St Georges Care Home

St George’s is a residential care home providing personal and nursing care to up 68 people. The service provides support to older people and people living with dementia. At the time of our inspection there were 53 people using the service. People were accommodated over two floors with the upper floor being used for people living with dementia.

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

People told us they felt safe and that staff treated them well. We received comments such as staff being “brilliant” and they “go above and beyond”. However, we did receive feedback consistently from both staff and people in the home that staffing levels were at times challenging. This didn’t impact on people’s safety, however it did mean that staff weren’t always able to provide the level of personalised care they would have liked to. The home were actively recruiting to fill the hours of cover required but in the interim were reliant on agency staff.

We found that some improvement was required to ensure that the service was person centred in nature. The environment of the floor for people living with dementia needed to be addressed to provide an environment more suited to people’s needs. This included for example making different areas of the floor and individual rooms, more easily identifiable. Some repair and decoration was also required, as identified in the provider’s own audit.

The registered manager and provider were working with stakeholders to make improvement. There was recognition that it would take time to embed changes and stabilise the staff team. However, the provider was proactive at sharing progress with CQC and the local authority in the form of their action plan. The registered manager was receiving support from other registered managers in the organisation and the area manager.

People were protected from the risk of abuse because staff were trained and knew how to report concerns if they had them. There were safe recruitment practices in place, including Disclosure and Barring service checks (DBS).

Risk assessments were used to identify areas where people’s safety was at risk. Where a risk was identified, measures were in place to manage that risk such as support to reposition people where pressure damage was a concern.

People were supported to have maximum choice and control of their lives and staff supported not support 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 the service under the previous provider was good published on 1 April 2021.

At this inspection we found improvements were required and the home was rated requires improvement.

Why we inspected

The inspection was prompted in part due to concerns received about how the home were meeting people’s clinical needs. A decision was made for us to inspect and examine those risks.

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.

We have found evidence that the provider needs to make improvements.

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

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. This is based on the findings at this inspection.

Enforcement

We found one breach of regulation in relation to staffing levels. We made a recommendation in relation to the home environment.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following example of good practice.

The service had visiting procedures in place to check visitor’s temperature’s and they signed a disclaimer confirming they were well and had no symptoms of COVID-19. Visitors were not let into the home if they were running a high temperature. There was plenty of personal protective equipment (PPE) available for visitors on arrival along with hand sanitiser and hand washing facilities.

There was additional cleaning in place including high touch areas such as door handles, light switches and handrails. The home was equipped with all the necessary equipment and cleaning products to maintain a clean and safe environment.

There was a weekly testing programme for staff. This consisted of a polymerase chain reaction (PCR) test and a twice weekly lateral flow test (LFT). Most people and staff had received their first dose of the vaccine.

The home was open to admissions. When people were admitted from home or hospital, they had to have a negative PCR result and had to isolate in their room for a 14-day period.

Staff had access to plenty of personal protective equipment (PPE) and staff had received training in infection prevention control. At the time of the inspection the staff team were supporting people with telephone calls and video calls in order to keep in contact with their family.

At the last inspection on 25 and 26 October 2017 the service was rated Requires Improvement. We found repeated breaches of the regulation relating to accuracy of records and quality assurance systems. We issued a requirement action. Following the inspection, the provider sent us an action plan telling us how they would make the required improvements.

We carried out a comprehensive inspection on 18 and 19 September 2018. At this inspection, we found significant improvements had been made and the legal requirements had been met.

The service has improved to Good.

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.

Sufficient numbers of staff were deployed at the time of our visit. Staff performance was monitored. Staff received supervision and training to ensure they could meet people’s needs.

Medicines management shortfalls were promptly acted upon and actions taken to make improvements.

Staff demonstrated a good understanding of safeguarding and whistle-blowing and knew how to report concerns.

People were helped to exercise support and control over their lives. People were supported to consent to care and make decisions. The principles of the Mental Capacity Act (MCA) 2005 had been followed.

Risk assessments and risk management plans were in place. Personal and nursing care was delivered in line with assessed needs and accurate monitoring records were maintained.

Incidents and accidents were recorded and showed that actions were taken to minimise the risk of recurrence.

People’s dietary requirements and preferences were recorded and people were provided with choices at mealtimes.

Staff were kind and caring. People were being treated with dignity and respect and people’s privacy was maintained.

A range of activities were offered and provided people with entertainment in communal areas and in their rooms.

Systems were in place for monitoring quality and safety. Where improvements were needed the provider acted to address identified shortfalls.

In addition to being placed in special measures, we imposed a condition on the provider’s registration relating to person centred care and treatment, dignity and respect, completion of statutory notifications, consent to care, risk management, administration of medicines, safeguarding people from abuse, complaints management, record keeping, quality monitoring and governance, staffing levels and staff supervision and training.

We carried out a comprehensive inspection on 25 and 26 October 2017 to review what improvements had been made at the service since they had been placed in special measures.

St Georges Care Home is a 68 bedded home that provides accommodation for persons who require nursing and personal care. At the time of our inspection there were 40 people living in the care home.

The manager in post received confirmation on 17 November 2017 that their application for registered manager had been successful. 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.

Overall, we found there had been significant improvements in all areas for the home to be taken out of special measures. Further work was needed to ensure that improvements were consistent and embedded throughout the home.

Sufficient numbers of staff were deployed. However, the home was only 59% occupied. Staff performance was being more effectively monitored. Staff had received supervision and training to ensure they could meet people’s needs. Additional support and training was provided by the NHS care home support teams.

Staff were kind and caring. We found people were being treated with dignity and respect and we found people’s privacy was maintained.

Systems were in place for monitoring quality and safety. However, further improvements were needed.

At this inspection we found a breach of one of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, relating to accuracy of records and quality assurance.

