Georgian House

Georgian House is registered to provide personal care and accommodation for up to 43 people who may have needs associated with their physical and/or mental health. At the time of the inspection, there were 33 people living at the home. Georgian House is also registered to provide personal care to people in their own homes. At the time of the inspection, there was no one receiving care in their own home, so this activity was not included in this inspection.

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

The majority of people told us they were safe, happy, liked living at Georgian House and were well cared for by kind and caring staff. We received mixed feedback from relatives regarding people’s experiences. Most relatives told us they did not have any concerns for their loved one’s safety. However, two relatives told us they did not have confidence in the care people were receiving or the management team. These concerns are being dealt with under formal complaints and safeguarding procedures and CQC will be informed of the outcome.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

We found the service was not always operating in accordance with the regulations and best practice guidance. Some systems were either not in place or had not been undertaken robustly to identify and monitor the quality of the service and drive improvements. This meant some systems operated by the provider had failed to identify concerns and shortfalls we found during this inspection and could not be relied upon as a source to measure quality and risk.

Safeguarding systems were established and the provider had clear policies and procedures in relation to safeguarding adults. However, we found safeguarding processes did not always operate effectively.

People were not always protected from the risk of avoidable harm. We found where some risks had been identified, enough action had not always been taken to mitigate those risks and keep people safe.

People were not always supported to have maximum choice and control of their lives and staff were not always supporting people in the least restrictive way possible. The service could not always demonstrate they were acting in people’s best interests.

Most medicines were given safely and correctly. Some improvements were needed and these were being implemented.

People did not always receive their commissioned individual support hours.

People were mostly supported by staff who had the skills and experience to meet their needs. However, we found there were gaps in training and some staff had not completed a full induction.

People’s needs were assessed prior to admission.

Staff knew people well and understood how to communicate effectively with people and spoke about people in a dignified and respectful way.

The registered manager was keen to put processes in place to address any areas of concern or improve practice. The provider had identified particular areas such as compliance, staff welfare, learning and development as areas they needed to focus on.

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 27 September 2019).

Why we inspected

This inspection was prompted by a review of the information we held about this service. 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 good to requires improvement based on the findings of this inspection.

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 the ‘all reports’ link for Georgian House on our website at www.cqc.org.uk.

Enforcement and Recommendations

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 safeguarding, safe care and treatment, staffing, the need for consent, notifications and governance at this inspection. We have also made recommendations in relation to Fire safety and person-centred care.

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.

Georgian House is a residential care home providing accommodation and personal and nursing care to 43 people in one adapted building. The home can support younger and older adults who living with dementia, mental health needs or a physical disability. At the time of the inspection, 35 people were living at the home. The providers are also registered to provide personal care to people in their own homes. However, this service was not supporting anyone at the time of the inspection.

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

The home was well managed. The provider and management team had continued to invest in and develop the home to ensure people received safe and personalised support. People spoke positively about the registered manager. One person said, “Things changed a lot for the good” and another said, “I know the manager, she has a nice nature and can talk to anybody.” Care planning, risk management, protecting people’s rights, social engagement and staff training were all areas that had improved since the previous inspection in May 2018.

People told us they liked living at Georgian House and felt safe. Staff were safely recruited and received training in safeguarding adults. They were aware of their responsibilities to protect people. The home used CCTV in the communal areas of the home. This was used to safeguard people from abuse and was reviewed if an altercation between people occurred. A comprehensive training programme ensured staff were provided with the information and guidance they required to support people’s physical and mental health needs. In addition, staff were supported to undertake qualifications in health and social care or mental health needs.

Medicines were managed safely, and people were supported by health and social care professionals as needed.

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. Where restrictions had been placed upon people, such as with smoking, or where people weren’t able to give consent, capacity assessments had been undertaken and best interest decisions made on people’s behalf.

Care plans provided staff with clear guidance to ensure support was person centred which promoted people’s well-being and independence. Care plans contained details of people’s religious, cultural and other beliefs that were important to them. The home recognised and supported people’s and staff’s diversity.

People told us they felt they could raise a complaint or say if anything was worrying them. The provider had effective systems to manage complaints and the records showed any concerns raised were recorded, fully investigated and responded to. The management team and provider used complaints as a learning experience and to change practice.

Effective quality assurance systems were in place. These included audits of care plans, medicine records, staff files and the environment. The home encouraged feedback from people’s relatives and staff and used this to review practice and make improvements.

