Archived: St George's Home

Updated 13 October 2023

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.

Inspection team

The inspection was undertaken by 2 inspectors and an Expert by Experience. 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 George's Home is a 'care home'. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. St George's Home is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

The provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was not a registered manager in post. The manager had submitted an application to register with us.

Notice of inspection

The first of our inspection visits was unannounced.

What we did before inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from two local authorities who work with the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke with 10 people who live at the home and 9 relatives about their experiences of the care provided. We spoke with 11 members of staff including the manager, the compliance manager, care assistants, senior care assistants, the cook, a domestic assistant, and the nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider.

We looked at a range of people’s care records and multiple medicine records. We reviewed records relating to the management of the service including, staff training data, fire safety records, some policies and procedures and the recruitment records for 3 staff members.

Updated 13 October 2023

About the service

St George’s Home is a care home providing personal care for up to 29 older adults. At the time of our inspection 24 people lived at the home, some people were living with dementia.

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

Lessons had not been learned since our last inspection. The quality and safety of the service had deteriorated since our last inspection and some previous standards had not been maintained. The provider's systems and processes designed to identify shortfalls, and drive improvement were not robust and remained ineffective. The providers oversight of the service provided was poor and the manager lacked knowledge of regulatory requirements which meant opportunities to make improvements were missed. The management team were being supported and were working closely with local authorities to improve outcomes for people.

People did not receive good quality, safe care. Information staff needed to help them provide care safely was not always available to them and staff did not always follow instructions to manage risks associated with people’s care. Environmental risks including fire safety had not been identified, assessed, and mitigated to keep people safe. Action had not been taken to improve fire safety since our last inspection.

People told us they felt safe, and staff knew what action to take if they thought someone was at risk of harm. Medicines were not managed safely in line with the providers policies and best practice medicines guidance.

Enough staff were employed to meet people needs but the provider's recruitment practices were not safe. Areas of the home were dirty, and improvements required in relation to the prevention and control of infection had not been made. The provider's staff recruitment practices were not safe or robust.

People were not 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 did not support this practice.

Staff were not suitably trained to meet people’s needs. Most people and their relatives told us staff provided effective care, but we saw how the lack of staff training negatively impacted on people's safety and experiences and training staff had completed was not always effective.

The environment did not support people’s sensory needs and sufficient signage was not in people to help people orientate themselves around their home. Some relatives told us the environment needed to be redecorated to ensure the home was a nice place for people to live. Our observations confirmed redecoration and refurbishment was needed.

People spoke positively about the food and drinks provided, however the mealtime experience needed to be improved. Staff did not always offer the timely support people needed to enjoy their meals.

People had access to health professionals which supported their health and wellbeing. People felt listened to and provided positive feedback about the manager. Relatives told us the manager was approachable and that communication between them and the service was good. Staff felt supported and enjoyed working at St George’s Home.

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 14 December 2022). There were breaches of the regulations. 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 the provider remained in breach of regulations.

Why we inspected

The inspection was prompted due to concerns we received about the quality and safety of the service provided. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

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.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to inadequate based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for St George’s Home on our website at www.cqc.org.uk

Enforcement

Following our inspection visits, we asked the provider to respond to the immediate concerns we found. We continued to seek their updates and assurances they had mitigated the immediate risks to people.

We have identified a continued breach in relation to governance and identified further breaches in relation to safety, safeguarding and staffing.

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 request an action plan from 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 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 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 of 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.