St Georges

We found the following examples of good practice.

Visiting procedures were robust to reduce the risk of COVID-19. All visitors were required to show a negative COVID-19 test, their temperature was taken, and a COVID-19 screening questionnaire completed before they entered the service. Visitors were also required to wear personal protective equipment (PPE).

People received visits from friends and family in their bedroom or a visiting pod was used if preferred. Visits were booked in advance to enable visits to be conducted safely.

Staff had supported people to maintain contact with friends and family during the pandemic via window visits, telephone calls and face time calls.

Staff had received refresher training in infection prevention and control best practice guidance. Information and ongoing government guidance in the management of COVID-19 was shared with staff.

Staff and people using the service participated in the testing and vaccination programme. COVID-19 related risk assessments had been completed, and contingency plans and relevant policies were in place to manage a COVID-19 outbreak.

Isolation, cohorting and zoning was used to manage the spread of infection. This meant people self-isolated in their bedrooms rooms where necessary. We observed staff wearing the correct PPE throughout our inspection.

St. Georges is a residential care home providing personal and nursing care to 34 older people and people living with dementia, at the time of inspection. The service can accommodate up to 36 people in one adapted two-storey building.

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

The provider's systems and processes used to monitor quality and safety were not used robustly to manage the service effectively. Quality assurance systems had not identified the issues and concerns we found.

There were not enough staff to provide quality care and support to people. The service had been consistently short staffed and staff deployment was not managed effectively. The regional director addressed the staff shortages for the day but further action was needed to maintain safe staffing levels.

People, staff and visitors were not always protected from risk of infection. Some areas of the service were not always cleaned promptly. Staff did not always wear face masks correctly. The manager took action immediately to address this.

Risk to people had been assessed and care plans provided guidance for staff to manage those risks such as falling or swallowing difficulties. These needed further improvements to ensure the impact of people’s health condition such as dementia, had been taken into account and the role of staff to support them. Records did not fully reflect whether essential care had been provided.

People felt safe with the staff and the care provided. Staff recruitment procedures ensured that appropriate pre-employment checks were carried out. Staff understood what abuse was and how to report concerns.

People received their medicines safely. 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.

The manager and staff team worked with external health and social care professionals and followed recommendations made.

The manager had begun the process to be registered with the Care Quality Commission (CQC). People, relatives and staff spoke positively about the manager, who they described as approachable, supportive and addressed issues as soon as practicable.

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 this service was Good (published 18 April 2018).

Why we inspected

The inspection was prompted in part due to concerns received about staffing levels. We made a decision 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 COVID-19 and other infection outbreaks effectively.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvements in relation to staffing and quality monitoring and governance. Please see the safe 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 ‘all reports’ linked for St Georges 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.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and 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.

St. Georges provides residential care to older people including people recovering from health issues and some who are living with dementia. St. Georges is registered to provide care for up to 36 people. At the time of our inspection there were 30 people living at the 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.

There was a registered manager was in post. 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.

St. Georges Care Homes 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.

The provider used a wide range of quality monitoring checks. Quality monitoring had been carried out effectively. The provider had a clear management structure within the home, which meant that the staff were aware who to contact out of hours if an emergency arose, or an equipment repair was necessary. Staff had access to the maintenance diary to manage any emergency repairs. The provider had developed opportunities for people to express their views about the service. These included the views and suggestions from people using the service and their relatives.

We found that applications had been made to the local authority to legally deprive people of their liberty. The registered manager and care staff had been trained in the Mental Capacity Act (MCA) 2005. They were also aware of best interests meetings to ensure peoples treatment was in line with the MCA and Deprivation of Liberty Safeguards. People were asked for their written consent to care following their admission to the home. This was in addition to staff agreeing their actions prior to each caring intervention.

Staff were subject to a thorough recruitment procedure that ensured staff were qualified and suitable to work at the home. Following their recruitment staff received on-going training for their particular job role. Staff were able to explain how they kept people safe from abuse, and were aware of whistleblowing and what external assistance there was to follow up and report suspected abuse.

People were provided with a choice of meals that met their dietary and cultural needs. The catering staff were aware of people’s dietary needs, and sought people’s opinions about the menu choices to meet their individual needs and preferences. Staff and external agencies regularly provided a range of activities that were tailored to people’s interests. Staff had access to information and through this, developed a good understanding of people’s care needs. People were able to maintain contact with family and friends and visitors were welcome without undue restrictions.

Relatives we spoke with were complimentary about the provider, registered manager and staff, and the care offered to their relations. People or their relatives were involved in the review of their care plan. Staff had access to people’s care plans and received regular updates about their care needs. Care plans were updated to include changes to peoples care and treatment. People were offered and attended routine health checks, with health professionals both in the home and externally.