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 requires improvement (published in 31 July 2018) and there was one breach 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.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Georgian House was previously inspected in August 2017; we found the provider had not taken sufficient action to ensure people received safe and high quality care from well-trained and competent staff. The quality monitoring systems were not effective and had failed to identify and address the concerns we had found. Following that inspection action was taken to support the home to improve by the local authority and any safeguarding concerns were addressed.

Following the inspection in August 2017, Georgian House was placed in ‘Special Measures’. Homes that are in Special Measures are kept under review and inspected again within six months. We expect homes to make significant improvements within this timeframe. During this inspection in May 2018, the home demonstrated to us that improvements had been made and it is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of ‘Special Measures’.

Georgian House is registered to provide personal care and accommodation for up to 43 people who may have needs associated with their physical and/or mental health. At the time of this inspection, there were 33 people living at the home. Georgian House is also registered to provide personal care to people in their own homes. This was referred to as 'the step-down service' during the inspection. At the time of the inspection, the provider confirmed the ‘step down service’ was not providing a regulated activity and as such was not included as part of this inspection. This was because we only inspect services where personal care is being provided.

The home had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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 home is run.

Following the inspection in August 2017, Georgian House appointed a new senior management team and worked with the local authority's Quality Assurance and Improvement Team, (QAIT) to improve the quality of the care and support provided by the home. Although the home had made a number of significant improvements, some improvements were still needed.

We checked whether the home was working within the principles of The Mental Capacity Act 2005 (MCA). We found the home was not always taking appropriate action to protect some people's rights. For example, where the home held or managed some people’s money or tobacco there were no mental capacity assessments to show that people did not have capacity to manage their own finances or cigarettes. There were no records to show the rational for these decisions, or whether this was being managed in their best interests.

Where monitoring arrangements had previously failed, we found improvements had been made. These included the auditing of medicines, care plans, risk assessments, people’s nutritional and hydration needs, weights, recruitment, inductions, infection control, health and safety as well as all aspects of the maintenance of the building. We found the new management team had a good understanding of how to improve people’s lives and they had a clear vision of how to achieve this.

In August 2017, we found some people’s care and support plans lacked sufficient detail and did not always give staff the information they needed to meet people's needs in a person-centred way. At this inspection, in May 2018, we found the process of reviewing and updating people’s care records was ongoing and needed to be completed. Although we found the standard of record keeping had much improved.

At the previous inspection, we found the systems in place to provide staff with a suitable induction were not effective and did not demonstrate that staff had been provided with the necessary skills to enable them to carry out their duties. At this inspection, we found there was a staff-training programme in place, staff confirmed they received regular training in a variety of topics. We reviewed the individual training records for three staff and identified that one staff member had completed 11 training courses on one day, this included courses entitled person centred care, MCA and DoLS, end of life care and infection control. We have made a recommendation in relation to training.

People, relatives and staff told us the home had improved since the last inspection, which they attributed to the new management team. People living at the home spoke positively about the changes that had taken place. One person said, “It’s much better now everybody’s happier.” A relative said, “I no longer have to worry about my mother’s care.”

People were encouraged and supported to engage with a range of healthcare services and staff supported people to attend appointments. People received their medicines when they needed them and in a safe way. People were cared for and supported by staff who knew them well. Staff were kind, caring, treated people with respect and maintained their dignity. The manager and staff understood their roles and responsibilities to keep people safe from harm; protect people from discrimination.

People were encouraged and supported to maintain links with the community to help ensure they were not socially isolated. People’s support plans contained detailed information about people’s hobbies and interests and staff told us how they supported people to maintain their independence.

People were aware of how to make a complaint and felt able to raise concerns if something was not right. The provider and manager welcomed comments and complaints and we saw where concerns had been received these had been investigated in line with the home’s policy and procedures.

The home was clean and people were protected from the risk of cross contamination and the spread of infection. Staff had access to personal protective equipment (PPE) and received training in infection control. Equipment used within the home was regularly serviced to help ensure it remained safe to use.

People, relatives and staff told us they were encouraged to share their views and spoke positively about the new leadership of the home. The registered manager was aware of their responsibilities in ensuring the Care Quality Commission (CQC) and other agencies were made aware of incidents, which affected the safety and welfare of people who used the home.

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.

Georgian House is registered to provide personal care and accommodation for up to 43 people who may have a physical and/or mental health needs. At the time of the inspection, there were 41 people living at the home. Georgian House is also registered to provide personal care to people in their own homes. This was referred to as ‘the step down service’ during the inspection.

