showed us that staff were recruited safely.

We looked at protocols and recording systems for people who take medicines ‘as and when required’ and we found recording systems were not always consistent.

We observed how the service stored and administered medicines. We looked at how records were kept and spoke with the management team about how staff were trained to administer medication and we found that medicines were administered safely.

During the inspection we witnessed the staff rapport with the people who used the service and saw consistent positive, caring and warm interactions took place.

We saw people were encouraged to eat and drink sufficient amounts to meet their needs. However we saw people having their meals and peoples dining experience wasn’t always enjoyable. The daily menu was not developed with the people who used the service to incorporate their likes and preferences but was adapted to meet people’s needs and preferences.

We saw complaints and compliments procedure was in place and this provided information on the action to take if someone wished to make a complaint and what they should expect to happen next. We saw evidence that the complaints procedure was adhered to. People who used the service were aware of how to complain and were supported to do so.

We found that quality assurance checks took place regularly and where issues were identified and there were active action plans in place.

A programme of audits was carried out by the manager regularly.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that as far as possible people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible.

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. We found the service had a policy in place that was working within the principles of the MCA.

During the inspection we found breaches 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 the report.

13 July 2016

During an inspection looking at part of the service

We carried out an un-announced comprehensive inspection of the service on 28, 29 January and 1 February 2016. Breaches of legal requirements were found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches.

Regulation 18 (Staffing) of the Health and Social Care Act 2008 (Regulated Activities)

Regulations 2014.

Regulation 9 (Person – centred care) of the Health and Social Care Act 2008 (Regulated

Activities) Regulations 2014.

We undertook this focused inspection to see what progress had been made in relation to their action plan. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for St Georges Hall and Lodge on our website at www.cqc.org.uk.

Our inspection was carried out on 13 July 2016 and was unannounced. This meant that the service was not expecting us. The inspection team consisted of two Adult Social Care inspectors. At the inspection we spoke with six people who used the service, four relatives, the manager, the administrator, the operations manager, the clinical lead, nursing staff, two kitchen staff, domestic staff, three members of care staff and three members of agency staff.

St Georges Hall and Lodge is a residential care home based in Middleton St George on the outskirts of Darlington, County Durham. The home provides care to older people and people living with dementia. It is not situated close to a town centre or close to any local amenities. Transport links to Darlington and Middleton St George village are limited. On the day of our inspection there were 61 people using the service.

The service had a manager in place who had submitted their application to register with CQC and was awaiting an interview to determine if they were ‘fit’ to become the registered manager for 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.

At the last inspection on 28, 29 January and 1 February 2016. we asked the provider to take action to make improvements in the following areas; staff training, personalised care plans, dining experience for people who used the service and to provide a dementia friendly environment.

At this inspection we found that the provider had made progress with some of the actions. The number of staff who had received up to date training had increased. Some care plans now included more personalised information regarding their personal routines and some history information and the provider assured us that more personalised information was to be included.

During breakfast time we saw that the kitchen staff were helping out in the dining room and this improved the efficiency of the meal time. We saw that fresh snacks had been introduced and were available but we still received mixed reviews about the food on offer at the service.

There had been no further improvements at the service regarding improving the physical environment to support people living with dementia. The registered provider assured us that this was being researched and planned.

You can see what action we told the provider to take at the back of the full version of the report.

28 January 2016

During a routine inspection

The inspection took place on 28, 29 January and 1 February 2016. The inspection was unannounced. We previously inspected this service on 9 July 2014 and found the service to be compliant.

St Georges Hall and Lodge is a residential care home based in Middleton St George on the outskirts of Darlington, County Durham. The home provides care to older people and people living with dementia. It is not situated close to a town centre or close to any local amenities. Transport links to Darlington and Middleton St George village are close by. On the day of our inspection there were 62 people using the service.

The home had a temporary manager who at the time of our inspection wasn’t 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.

We spoke with a range of different team members; care, nursing, senior and kitchen staff who told us they felt well supported and that the manager although temporary, was supportive and approachable. Throughout the day we saw that people who used the service and staff were comfortable, relaxed and had a positive rapport with the manager and with each other. The atmosphere was welcoming, but very busy. We saw that staff interacted with each other and the people who used the service in a friendly, caring, positive manner.