We observed staff interacted positively with people throughout the inspection, people were offered choices and their decisions were respected.

We received positive feedback from the staff at the local authority with regard to the improved care and services offered to people at St. Georges Care Homes.

St. Georges provides residential care to older people including people recovering from health issues and some who are living with dementia. St. Georges is registered to provide care for up to 36 people. At the time of our inspection there were 33 people living at the home.

St. Georges had a registered manager in post. The registered manager was also the provider, and he was supported by a care manager at 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.

Care plans were personalised and each file contained information about the person's likes, dislikes, preferences and the people who were important to them, however some areas were not covered or planned for appropriately. We found the registered manager had not involved people or their relatives in the review of their care plan. Care plans also included information that enabled the staff to monitor the well-being of people. Staff had access to people’s care plans and received regular updates about people’s care needs. There were systems in place for staff to share information through detailed records for each person. Risk assessments and management plans covered relevant aspects of people’s needs and included finances, health and daily routines.

People felt staff were kind and caring, and their privacy and dignity was respected in the delivery of care and their choice of lifestyle. Relatives we spoke with were also complimentary about the staff and the care offered to their relatives. We observed staff offered people everyday choices and respected their decisions.

The environment of the home was not meeting the needs of people living with dementia. Heating was not available in some bathing areas and staff were not made aware of infection control issues to ensure people are protected.

There were appropriate arrangements for the storing, recording and checking of medicines to ensure people’s health and welfare was protected against the risks associated with the handling of medicines.

Staff worked as a team however they were not deployed to provide the appropriate level of assistance at meal times. People had mixed opinions of whether food was satisfactory and the registered manager had arranged a meeting to improve the variety on offer.

The provider had recruitment procedures that ensured staff were of a suitable character to work with people at the home. Most staff had received training in the areas the provider considered essential for meeting the needs of people in a care environment safely and effectively. Training was planned to update the remainder of the staff to ensure all staffs’ knowledge was up to date.

New staff received an induction prior to working with people. This helped them get to know people’s needs and establish a relationship with them before working with people on a one to one basis. Staff had been provided with safeguarding training and were aware and had an understanding of their responsibilities to protect people from harm. The registered manager understood their responsibilities to manage any safeguarding concerns raised by staff, and report any instances to the appropriate authorities.

Staff worked within the principles of the Mental Capacity Act 2005 and had a good understanding of their responsibilities in making sure people were supported in accordance with their preferences and wishes. Staff knew people's individual communication skills and abilities and showed concern for people's wellbeing in a caring and meaningful way. However they were observant of peoples dignity at all times.

There was a clear management structure within the home, which meant that the staff were aware who to contact out of hours. The registered manager undertook quality monitoring in the home however this was not wholly effective in revealing recurrent issues. Staff were aware of the reporting procedure for faults and repairs and had access to the maintenance to manage any emergency repairs. The provider had developed opportunities for people to express their views about the service. These included the views and suggestions from people using the service, their relatives and health and social care professionals.

We spoke with four people using the service and two relatives visiting their family members. We also spoke to three members of staff and two visiting health care professionals. We looked at four people's care records.

People experienced care, treatment and support that met their needs and protected their rights. One relative told us: 'The staff are compassionate, kind and caring, though they do not always recognise [relative's] specific care needs and I have to prompt them'.

Whilst we found the provider had systems in place to reduce the risk and spread of infection, we found these systems were not effective. There were a number of issues relating to the overall cleanliness of St Georges.

We found that the provider did not have appropriate arrangements in place to manage medicines which meant that people may not be protected against the risks associated with medicines. We found issues with people receiving their prescribed medication and with the recording of the use of controlled drugs.

During our inspection, we noted the provider did not manage medicines effectively to avoid risks to people using the service and staff. We did not speak with people using the service about this, but from our observations, we found there were risks to people's safety.

The people we spoke with told us they were satisfied with the service. They told us they were involved in decisions about their care. We spoke with visitors to a person using the service. They told us the person's views were respected and they were always involved in decisions about the person's care. We saw that care workers treated people with respect and promoted their dignity.

They all said the food was good and there were sufficient amounts. We observed the lunchtime meal. People were given sufficient amounts of food. People we spoke with thought the service was clean. We found the provider did not have effective systems for ensuring cleanliness, particularly of bathrooms and toilets.

We spoke with two care workers, who were competent in describing how they met people's needs. Care workers did not all receive regular formal feedback on their performance. The registered manager told us they planned to introduce regular supervision and appraisals for all staff.

Medication was administered, stored and recorded properly so that people were protected from risks associated with medicines.