At the time of the inspection, the provider confirmed the step down service was providing support to two people. However, neither was receiving personal care therefore, this part of service was not included in this inspection. This was because we only inspect services where personal care is being provided.

The home had 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.

People were not always protected from the risk of abuse. Georgian House did have in place a policy and procedures to follow if staff suspected someone was at risk of abuse or harm and staff had received training in safeguarding adults. Upon reviewing people’s records, we identified two incidents of alleged abuse and one of abusive practice, which had not been reported to the local authority safeguarding team. For example, one person’s records showed staff had documented on the 1 June 2017, during an altercation between two people living at the home, that one had punched and pushed the other. Records for another person showed on the 4th July 2017, staff had stopped a person’s cigarettes due to their violent behaviour. Staff had not recognised these incidents as abuse or matters they needed to refer to the local authorities safeguarding team.

During the inspection, we made three safeguarding referrals to the local authority and asked the provider to make another, which they did.

Some risks to people health and wellbeing were not always managed safely. Where staff had been provided with guidance by health and social care professionals, this was not always followed.

People were not always supported to have sufficient to eat and drink, and to maintain a healthy weight. For example, where some people had been identified as being at risk of malnutrition, food and fluid charts were not always completed. Records we saw did not demonstrate that some people did not receive their nutritional supplements as prescribed.

People received most of their prescribed medicines on time and in a safe way. However, some improvements were needed in the storage arrangements for people medicines as well as the management of topical applications.

Systems in place had not identified that the home was not always taking appropriate action to protect people's rights. For example, where the home held or managed one person’s monies and/or bankcards, there were no mental capacity assessments to show that people did not have capacity to manage their own finances. There were no records to show the rational for these decisions, or whether this was being carried out in their best interests.

Whilst some premises checks had been completed, risks to people's health, safety, and wellbeing had not always been identified, assessed, or mitigated. We noticed two windows on the first floor were not properly restricted or had safety film applied to the glazing to protect people from accidental injury if the glass were to be broken. In one of the first floor bathrooms, the casing to a waterproof electrical supply box was cracked. We brought this to the attention for the provider they took immediate action and arranged to have this replaced.

We reviewed the home’s fire safety precautions. Records showed that routine checks on fire and premises safety had been completed. The provider did have in place a Fire Risk Assessment, which is a legal requirement under The Fire Safety Order.

People were not always supported by staff who had the necessary skills and knowledge to meet their needs. Records showed that staff inductions, supervisions, and annual appraisals were poorly documented. Whilst we did see some positive interactions between staff and people living at the home, staff were focused on the task they were completing and did not always engage people in conversation.

Some of the people we spoke with told us they were happy living at Georgian House. One person told us that staff were, "wonderful.” Another person said, "The staff are very nice." However, one person told us they did not feel cared for at all, and another told us, they were deeply unhappy about having to share their room with another person living at the home. Although staff told us they knew this person was unhappy with the room sharing arrangements we found this had not been recorded within this person’s daily observations.

People told us they were encouraged to share their views and were able to speak to the registered manager or provider when they needed to. We saw quality control feedback form which had been submitted by visiting professionals over the last six months had rated the home as being ‘good’ in relation to the professionalism of staff and the level of care they provided.

The home maintained a high standard of cleanliness and steps had been taken to minimise the spread of infection. We saw the premises and equipment were clean and staff had been provided with aprons and gloves. Equipment used within the home was regularly serviced to help ensure it remained safe to use.

The home’s quality assurance and governance systems had not identified a number of concerns we found at this inspection, and there was a lack of management oversight.

During the inspection, we identified a number of concerns about the care, safety and welfare of people who lived at Georgian House. We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

You can see what action we told the provider to take at the back of the full version of the report.

This unannounced inspection took place on 19 and 22 April 2016. On the day of the inspection there were 43 people living at the service. The service was last inspected on 7 and 18 July 2014 when it was rated as ‘Requires improvement’ overall. Following the inspection in July 2014 we asked the provider to take action to make improvements to the way medicines were managed, the way meal times were managed, the quality assurance systems and the attitudes of some staff. At this inspection in April 2016 we found improvements had been made and sustained.

A registered manager was employed. 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.

Risks to people were assessed and plans put in place to minimise and manage any identified risks. Risks included choking, epilepsy, and pressure areas.

People were supported by staff that knew them well. Staff were kind and caring and ensured people’s privacy and dignity was respected. When addressing people staff used people’s preferred names and appropriate language that was not patronising. One staff member said “there’s no ‘hi darling, hi babe’ here!” We observed positive relationships between staff and the people we met at the service. There was much fun, laughter and appropriate banter between staff and the people they supported. Throughout the inspection people approached staff in a relaxed manner, smiling and laughing. This indicated they felt safe in the company of staff.