In April and May 2015 St Georges Care Home received its first ‘rating’ inspection and was rated requires improvement. We issued five regulatory requirement actions for regulatory breaches relating to safe care and treatment, person centred care, staffing, good governance and dignity and respect. After the inspection, the provider wrote to us to say what they would do to meet the legal requirements.

We undertook a focused inspection on 6 and 7 January 2016 to check the provider had followed their plan and to confirm they now met the legal requirements. We had also received information from the local authority that had concerns about the quality and safety of the service provided for people in the home.

We found insufficient actions had been taken in response to some of the breaches identified at the previous comprehensive inspection in 2015. There were five regulations breached at this inspection in relation to safe care and treatment, safeguarding service users from abuse and improper treatment, person centred care, staffing and good governance. A warning notice was issued in relation to safe care and treatment.

The last comprehensive inspection took place in July 2016; the service was rated requires improvement. We found that sufficient action had been taken in relation to the warning notice we had issued following the previous inspection. Improvements had been made since the last inspection however further improvements were needed to embed the changes. There were two breaches of regulations in relation to staffing and good governance at this inspection.

At this inspection (January 2017) we found nine breaches of regulations. Both of the previous breaches from the last comprehensive inspection in July 2016 had been repeated. We also found seven further breaches in relation to safe care and treatment, person centred care, safeguarding people from abuse and improper treatment, consent, complaints, dignity and respect, and statutory notifications.

St Georges Care Home is a 68 bedded home that provides accommodation for persons who require nursing or personal care. At the time of our inspection there were 50 people living in the care home.

At this inspection the overall rating for the service is 'Inadequate' it will therefore be placed into special measures. The commission is now considering the appropriate regulatory response to resolve the problems we found.

There was a registered manager in place at the time of our inspection; 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.

There were widespread and systemic failings identified during the inspection. Overall we found that quality and safety monitoring systems were not fully effective in identifying and directing the service to act upon risks to people who used the service and ensuring the quality of service provision. The failings included issues around staff management and staff cohesiveness that impacted on service delivery.

The registered manager and provider had failed to make appropriate statutory notifications; notifications tell us about significant events that happen in the service. We use this information to monitor the service and to check how events have been handled.

There was a failure to safeguard people. The registered manager had failed to report and take appropriate action regarding adverse incidents. The registered manager had failed to recognise the inappropriate restraint of people.

The registered manager had made applications for Deprivation of Liberty Safeguards (DoLS ) where they had been assessed as being required. These safeguards aim to protect people living in care homes from being inappropriately deprived of their liberty. These safeguards can only be used when a person lacks the mental capacity to make certain decisions and there is no other way of supporting the person safely.

We found however that the registered manager and other staff had a variable understanding of the Mental Capacity Act 2005 and DoLS. The registered manager had failed to ensure staff met the DoLS conditions for a person with DoLS.

There were not enough suitably trained staff to meet people’s needs. Staff had not received training and supervision which supported them in their roles.

Care plans were not person centred. Peoples' risk assessments were not reflective of people’s needs. Records used to monitor peoples' health were not always completed. This exposed people to risks of neglect and unsafe or inappropriate care or treatment. The administration of people's medicines was not in line with best practice.

We observed occasions when care delivered by staff compromised peoples dignity and respect. There was a divisive staff culture and poor communication between staff which impacted negatively on care delivery. Complaints made by people and relatives were not always recorded and resolved to the satisfaction of complainants.

Recruitment procedures were followed appropriately to ensure safe recruitment practices

We found nine breaches of regulations at this inspection and will be asking the provider to send us a report of the improvements they will make.

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.

Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

After the inspection, the provider wrote to us to say what they would do to meet the legal requirements. You can read the report from our last inspection by selecting the ‘All reports’ link for ‘St Georges Care Home’ on our website at www.cqc.org.uk.

We carried out a comprehensive inspection on 19 and 20 July 2016. St Georges Care Home is a 68 bedded home that provides accommodation for persons who require nursing and personal care. At the time of our inspection there were 56 people living in the care home.

There was no registered manager in place at the time of our inspection. The manager in charge of the home had submitted an application to the Commission to become the registered manager and this was being processed. 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.

At our inspection on 19 and 20 July 2016, we found that sufficient action had been taken in relation to the warning notice we had issued following the previous inspection. Overall, although we found improvements had been made, further improvements were needed to embed the changes. We found two breaches of the legal requirements.

Sufficient numbers of staff were not always deployed to meet the needs of people living in the care home. Care was sometimes rushed and monitoring charts were not always completed.

Staff received appropriate training to carry out their roles and staff performance was monitored effectively. Staff had received training to ensure they could meet people’s needs and care for them in a safe way. For example, staff had received training in how to care for people living with dementia.

People were protected from the risks of unsafe care because care plans reflected current health care needs.

Systems were in place for monitoring quality and safety and actions were taken when improvements were needed. Further improvements were needed to make sure shortfalls in care monitoring records were identified and acted upon.

Staff were kind and caring. We found people were being treated with dignity and respect and we found people’s privacy was maintained.

We found two breaches of the regulations at this inspection. You can see what action we told the provider to take at the back of the full version of the report.

During our inspection we spoke with eight people who lived in the home, six staff including registered nurses, four visitors/ relatives, the manager and the deputy manager.

We examined six personal care files and associated records for people who lived in the home. We observed how staff interacted and supported people in communal areas.

We were supported on this inspection by an expert-by-experience. This is a person who has personal experience of using or caring for someone who used this type of care service. This person gained the views of people living in the home and their experiences.

All the visitors we spoke with were positive about the care their family member received. One relative told us 'they are helpful and if I had a problem I know who to go to'. Another person told us 'activities could be a bit more plentiful. