Archived: St George's Residential Care Home

Updated 17 January 2017

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This unannounced inspection took place on 21 November 2016. An Adult Social Care (ASC) Inspector carried out the inspection.

We spent time speaking with and observing people who lived in the home within the communal areas of the home and spoke with people in private. We were able to see some people’s bedrooms, bathrooms and the communal bathrooms.

Some people living at the home could not easily give us their views and opinions about their care and support. We used the Short Observational Framework for Inspection (SOFI) to help our observations in the home. SOFI is a specific way of observing care to help us better understand the experiences of people who could not easily talk with us. It is a useful tool to help assess the quality of interactions between people who use a service and the staff who supported them.

During the inspection we spoke with 12 people who lived in the home, three relatives, four of the care staff, a visiting health care professional, the senior care worker and the registered manager.

We looked at care plans for six people living in the home, their medication records and care plans relating to the use of their medicines. We observed medicines being handled and discussed medicines management with the staff involved in this. We checked the medicines and records for six people and spoke with members of care staff with responsibility for medicines.

We looked at records relating to the maintenance and management of the service and records of checks or ‘audits’ being done to assess and monitor the quality of the service provision. We also looked at the staff rotas for the previous month and staff recruitment and training records.

Before our inspection we reviewed the information we held about the service. We spoke with commissioners of the service. We looked at the information we held about notifications sent to us about incidents affecting the service and people living there. We looked at the information we held on safeguarding referrals, concerns raised with us and applications the registered manager had made under Deprivation of Liberty Safeguards (DoLS).

Before the inspection, the provider completed a Provider Information Return (PIR). The PIR is a form that asks the provider to give us some key information about the service, what the service does well and improvements they plan to make.

Updated 17 January 2017

This unannounced inspection took place on 21 November 2016. We last inspected St Georges Residential Care Home in March 2015. At the inspection in March 2015 we found the service was not meeting all the regulations that we assessed and we asked the provider to take action to make improvements. This was in relation to medicine management, providing consistently appropriate and person centred treatment, restrictions on a person’s liberty and effectively monitoring the quality of service provision.

We issued four requirement notices and asked the registered provider to tell us how they were going to make the improvements required. At this inspection on 21 November 2016, we found that the registered provider and registered manager had made the changes and improvements needed to meet the requirement notices from the previous inspection

St George's Residential Home provides accommodation and personal care for up to 41 older people. The home is in an older property, close to local amenities in the town of Millom and has been adapted and extended for its current use. The bedrooms in the home vary in size and layout. There is a garden to the rear of the home for people living there and this is private and has accessible outdoor seating. There is parking available at the front of the home for staff and visitors. There were 28 people living at the home at the time of our inspection.

The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 and associated Regulations about how the service was run. We noted that there was a clear structure and lines of responsibility being promoted by the registered manager and deputy. A member of care staff told us, “It’s a very open and friendly place to work”.

People living in the home told us that they felt safe living there and relatives we spoke with told us they were satisfied and “more than happy” with the care being provided. Some people who were living with dementia could not tell us their views but those people who could told us they felt “safe” and “secure” living there. We were told by one person who lived there, “I am happy here”.

People confirmed they had a choice of meals and drinks and they told us the food was “good” and that they enjoyed their meals. People were involved in discussions and feedback about food at their ‘residents’ meetings.

We saw that the people who lived there were being well cared for and were relaxed and comfortable in the home and with the staff that were supporting them. The atmosphere was informal and inclusive and people told us that they would be comfortable raising any complaints or concerns with the registered manager. Everyone we spoke with praised the staff that supported them and the friendliness of the staff and management.

People told us that care staff were available to help them when they needed assistance and that staff respected their privacy. People living at St Georges told us they were able to see their friends and families as they wanted and go out into the community with support. There were no restrictions on when people could visit them in their home. People were able to follow their own interests, practice their religious beliefs and see their friends and families as they wanted. People commented positively on the range of activities available to them in the home and the social events arranged for them.

The registered manager had a system to calculate dependency and staffing needs which they reviewed at three monthly intervals. We could see that the home was being adequately staffed to meet people’s needs during the day. We have made a recommendation that the registered manager reviewed their dependency tool to consider the layout of the home and sought guidance on current best practice on risk assessing safe staffing levels at night.

The service had safe systems for the recruitment of staff to make sure the staff taken on were suited to working there. We saw that care staff had received induction training and training for their roles and development and had regular supervision and annual appraisal. Staff said they were well supported by the management team. There was an on call system for staff to access management support at night.

Staff had received training in safeguarding adults. Staff we spoke with knew the appropriate action to take if they believed someone was at risk of abuse. People knew how they could complain about the service they received and information on this was displayed in the home. People we spoke with were confident that action would be taken in response to any concerns they raised.

The service had followed the requirements of the Mental Capacity Act 2005 Code of practice and Deprivation of Liberty Safeguards. This helped to protect the rights of people who were not able to make important decisions themselves. We looked at people’s records and saw that the registered manager had applied to relevant supervisory authorities for deprivation of liberty authorisations for people.

During this inspection, we looked at the way medicines were managed and handled in the home. We found that medicines were being administered safely and records were being kept of the medicines in the home.

The service worked with local GPs, district nurses and health care professionals and external agencies to provide appropriate care to meet people’s different physical, psychological and emotional needs.

We looked at care plans and saw there were risk assessments in place and control measures to help minimise them. We looked at the risk assessments in place regarding how people would be moved in the event of fire or other emergency. These had been kept under review. We noted that risk assessments were not being formally carried out to assess the risks of choking for people. The registered manager knew this needed to be formalised and was addressing it as part of their care planning review. We made a recommendation that in their review of risk assessments the registered manager considers current guidance and best practice on assessing the specific risks of people choking.