Archived: St George's Home

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.

St George’s Home is a residential care home providing personal care to up to 29 people. The service provides support to older adults. At the time of our inspection there were 21 people using the service.

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

The provider had not fully embedded the systems and processes required to keep people safe. This meant improvements in areas such as fire safety and infection prevention and control had not been fully implemented. Staff did not always complete charts relating to the health and well-being of people living in the home and some maintenance and cleaning tasks had not been completed.

The provider had implemented audits, but the systems did not allow the manager to complete these fully or understand where improvements could be made to improve the quality of the service.

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.

Staff had been recruited safely and in line with the providers policies and procedures. Staff received regular supervision and felt well supported by the manager. Accidents and incidents were investigated and learning from these was shared with staff.

The manager and staff had developed a caring and open culture within the home. People were happy and staff demonstrated a good understanding of their needs. Relatives were pleased with the care provided and felt included and part of the ‘family’ within the 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 23 June 2021). The service remains rated requires improvement. This service has been rated requires improvement for the last four consecutive inspections.

At our last inspection we recommended that the provider should improve oversight and governance of the home. At this inspection we found the provider had acted on some recommendations and had made improvements however we identified other areas of concern. At this inspection we found the provider remained in breach of regulations.

Why we inspected

We received concerns in relation to staffing levels, high levels of falls reported at night, people leaving the building without staff being aware and restrictions on visiting. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. We made the decision to include caring which had been rated requires improvement after seeing the improved levels of care being provided during the visit and the positive feedback from relatives.

We have found evidence that the provider needs to make improvements. We found no evidence during this inspection that people were at risk of harm from these concerns. The provider gave CQC additional evidence to show the actions they had taken to mitigate the risks from the concerns raised. Please see the safe, caring and well-led sections of this full report.

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 not changed from requires improvement. 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.

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

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 safety and governance of the home. This because the oversight and audits did not fully show areas for improvement such as fire safety, maintenance, completion of some records and management of infection prevention and control.

Please see the action we have told the provider to take at the end of this report.

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.

St George’s Home is a residential care home registered to provide personal care for up to 29 people aged 65 and over. At the time of our inspection eight people lived at the home.

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

The registered manager had made improvements in the home since taking up post in November 2019. These improvements and those identified on inspection will need to be sustained over time.

People’s risk had been identified and recorded, and where needed changes had been made.

The prevention and control of infection was effective, however further assurances is needed to ensure best practice is used for cleaning frequently touched areas.

People’s medicines were administered as needed, but further improvements were required to ensure medicines were safely administered at night.

People’s care and support needs were safely met by staff who were trained and supported in their role.

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 4 February 2020) and there were multiple 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 improvements had been made and the provider was no longer in breach of regulations.

This service has been in Special Measures since February 2020. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

We received concerns in relation to staffing levels. As a result, we undertook a focused inspection to review the key questions of safe 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 not changed from requires improvements This is based on the findings at this inspection.

We have found evidence the provider needs to make improvements. Please see the Safe and Well-Led sections of this full report. The provider had taken effective action to mitigate the risks, such as more increasing the number of staff on duty and further staff training.

You can see what action we have asked the provider to take at the end of this full report.

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 not changed from Requires Improvement to Requires Improvement. This is based on the findings at this inspection. The service is no longer in ‘Special Measures’.

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 at this inspection in relation to good governance and there were areas which had not been checked.

Follow up

We will continue to monitor information we receive about the service.

St Georges Home is a care home that provides personal care and accommodation for up to 29 older people.

At the time of our visit there were 16 people living at the home.

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

There continued to be significant shortfalls in consistent leadership and how the service was led. Breaches of regulations remain in place. The provider’s delivery of high-quality care could not be demonstrated and while a new manager was in post, further development was needed in leadership, governance and the culture in place.

There were inconsistent approaches in how infection control measures were undertaken which potentially puts people’s health and well-being at risk. The expectations to give people a clean home had not been met.

The care and support people received was inconsistent as staffing support had not been in place to maintain staff’s professional skills or knowledge of best practice in caring for people. People hydration needs required more detailed monitoring to ensure their needs were met. People would benefit from an increase in time with staff for a meaningful length of time.

People’s dignity was not always maintained. This included people using the toilet not being protected from the view of other people or visitors to the home. This was not intentional, however it the provider had not upheld people’s dignity and respect.

People’s planned care needs had been recorded and were in the process of being improved, however end of life care plans did not meet people’s needs. The service has not fully implemented the Accessible Information Standard to identify, record, flag, share and meet the information and communication needs of people with a disability or sensory loss. We have made a recommendation about the premises being improved to best promote people’s independence.

