St George's Nursing Home cares for up to 77 people who require nursing and personal care. The service was divided into six specialist units caring for people living with dementia, older adults, younger adults, people with physical disabilities and mental health needs. There were 71 people using the service at the time of the inspection. The service had re-registered with a new provider in July 2014 and this was the first time we had inspected the service since then. The inspection was carried out on 4 and 5 October 2016 and was unannounced. The inspection was carried out by two inspectors and a specialist advisor.
A registered manager was in post and had registered with the Care Quality Commission in June 2016. 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.
We found shortfalls in the administration of medicines as policies and procedures for the safe storage, administration and recording of medicines were not always followed. We also found that some areas of the home were not kept satisfactorily clean, and that hazardous substances were not always stored safely. The registered manager had addressed some of our concerns by the second day of the inspection.
Staff had received training in the safeguarding of vulnerable adults and the service followed the protocols set out by the local authority for the recording and reporting of incidents of a safeguarding nature.
There were suitable numbers of staff on duty, and safe staff recruitment processes were in place which helped to protect people from abuse. There were some staff vacancies and recruitment was in progress to fill these. Where agency staff were being used, the registered manager tried to book the same agency staff to provide consistency and continuity of care.
Systems were in place to assess and monitor the safety of the premises and equipment. Individual risks to people were also assessed and plans were put in place to mitigate these.
Staff received regular training, supervision and appraisals. A new system had been put in place to ensure these were brought up to date by the new registered manager, as a number had been out of date. We found that progress was being made in this area and staff told us they felt well supported. A training facilitator worked in the service and was responsible for planning and delivering training. Specialist trainers were brought in to provide training related to specific needs, such as particular medical conditions or specialist equipment. There were some gaps in training but there were plans in place to address these. The standard of training materials and resources was high.
The service was working within the principles of the Mental Capacity Act and applications had been made to the local authority to deprive people of their liberty in line with legal requirements. Decisions taken in the best interests of people were not always appropriately recorded or reviewed on a regular basis.
People were supported with eating and drinking, and special diets were catered for. Nutritional assessments were carried out, and where people were found to be losing weight, specialist input was sought. There were mixed views about the quality of the food, and we were told that the contract with the external catering company was due to end, and that catering would be provided by the provider’s organisation in the near future. We reviewed food and fluid records and observed staff completing these. We found that they were not always completed accurately and that there were some gaps in records.
The premises were generally clean and tidy, and there was access to outdoor space with supervision. Gardens were well maintained and tidy. There was a rehabilitation kitchen, hairdresser and old fashioned sweet shop on site. The design supported the needs of people living with dementia, including good use of signage to support way finding. Some towels and bedding although clean, were worn, and the registered manager told us she had recently ordered replacements.
Staff were observed to be kind and caring in their interactions with people throughout the inspection. The units we visited were calm and staff communicated with people in reassuring tones. We observed that when people became upset, staff intervened quickly. We observed people interacting with staff with warmth and humour, and they told us that they felt well cared for and that staff were nice. People’s privacy and dignity was respected and promoted.
Care plans were in place which contained person centred information. These varied in quality and format and it was not always easy to locate the most up to date information. The registered manager had set up a working group to review, streamline and standardise care records. We found that essential information and care plans to meet people's needs was available in the main but that care plans needed to be further developed. We have made a recommendation about this.
A number of activities were available to people. We observed people taking part in activities during the inspection and they were well supported by staff to take part. Three activity coordinators were in post which meant that activities could take place over seven days per week.
A complaints procedure was in place and a log of any complaints was maintained. We saw that complaints received had been responded to appropriately by the manager. Systems were being improved to capture low level issues to improve the quality of the service by addressing concerns at the earliest opportunity.
We found shortfalls in some aspects of the management of the service. Systems for monitoring the quality and safety of the service were not sufficiently robust to pick up some of the concerns we identified during the inspection. The registered manager was keen to address issues we identified as soon as possible. They had made improvements in a number of areas and told us they planned to use the inspection outcome as a benchmark from which to continue to make improvements.
We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to safe care and treatment and good governance.
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.