People’s needs were met in a safe and timely way as there were enough staff available. Support staff were employed to provide individual support and activities for people. We saw people enjoying varied activities throughout the inspection.

Care plans were detailed and gave good information to staff about people’s needs. People were supported to be involved in making decisions about their care. One person told us they had attended a meeting to review their care the day before our inspection. They told us they had been able to invite anyone to the meeting and a relative had attended. We spoke with a visiting community care worker who was completing a review of one person’s care. They said “it’s all very positive [person’s name] is happy and well supported”. They told us the person’s care plan included clear objectives, which were being met.

People living at the service told us they liked the food and it had improved. One person said “There is good food and plenty of it”. However, some staff and visitors told usthe quality of food provided could be improved. We discussed this with the cook and the management team who told us they had checked each item of food for quality. Menus showed a good variety of food provided.

People were supported to maintain good health from a number of visiting healthcare professionals. Records confirmed people received regular visits from GPs and community nurses. One person told us “if I need a doctor a visit is arranged for me quickly”.

Regular meetings were held for people to discuss any issues. People were involved in planning future social and fund raising events and deciding which charity any profits should go to. An ‘Alice in Wonderland’ themed cake sale was taking place on 27th April 2016. This had been suggested by a person living at the home and people had decided profits should be donated to a local mental health charity.

People were protected by robust recruitment procedures. All the required checks were made before staff were employed. People were protected from the risks of abuse because staff knew how to recognise and report suspicions of abuse. Staff had received training in this area as well as a variety of other training including, first aid and food hygiene. There were safe systems in place to manage people's medicines. Medicines were stored safely and staff had received training in administering medicines.

People were supported by staff who had received training in the principles of the Mental Capacity Act 2005 and the associated Deprivation of Liberty Safeguards (DoLS). Some people were subject to a authorised DoLS procedures. Applications had been made to deprive others of their liberty in order to maintain their safety.

Infection control risks were managed well. Liquid soap and gloves and hand towels were available. Dispose of clinical waste was managed safely. Staff were seen wearing disposable gloves and aprons when needed.

People’s needs were met by the adaptation, design and decoration of the service. The building was well maintained. It was decorated and furnished in a modern, bright and homely way. The space was big enough to accommodate such a diverse mix of people.

The management team were open and supportive. People told us they were confident any concerns would be dealt with. Staff told us they were able to make suggestions to improve the service.

There were effective quality assurance systems in place to monitor care and plan on-going improvements. Records were well maintained and kept securely.

Prior to this scheduled visit on 29 July 2013we received concerns that related to staffing levels, recording on care plans, staff attitudes, choice of food and the personal care of people who lived at the home. We found no evidence to support these concerns.

We saw that staff supported people to make choices. People confirmed they were able to make choices about how they wanted to spend their time. People also told us they could have a choice of food at meal times.

We found that care was planned and delivered to ensure people's welfare and safety. Records showed that risks had been identified and planned for. A range of risk assessments had been completed including those for pressure areas, falls and moving and handling.

We found that the home managed the medication for people who lived there in an appropriate manner.

We looked at four staff files which showed us there were effective recruitment procedures in place. We saw that criminal record checks had been obtained. These checks helped to reduce the risks associated with staff who may be unsuitable to work with vulnerable people.

People who lived at the home told us that staff were sometimes busy, but always had time to talk to them. Comments included 'whether it's late at night or anytime they always have time to talk with me',

We visited this service in response to anonymous information. This included allegations that a person was made to sit in a chair, that people were shouted at and were unkempt, that drugs were left on the floor and that staff were working very long hours.

We spoke to people living at the home, all of whom told us that they were happy there and that they felt safe in the home. Many people told us that they had had a great Christmas at the home and were well cared for.

We looked at the assessments for the people and saw that they contained detailed information about individual likes and dislikes. They were clear about the level of support people needed and what they could manage on their own.

Our observations showed that staff interacted well with the people in the home. Staff spoke to people in a respectful manner and responded to people's requests and listened to what they had to say.

We spoke to staff about their hours worked and examined staff rotas.

We toured the communal areas of the home and looked in some of the bedrooms. We saw that many rooms in the home had been refurbished to a high standard. We saw that the home was clean and had been decorated for Christmas.

We found that there was no evidence to support any of the allegations made.