People were complimentary about the staff and how they were supported. Families also positively commented on the care their relatives received and no concerns were raised.

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.

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 26 June 2019) and there were multiple 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 enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to staffing, cleanliness and how the service was managed 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.

Since the last inspection we recognised that the provider had failed to meet their condition of registration to have a registered manager. This was a breach of regulation. Full information about CQC’s regulatory response to this is added to reports after any representations and appeals have been concluded.

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

Special Measures

The overall rating for this service is ‘Requires improvement’. However, we are placing the service in 'special measures' because this service has been rated as 'Inadequate' in any/other Key Question over two consecutive comprehensive inspections. The ‘Inadequate’ rating does not need to be in the same question at each of these inspections for us to place services 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, 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.

People’s experience of using this service:

We last inspected St Georges Home in August 2018 when we rated the service as 'Requires Improvement’ in all key questions, together with breaches of the regulations. At this inspection we found action taken had not been sufficient to address the improvements needed and the service rating continues to be ‘Requires Improvement’.

There was no registered manager at the home and there was a lack of management oversight of the service. There was an acting manager, who worked at another of the provider’s homes, providing support three days per week to St Georges Home. Quality assurance systems were not effective because the manager had limited time to identify areas of improvement and ensure improvements implemented were effective. Audit systems had not identified all areas for improvement such as environmental risks and risks related to equipment.

Staff had some understanding of how to support people to keep them safe but did not always follow care plans or safe practice to ensure people received care safely consistently. The provider had not ensured safeguarding procedures were always followed to keep people safe.

Medicines were not always well managed as records had not been completed clearly and consistently to show creams prescribed for people had been applied. Staff had completed some training, but further improvements were needed to check staff had learnt from their training to confirm they were competent.

People with complex needs such as those who were registered blind, people who were living with learning disabilities or dementia did not always have their needs effectively managed. Staffing arrangements meant there was limited time for staff to support people with activities and there was limited social interaction. At lunchtime people were not supported in a timely or dignified manner.

Staff did not always promptly support people to ensure their privacy and dignity was maintained.

People had access to the healthcare support they required to meet their needs.

People felt safe and spoke positively of living at the home and of the support they received from staff. There was a system to manage complaints and people felt comfortable to raise concerns if they needed to.

The manager knew about many of the improvements and was committed to supporting the service to make these improvements. The provider told us of plans following our inspection visit to have a register manager in post.

This is the second consecutive time the home has been rated as Requires Improvement. The registered provider has been found to be in breach of the Regulations 10, 12, 13, and 17 of the Health and Social Care Act 2008(Regulated Activities) Regulations 2014 and Regulation 18 of the Care Quality Commission (Registration) Regulations 2009.

Rating at last inspection: At the last inspection the service was rated as requires improvement. The last report was published on 24 September 2018.

Why we inspected:

This was a planned inspection based on the rating at the last inspection. The service continues to be rated as 'Requires Improvement' overall.

Enforcement: Action we told provider to take (refer to end of full report).

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our inspection programme. If any concerning information is received, we may inspect sooner.

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

St George’s home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

At our previous inspection on 27 March 2017 the overall rating for the home was ‘requires improvement’ and we asked the provider to make the necessary improvements. At this inspection, we found there had been insufficient action to improve and found additional areas needing improvement across all the key questions. We identified four breaches in the regulations and therefore the home continues to be ‘Requires Improvement’ overall. Breaches related to the safe care and treatment people received, safeguarding people from abuse, not submitting statutory notifications related to incidents at the home and failing to ensure there was good governance of the service.

The provider had not taken all reasonable measures to minimise risks to people’s health, safety and wellbeing. Systems and processes had not been effective in identifying and driving improvement at the home. Following the inspection visit we met with the provider and they explained how they would make the required improvements.

The registered manager in post at our previous inspection had left and a new manager, who had previously been the deputy manager, had been appointed. They were not registered with us at the time of this inspection. The provider told us of their plans for an application to be made for this person to be registered with us. 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.

During this inspection we found numerous reportable incidents had occurred at the home that had resulted in safeguarding referrals being made to the local authority. These had not been reported to us as required. There were also increasing numbers of accidents and incidents within the home and these had not been analysed and considered to help minimise the risk of them happening again.

People had limited involvement in the ongoing review and planning of their care. Staff told us and people confirmed, consent was sought from people before delivering care. The relevant applications had been made where it was considered people were being deprived of their liberty. However, some of the information around people’s capacity was conflicting and the reason for the application was not always clear.

We saw staffing arrangements were not always effective because care staff sometimes completed ancillary duties such as laundry and cleaning. This impacted on the amount of time staff could spend with people as well as the amount of time that could be spent keeping all areas of the home clean.

Some staff had not completed training the provider considered essential to manage people’s care safely. Some staff practice was not safe such as techniques used to move and transfer people although we saw further training was planned.

Systems did not consistently demonstrate that people always received care and support in accordance with their needs.

Health and safety checks were completed such as gas, electrical and water to ensure both equipment and the environment was safe for people. However, audit checks of the environment and equipment were not consistently effective as we had identified some potential risks. This included risks related to infection control and the home not being sufficiently secure to keep people safe. Equipment checks had not identified repairs needed to ensure these were completed in a timely manner and equipment people used was safe.

Most people’s medicines were managed and administered safely to maintain their health but records in regard to the applications of creams were not always completed to show they had been applied as prescribed.

Systems for the recruitment of staff were not consistently followed to ensure staff were safe to work with people.

People were able to access healthcare professionals to address their healthcare needs when required.

Staff had some understanding of their responsibilities to protect people from harm and were aware of the provider’s whistleblowing policies.

People and their family members spoke positively of living at the home and of the staff and said they had no concerns and felt at ease to raise any complaints with staff if they needed to. We saw staff were caring and respectful in their approach.

People and their relatives were given the opportunity to comment on the quality of the service through satisfaction questionnaires and meetings. Staff also had regular meetings where they could discuss any concerns or development needs they had.

People had access to some activities but the time staff spent with people was variable with little time spent on activities linked to people’s interests, preferences and abilities.

People liked the food available and said they had a choice of meals. Those people who needed support to eat were provided with this as required.

We identified four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

St George’s Home provides personal care and accommodation for up to 29 older people. There were 24 people living at the home at the time of our inspection. This included a number of people living with dementia.

There was a registered manager 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.

During our last inspection on 5 May 2016, the provider was not fully meeting the standards required in relation to the “Safe” “Responsive” and “Well Led” key questions. The registered manager and staff did not have sufficient knowledge of what constituted abuse and referrals were not being made to the Local Authority and notified to us as required. We asked the provider to take action to make the necessary improvements.

During this inspection we found some action had been taken to ensure safeguarding referrals were made to the Local Authority, but there continued to be some that were not reported to us as required. Safeguarding systems and processes remained in need of improvement as they were not sufficiently clear to ensure people were protected from potential abuse. Both the registered manager and staff continued to have gaps in knowledge of what constituted abuse.

Despite safeguarding processes not being clear, people told us they felt safe living at the home and we saw there was enough staff on duty to keep people safe and meet their needs. People received their medicines as prescribed but the procedures for managing prescribed creams were in need of review to ensure these were being managed safely and effectively.

Staff were knowledgeable about the risks associated with people’s care and knew people's needs varied according to their abilities and preferred routines. However, risk assessments and management plans for people were was not always clear enough to provide guidance to staff to minimise risks.

People were able to access healthcare professionals when they needed to ensure their healthcare needs were met.

Recruitment checks were carried out prior to staff starting work at the home to make sure they were suitable for employment. New staff received an induction to the home to prepare them for their role and all staff had access to ongoing training to develop their skills and knowledge.

The manager and staff understood their responsibilities under the Mental Capacity Act and the Deprivation of Liberty Safeguards (DoLS). People who lacked capacity were supported in decision making, and where appropriate, applications had been made to authorise any restrictions on their freedom that were in their best interests.

People received a choice of meals and overall people were positive about the food provided. Drinks were regularly made available to people so they had enough to drink.

Some group social activities were arranged and some people were taken out on a one-to-one basis, however, activities were not consistently provided in accordance with people’s needs, preferences and wishes.

Staff were kind and patient and showed respect to people. People were encouraged to maintain relationships with people important to them and visitors were welcomed at the home.

A complaints procedure was in place and complaints received had been appropriately investigated. People and their families were positive about the care being provided and they told us they knew who to approach if they had a complaint.

People, their visitors and the staff were positive about the management team and the running of the home. There were processes to monitor the quality and safety of the service provided but some of these were in need of review to ensure the quality of care and services provided were consistent.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

St George’s Home provides personal care and accommodation for up to 29 older people. There were 25 people living at the home at the time of our inspection. This included a number of people living with dementia.

There was a registered manager 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.

We could not be sure the registered manager and care workers had sufficient knowledge of what constituted abuse because referrals were not always made to the local authority when safeguarding concerns were identified.

People told us they felt safe living at the home and we saw there was enough staff on duty to keep people safe and meet their needs. Medicines were managed safely so that people received their medicines as prescribed.

Risks associated with people’s care had been assessed to keep people safe however; records did not always reflect current risks and records were not always kept up to date. Care workers we spoke understood of the risks associated with people’s care.

