Background to this inspection
Updated
10 August 2022
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.
As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.
Inspection team
This inspection was carried out by two inspectors and a medicines inspector who specifically looked at the safe management of people's medicines. Following our visit on site an Expert by Experience made telephone calls to people and their relatives to seek their feedback. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service
Service and service type
St Georges Care Service is a ‘care service’. People in care services receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. St Georges Care Service is a care service without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
Registered Manager
This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
At the time of our inspection there was a registered manager in post however the registered manager was also the regional manager and therefore was overseeing some of the providers other care services as well. The registered manager was also the CQC nominated individual for the provider. The nominated individual is responsible for supervising the management of the service on behalf of the provider. We have referred to this person as the ‘registered manager’ in this report.
There was a manager in post at St Georges Care Home who commenced employment in early 2022. This manager was in the process of applying to CQC to register and take over the registered managers position from the regional manager. We have referred to this person as the manager in this report.
Notice of inspection
This inspection was unannounced on both days.
What we did before the inspection
We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. The provider was not asked to complete a provider information return (PIR) prior to this inspection. The PIR is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report. We used all of this information to plan our inspection.
During the inspection
We spoke with relatives of eight people who used the service about their experience of their family members care provided. We also had contact with ten members of staff, including the manager and the registered manager.
We observed people's care to help us understand the experience of people who could not talk with us. We reviewed a range of records. This included people's care records and medication records. We looked at a variety of records relating to the management of the service.
Updated
10 August 2022
About the service
St Georges Care Service is a residential care service providing accommodation and personal care to up to 35 people aged 65 and over. Most people were living with dementia. At the time of the inspection there were 24 people living in the service.
People’s experience of using this service and what we found
Risks to people were not always recognised and mitigated. Medicines were not managed safely. There were not enough staff on duty to ensure people's care and support needs were being met. Appropriate checks were not always conducted prior to staff working at the service.
Risks to people were not always assessed, monitored and managed safely. Systems in place did not always protect people from the risk of abuse and improper treatment. Staff were not deployed effectively to ensure care was delivered in a safe way. Although large parts of the service were clean and well-maintained staff were not always following good infection prevention control as they frequently removed their mask/face covering in the vicinity of people living at the service.
Safeguarding and accident and incident records were inaccurate and incomplete, which impacted on the provider's ability to analyse information and to learn when things went wrong.
People continued to not always be safeguarded from the risk of abuse as oversight of these systems were not effective and the provider failed to take action when required.
The provider was not working in line with the principles of the Mental Capacity Act 2005. People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.
We were not assured the provider or manager understood regulatory requirements. The provider and registered manager had not notified CQC of all potential incidents and safeguarding concerns at the service. There was a lack of effective and robust quality assurance tools and oversight in place at the service.
The service had received support and guidance from the Local Authority and Clinical Commissioning Group (CCG) and there was an action plan in place. However, insufficient improvements had been made or sustained despite the additional support.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection and update
The last rating for this service was Inadequate (published 20 September 2021). The service remains rated Inadequate. This service has been rated either Requires Improvement or Inadequate with breaches of the regulations for the last six consecutive inspections both under the previous provider and this provider.
Why we inspected
This inspection was carried out to follow up on action we told the provider to take at the last inspection.
We looked at infection prevention and control measures under the Safe key question. We look at this in all care service inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.
We have found evidence that the provider needs to make improvements. Please see all of the key question sections of this full report.
You can see what action we have asked the provider to take at the end of this full report. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for ‘St Georges Care Home”.
Enforcement and Recommendations
We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.
We have identified breaches in relation to staffing, risk management, person centred care, the application of the Mental Capacity Act 2005, notifications and oversight at this inspection.
Please see the action we have told the provider to take at the end of this report.
Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.
Follow up
We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.
Special Measures:
The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.
If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.