St Georges Care Home

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

Well-led – this means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture.

At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement. We found a breach of 1 legal regulation in relation to good governance.

This meant the management and leadership was inconsistent. Leaders and the culture they created did not always support the delivery of high-quality, person-centred care.

This service scored 57 (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 new management team at the service who were keen to make improvements to the culture of the organisation. Staff had regular meetings and were supported with their individual needs, however they felt some improvements were still needed to the management of the service.

For example, we received mixed feedback from staff on the management of the service and the support provided to them. As 1 member of staff told us, “Management is improving.” Another member of staff told us, “They’ve been supportive.” One member of staff felt there were still improvements needed to the management of the service. The provider’s management team were aware following feedback from the last staff survey, improvements were needed to how the service was being managed.

The registered manager and deputy told us they had started to hold regular meetings and provide staff with supervision. Team meetings recorded areas for the team to focus on. For example, ensuring accurate recording within people’s documentation.

The provider’s management team had a development plan in place. This had identified areas of improvement for the service. The management team and senior staff attended a daily meeting where any priorities were discussed. Staff attended hand over meetings where people’s needs and any changes were discussed.

The provider had a management team who led the service with clinical knowledge and experience. They were open about the improvements needed to the service.

People and relatives were familiar with the leadership in the service. However, staff gave us mixed feedback on if they felt able to raise any concerns with the management of the service. For example, 1 member of staff told us, “Management is improving”. Another member commented that it depended on who they went to. Another member of staff told us, “Management have been supportive”. The regional director and the regional clinical manager visited the service, whilst visiting the service they confirmed they liaised with staff. The provider had completed a staff survey and had an ongoing action plan to support improvements to the service.

The registered manager, deputy manager and clinical lead were all new to the service. They were all keen to make improvements to the care and support provided to people and to liaise with professionals so this was achieved.

The provider was making improvements to how staff felt able to raise any concerns so their voice would be heard.

The service displayed information explaining how to raise a safeguarding concern within the home and a whistleblowing policy was in place. However, some staff raised with us they felt improvements were still needed to the management of the service. The provider had organised an employee feedback session where staff had been provided with an opportunity to speak up and make improvements in the service. The provider continued to work through their action plan to make improvements to the service.

The service provided staff with a handbook which included information for staff on how they could speak up and explained the provider’s approach to discrimination and harassment.

The provider valued diversity in their workforce. They worked towards an inclusive and fair culture by improving equality and equity for people who worked for them.

The provider ensured policies and procedures supported equality, diversity and human rights to guide staff on best practice. The service offered flexible working arrangements to staff where they could be accommodated. Where standard shift times had recently changed, the manager had consulted with staff and provided sufficient notice of the change.

Staff were employed from different backgrounds, and the service had a diverse workforce. While current staff did not require any reasonable adjustments, the registered manager told us they would be happy to accommodate these where needed. Staff were being provided with opportunities to grow and develop through training and qualifications. However, 1 member of staff raised with us they had requested this, but it had not been offered to them. We observed staff demonstrating respect for each other and the people they were supporting.

The provider’s governance and quality assurance systems were not identifying all shortfalls so improvements could be made to the service and to people’s care and experience.

For example, during the inspection we identified improvements needed to 2 people’s diabetes care planning information, risk assessments and mental capacity and best interest decisions needing to be completed for diabetes care. Improvements to people’s care planning documentation relating to their mobility needs and guidance for staff in how to use this equipment. On occasions we observed people not being supported by enough staff and people raised with us they had to wait on occasions for assistance from staff. Not all equipment was being suitably stored or checked to ensure it was safe for people, this also included people who were at risk of pressure sores. Some people were losing weight, and it was not clear the service were doing all they could to support the person to meet their nutritional needs, whilst also raising a referral. Not all incidents and accidents and safeguarding concerns had an outcome of actions taken or a referral made if required.

The provider’s governance arrangements had also failed to identify improvements needed to ensure all staff completed training to support people with their individual needs. Such as where staff were applying topical creams and where staff could benefit from diabetes training.

The provider’s management team started to take action during our inspection and improvements were made to people’s equipment, and where incidents and accidents needed referrals and a review. Although the management team had started to take these actions during our inspection, improvements were still required to the provider’s governance arrangements.

The provider had a service improvement plan in place. This identified actions needed, if they had been completed or if they were still outstanding. We found the action plan had not identified all shortfalls found during our inspection. We shared our inspection findings with the registered manager and the provider’s senior managers so they could review these shortfalls and any changes they needed to make to the service improvement plan.

The provider’s statement of purpose had limited information on the aims and objectives of the service. We provided information on what CQC expects within the provider’s statement of purpose so the provider could review this and send an up-to-date statement of purpose. As part of the inspection, we found some changes were being made to the available bedrooms at the service. We recommended the provider reviews these changes to ensure the service is registered with us accurately.

The provider was displaying their rating on their website as required.

The registered manager understood their duty to collaborate and work in partnership, so services worked seamlessly for people. However, we found there was not always a joined-up approach so relatives were familiar with any changes to people’s needs or referrals were being made when required.

The registered manager felt there had been improvements made to how the service liaised and worked in partnership with health and social care professionals.

The registered manager, deputy manager and clinical lead were responsible for making referrals to health and social care professionals. However, we found during our inspection some referrals were not being made as the earliest opportunity. For example, when people were losing weight. One person had been losing weight for a few months, and a referral had only recently been made. Not all relatives we spoke with felt the service provided them with important information if there had been any changes to the person’s needs. For example, 1 relative told us they were awaiting an update after raising something with the management. Another relative, was unable to confirm the outcome of a safeguarding concern. At the time of the inspection no relatives’ meetings were being held. However, the registered manager confirmed they were hoping to improve this.

The provider was not always ensuring there was continuous learning, innovation and improvement across the organisation and local system. We found they were not always ensuring incidents and accidents had actions and outcomes confirmed and referrals were being made when required.

For example, there was not always a proactive and positive culture when concerns were raised as we found 1 person with an unexplained bruise on their arm there was no incident form confirming what action had been taken or any referrals made. The provider’s quality assurance team reviewed incidents raised as a safety event. However, we found not all of these had an outcome confirming what actions had been taken and if they had been resolved. This meant we were not always able to establish what learning and improvements had or were being made to prevent similar incidents from occurring again. We raised this with the provider so they could review this feedback.

Daily clinical meetings were held with nursing staff. These meetings were an opportunity to review any changes to people’s immediate needs such as if they had experienced a fall or if they were unwell that day. The registered manager undertook reviews of incidents and accidents. However, we found limited documentation of any learning and actions taken with staff so any trends and themes could be identified, and people’s care and support could be improved on and referrals made if required.