From looking at people’s care plans we saw they were written in plain English, using a tick box template throughout, not written in a person centred way, didn’t include a ‘one page profile’ and didn’t make use of pictures. Peoples’ personal histories were missing from some of the care plans we looked at. They described individuals care, treatment and support needs and the daily record part of the plans were completed regularly and the care plans were regularly reviewed and updated by the care staff and the manager.

Individual care plans contained risk assessments. These identified risks and described the measures and interventions to be taken to ensure people were protected from the risk of harm. The care records we viewed also showed us that people’s health was monitored and referrals were made to other health care professionals where necessary for example: their GP, community nurse or Chiropodist.

Our observations during the inspection showed us that people who used the service were supported by sufficient numbers of staff to meet their basic care needs but not enough to be in a person centred way. The service used three different care agencies to manage staffing levels to cover sickness and vacancies and at times there were more agency staff than permanent members of staff.

When we looked at the staff training records they showed us staff were supported and able to maintain and develop their skills through training and development opportunities. The staff we spoke with confirmed they attended a range of learning opportunities. However we found that some mandatory training wasn’t up to date and staff needed to attend refresher training. Care staff we spoke with told us they had regular supervisions and appraisals with the manager, where they had the opportunity to discuss their care practice and identify further mandatory and vocational training needs. We also viewed records that showed us there were robust recruitment processes in place.

We observed how the service administered medicines and how they did this safely. We looked at how records were kept and spoke with the nursing staff and the service training manager about how staff were trained to administer medication and we found that the medication administering process was safe.

During the inspection we witnessed the staff rapport with the people who used the service and the positive interactions that took place. The staff were caring, positive, encouraging and attentive when communicating and supporting people.

People were encouraged to participate in activities that were planned in advance, including; bingo, crafts, music and singing. We saw staff spending their time positively engaging with people as a group on activities but not on a one to one basis with meaningful activities chosen by them. We saw evidence that people were being supported to go out and be active in the local community when it was possible but due to transport arrangements this was limited.

We saw people were encouraged to eat and drink sufficient amounts to meet their needs. We observed that drinks were available in some areas and in peoples rooms but not in others. We saw people were offered snacks at different times with drinks but there were no freely available snacks throughout the home for people to access. The daily menu that we saw offered 2 choices and it was not an issue if people wanted something different.

We saw a complaints and compliments procedure that was in place and this provided information on the action to take if someone wished to make a complaint and what they should expect to happen next. Although the complaints information poster on display on the notice board was out of date as all the staff named had left the service.

We found a quality assurance survey had taken place previously and we looked at the results. However there were no action plans attached to this or feedback for people who had taken part in the survey for example staff and relatives. The service had been regularly reviewed through an internal and external audits and there were actions identified that were on going to make improvements to the service. We saw that an action plan had been developed to improve the service and address issues found via the internal audits. We found people who used the service; their representatives were asked for their views at meetings but these had not been taking place recent months.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that as far as possible people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible.

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. We found the service was working within the principles of the MCA.

You can see what action we told the provider to take at the back of the full version of the report.

9 July 2014

During a routine inspection

Our inspection team was made up of two inspectors and an expert by experience. We gathered evidence against the outcomes we inspected to help answer the five key questions: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

We looked at a range of records, spoke with the manager, deputy manager, activity co-ordinator, seven members of staff, one visiting healthcare professional, 7 people who used the service and 3 relatives. We also observed the interactions between staff and people living at St Georges Hall and Lodge.

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

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

Is the service safe?

Everyone we spoke with told us they felt safe and secure living at St Georges Hall and Lodge. Staff we spoke to understood the procedures which they needed to follow that ensured people were safe.

People were protected against the risks associated with the use and management of medicines. They received their medicines at the times they needed them and in a safe way. Medicines were recorded appropriately and kept safely. People told us that they had no concerns about their medicines.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care home. The home had proper policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards. At the time of our inspection they had two DoLs safeguarding's in place. Staff had received training in relation to these topics along with the safeguarding of vulnerable adults and had an understanding of the actions to take. Staff were also taking responsive action in submitting applications for those people who were affected by the recent case law judgement passed by the Supreme Court in March 2014.

