Archived: St Georges Care Home

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.

St Georges Care Home is a residential care home providing accommodation and personal care to 30 people aged 65 and over at the time of the inspection. The service can support up to 35 people and has a large communal lounge and dining area. People's bedrooms were all on the ground floor.

People’s experience of using this service and what we found

Where people had come to harm, incidents had not always been reported to the local authority or CQC, as the provider was required to do. This meant there was no independent oversight to ensure people were fully protected.

Risks in relation to people's care were not always assessed or sufficiently detailed to ensure people were cared for in a safe way. There was not always accurate guidance in place for staff about how to manage or reduce risk.

Incidents and accidents were not always followed up to avoid the risk of recurrence. Records of incidents which had occurred were confusing and lacked detail on actions taken by staff. There was a lack of oversight and learning in relation to incidents and accidents.

There were not enough staff deployed at the service which put people at risk. Staff had not received appropriate training and supervision that ensured good practice within the service.

We could not be assured that people received their topical medicines, such as creams, as recording systems showed gaps in application. Medicines for use ‘as required’ did not always have a corresponding protocol so staff had guidance as to when these should be offered. This included medicines to reduce psychological agitation. Some topical medicines were not stored safely, which placed people at risk of harm.

There were systems in place to control the risks of infection such as cleaning schedules, but staff had not always followed these.

People did not always have choices around their care delivery and at times were not treated with dignity. There were not sufficient meaningful activities to keep people occupied and meet their need for mental stimulation and well-being. People told us there was not enough to do and they often felt bored. They said that in the main staff were kind to them, but they did not always have time to spend with them.

The provider's systems for monitoring and improving the quality of the service had not been effective. Audits had failed to identify the issues we found and were not being used to their full potential to identify trends which can reduce recurrence of incidents. Issues identified at our last inspection remained and we identified further concerns. The registered manager had not notified the CQC of reportable incidents and events as required with their registration. Regulatory responsibilities had not been met.

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 Requires Improvement (published 17 November 2020) and there were two breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found enough improvement had not been made and the provider was still in breach of previous regulations, and new breaches of regulation.

Why we inspected

We received concerns in relation to unsafe staffing levels and concerns about the quality of care people were receiving. As a result, we undertook a focused inspection to review the key questions of safe, caring, responsive and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from Requires Improvement to Inadequate. This is based on the findings at this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home 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 the safe, caring, responsive and well-led 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 on our website at www.cqc.org.uk.

Enforcement

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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We identified breaches in relation to assessing and managing risk, staffing, dignity, governance and reporting procedures.

Following the inspection we issued a Notice of Proposal to impose conditions on the providers registration. The provider did not make representations. We subsequently issued a Notice of Decision to impose conditions on the providers registration. The provider will send monthly information to us so we can monitor how the service is making improvements.

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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The overall rating for this service is ‘Inadequate’ and the service is therefore 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.

St Georges Care Home is a residential care home providing personal and nursing care to 20 people aged 65 and over at the time of the inspection. The service can support up to 35 people.

The care home accommodates people in one purpose built premises.

People’s experience of using this service and what we found

Medicines were not managed safely. Topical medicines were not always stored, applied and recorded appropriately. Records did not always show when medicines prescribed to be given when required should be given. Where people required their medicines to be administered covertly, such as crushed in food, there was a lack of guidance for staff as to how to support people with covert medicines. The service was working with the local Clinical Commissioning Group to improve their medicines management.

The registered manager is registered for this and two of the providers other services. This service is managed on a day to day basis by a deputy manager. The service has had three deputy managers since the provider took it over in January 2020 and the deputy manager in post on the first day of our inspection visit has left the service.

Audits carried out by the management team were not always used to drive improvement in the service.

People living in the service told us that staff respected their privacy and dignity. However, we observed occasions where people were not treated with dignity.

The registered manager and deputy manger were aware of current PPE guidance and staff had received infection control procedures. However, we observed staff were not always wearing masks appropriately.

Care plans contained sufficieint information for staff to deliver care and support according to people’s needs and preferences. Staff recording in care plans could be more detailed to reflect people’s mental well-being in addition to the physical care given. Care plans were not always updated to reflect people’s changing needs.

The registered manager told us that people were involved in their care planning where possible. However, people’s involvement was not recorded in the care plans. We received very mixed feedback from relatives about their involvement with their relatives’ care planning and contact from the service.

Staff told us that there were sufficient staff to provide care and support. Appropriate checks were carried out before staff provided care and support.

People told us they enjoyed the food. We observed the lunch time meal, people were offered a choice of food and received support as required.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. There was some lack of understanding by staff as to their role in assessing mental capacity in some instances.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection The last rating for the service under the previous provider was Inadequate, published in December 2019.

Why we inspected

This was a planned inspection based on the previous rating and was prompted in part due to concerns received about medicines and staffing levels. A decision was made for us to inspect and examine those risks.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

We have found evidence that the provider needs to make improvements. Please see the list of relevant key question sections 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 on our website at www.cqc.org.uk.

Enforcement

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

We have identified breaches in relation to the management of medicines and the overall management of the service. Please see the action we have told the provider to take at the end of this report.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.