People were referred to external healthcare professionals to ensure their health and well-being was maintained.

New staff received an induction to the home and staff received training in health and social care on an on-going basis to help develop their skills and knowledge further.

Recruitment checks were carried out prior to staff starting work at the home to make sure they were suitable for employment.

The manager and staff understood their responsibilities under the Mental Capacity Act and the Deprivation of Liberty Safeguards (DoLS) to ensure people were looked after in a way that did not inappropriately restrict their freedom.

People received a nutritious diet, had a choice of food, and were encouraged to have enough to drink.

Some group social activities were arranged, however, people told us they would like more variety and would enjoy more days out.

Staff were kind and patient and showed respect to people. People were encouraged to maintain relationships with people important to them and visitors were welcomed at the home.

A system was in place to manage complaints received about the service. People and their families were positive about the care being provided and they told us they knew how to make a complaint.

People, their visitors and the staff were positive about the management team and the running of the home. There were processes to monitor the quality and safety of the service provided.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service, their relatives and staff told us.

If you want to see the evidence that supports our summary, please read the full report.

Is the service safe?

People we spoke with told us they felt safe. One person we spoke with said: 'Oh yes, the staff are ever so kind and helpful.' Another person told us: 'I can lock my door if I want but there is no need to.' The three relatives we spoke with all said they had no concerns about their relative staying at St George's.

The provider and staff understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). The registered manager and staff were able to describe when an application should be considered and who should be involved in the process. We saw records that showed a number of staff had received training in mental capacity. The registered manager told us further MCA and DoLS training was booked in light of the recent ruling in these areas.

The home was clean and tidy with no unpleasant odours. The registered manager had implemented cleaning schedules which made sure people's rooms and communal areas were regularly cleaned. People and relatives we spoke with told us they had no concerns about the cleanliness of the home or their relatives' room.

People told us if they needed anything repaired or replaced, this had been done with minimal delay. We saw maintenance records that confirmed repairs had been undertaken promptly.

We found equipment was maintained and regularly serviced. We found the provider carried out regular fire checks and ensured people and staff knew what to do in the event of an emergency.

We looked at staffing levels and found staffing was calculated on people's individual dependency levels. The registered manager told us they had recently recruited two additional staff. Staff we spoke with told us that staffing levels enabled them to meet people's needs.

Is the service effective?

People had an individual care plan which explained what their needs were. People and relatives told us they had been involved in the care assessment and their contributions were listened to. Risk assessments were reviewed and identified current risks.

People had access to health care professionals which supported their health care needs.

We found staff had received the necessary training that enabled them to provide suitable and appropriate care for people.

Is the service caring?

People were supported by staff that provided care at people's preferred pace. Staff were kind and attentive and responded appropriately to people's requests. Staff promoted individual choice and supported people who wanted to remain as independent as possible. We found individual wishes were taken into account.

Is the service responsive?

People received help and support from other health professionals when required, such as doctors, dentists, occupational therapists and chiropodists. We found people had received oral treatment from a visiting dentist prior to our inspection. We also saw people were supported by a district nurse.

People were supported to participate in activities inside and outside of the home.

The service had systems in place to monitor the care provided to people. This included regular reviews with people and relatives. We found the provider held residents meetings to seek the views of people who used the service. We saw actions were taken when improvements had been identified.

People told us that concerns were listened to and acted on. People and relatives told us the staff and managers were very approachable.

Staff said they had a handover at the start of each shift to update them of any changes in people's needs since they were last on duty.

Is the service well led?

The service worked alongside other health care professionals and agencies to make sure people received the care they required.

The service had an effective system in place that assured them of the quality of service they provided. The service completed regular checks and sought the views of people who used the service. The service also gained the views of staff and we found the service listened and acted upon these views.

People's care records and other records were accurate, available and completed.

We found that were possible people had given their consent to the care and treatment to be provided. We saw that staff asked people about their choices. We found that staff had a good knowledge of people's care needs and were aware of people's preferences.

We asked people what it was like to live at St George's. People said, 'It's a good place, I've only been here a little while but everything has been okay so far' and 'It's a nice place, you get plenty of choices and staff treat you well.'

We looked in detail at the care provided to three people who lived at St George's. The care and support plans we viewed held good information and were easy to understand.

We looked at the medication procedures in the home. We found there was a safe procedure for handling medicines and people received their medication as prescribed.

We looked at how staff were recruited. We found the recruitment procedure made sure staff were properly checked before working in the home. Staff had the skills and knowledge to support people who lived at St George's.

All the records we requested to see were available. Documents we viewed were accurate and up to date.