This inspection took place on 25, 26 and 27 January 2017 and was unannounced.In April and May 2015 St Georges Care Home received its first ‘rating’ inspection and was rated requires improvement. We issued five regulatory requirement actions for regulatory breaches relating to safe care and treatment, person centred care, staffing, good governance and dignity and respect. After the inspection, the provider wrote to us to say what they would do to meet the legal requirements.
We undertook a focused inspection on 6 and 7 January 2016 to check the provider had followed their plan and to confirm they now met the legal requirements. We had also received information from the local authority that had concerns about the quality and safety of the service provided for people in the home.
We found insufficient actions had been taken in response to some of the breaches identified at the previous comprehensive inspection in 2015. There were five regulations breached at this inspection in relation to safe care and treatment, safeguarding service users from abuse and improper treatment, person centred care, staffing and good governance. A warning notice was issued in relation to safe care and treatment.
The last comprehensive inspection took place in July 2016; the service was rated requires improvement. We found that sufficient action had been taken in relation to the warning notice we had issued following the previous inspection. Improvements had been made since the last inspection however further improvements were needed to embed the changes. There were two breaches of regulations in relation to staffing and good governance at this inspection.
At this inspection (January 2017) we found nine breaches of regulations. Both of the previous breaches from the last comprehensive inspection in July 2016 had been repeated. We also found seven further breaches in relation to safe care and treatment, person centred care, safeguarding people from abuse and improper treatment, consent, complaints, dignity and respect, and statutory notifications.
St Georges Care Home is a 68 bedded home that provides accommodation for persons who require nursing or personal care. At the time of our inspection there were 50 people living in the care home.
At this inspection the overall rating for the service is 'Inadequate' it will therefore be placed into special measures. The commission is now considering the appropriate regulatory response to resolve the problems we found.
There was a registered manager in place at the time of our inspection; 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.
There were widespread and systemic failings identified during the inspection. Overall we found that quality and safety monitoring systems were not fully effective in identifying and directing the service to act upon risks to people who used the service and ensuring the quality of service provision. The failings included issues around staff management and staff cohesiveness that impacted on service delivery.
The registered manager and provider had failed to make appropriate statutory notifications; notifications tell us about significant events that happen in the service. We use this information to monitor the service and to check how events have been handled.
There was a failure to safeguard people. The registered manager had failed to report and take appropriate action regarding adverse incidents. The registered manager had failed to recognise the inappropriate restraint of people.
The registered manager had made applications for Deprivation of Liberty Safeguards (DoLS ) where they had been assessed as being required. These safeguards aim to protect people living in care homes from being inappropriately deprived of their liberty. These safeguards can only be used when a person lacks the mental capacity to make certain decisions and there is no other way of supporting the person safely.
We found however that the registered manager and other staff had a variable understanding of the Mental Capacity Act 2005 and DoLS. The registered manager had failed to ensure staff met the DoLS conditions for a person with DoLS.
There were not enough suitably trained staff to meet people’s needs. Staff had not received training and supervision which supported them in their roles.
Care plans were not person centred. Peoples' risk assessments were not reflective of people’s needs. Records used to monitor peoples' health were not always completed. This exposed people to risks of neglect and unsafe or inappropriate care or treatment. The administration of people's medicines was not in line with best practice.
We observed occasions when care delivered by staff compromised peoples dignity and respect. There was a divisive staff culture and poor communication between staff which impacted negatively on care delivery. Complaints made by people and relatives were not always recorded and resolved to the satisfaction of complainants.
Recruitment procedures were followed appropriately to ensure safe recruitment practices
We found nine breaches of regulations at this inspection and will be asking the provider to send us a report of the improvements they will make.
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.
Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.