People were aware of the complaints procedure and there were systems in place for monitoring complaints.

Is it effective?

People all had their needs assessed and had individual care records which set out their care needs. People told us that they received the care and support they needed. Relatives confirmed they had been asked for their input and opinions on their loved ones care plans. We saw evidence of how the information from people's care records were transferred into practice. Examples included the use of certain equipment, such as moving and handling equipment and how someone was cared for in bed.

It was clear from our observations and from speaking with staff that they had a good understanding of the people's care and support needs and that they knew them well.

Staff knew how and when to involve other health and social care professionals. We saw lots of evidence contained within people's care records. We also spoke with a GP who confirmed that the staff responded appropriately to people's changing healthcare needs.

Arrangements were in place to administer medicines at the right time in relation to meals, or to meet the needs of people who required their medicines at specific times of the day.

Is it caring?

People were supported by kind and attentive staff. We saw that staff engaged with people in a positive way and showed respect, kindness and gave people gentle encouragement.

People's needs had been assessed and care plans put in place which detailed people's needs and preferences. These records provided a good level of information to staff on what care and support people who lived at St Georges Hall and Lodge needed. Care and support had been provided in accordance with people's wishes.

Is it responsive?

There was clear evidence contained within people's care plans to show how they worked with other health and social care professionals.

People told us that they knew how to make a complaint if they needed to. When asked about the complaints process, the relatives we spoke with all said they would go to the manager with any problem which had not been resolved with care staff.

It is well led?

The service worked well with other agencies and services to make sure people received their care in a joined up way. People who used the service could use/consult with a chiropodist, dentist, hairdresser and optician who visit the home regularly. They have GP visits from two different surgeries with a Wednesday 'ward' round and the surgery matron visits every Monday and Friday to cover any urgent matters.

The home had a registered manager, who was supported by a deputy manager. There were systems in place to assure the quality of the service they provided. The way the service was run was regularly reviewed. Actions were put in place when needed and we were able to see that these actions had been addressed.

People who used the service, their relatives and friends had opportunities to attend regular meetings and to also give feedback about the service via an annual survey.

Staff were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and were knowledgeable about people's needs. This helped to ensure that people received a good quality service at all times.

We saw that a system for regular quality assurance and monitoring of medicines management was in place.

Several staff have undertaken 'champion courses' in different conditions: diabetes, hearing, dementia, sight and well man.

What people told us.

The majority of responses from relatives were concerning the staff and, without exception, all positive. One said 'They are very caring and open to requests' and 'We are really pleased with the staff, they are very caring.' Another said 'We visit at various time, unannounced, and the atmosphere and staff are good' and also 'They are very professional and the residents always come first,' 'I am kept involved with their care.'

People who used the service said 'This is a nice place to live, all the staff are good'.

A visiting healthcare professional said 'I always see familiar faces, I have no concerns and staff seem trained and able.'

Staff said 'We have a good shift pattern and staff and residents are lovely,' and 'We treat people as individuals, show them we love and care for them, some people like a laugh and a joke some don't,' and 'We get to know what makes them happy or sad.'

11 September 2013

During a routine inspection

Some of the people using the service had complex needs which meant they were unable to tell us their views because of this we used a number of different methods to help us understand their experiences.

The people living at the home told us they were happy with the service provided. One person told us that the staff were 'Great' and they knew them well. Another person said that the care home was 'Very nice' to live in and the food was good and there were 'No complaints' about the staff.

We spoke with a visiting health care professional on the day of our visit. She said that the person she had been to visit was 'Comfortable, happy and settled'. She said she thought the staff had a good knowledge of the person.

We found that people were given care and support which met their needs. The provider had taken steps to provide care in an environment that was suitably designed and adequately maintained and there were systems in place to identify, assess and manage risks to the health, safety and welfare of people using the service. There was also a complaints system available.

On the day of our visit there were enough qualified, skilled and experienced staff on duty to meet people's needs.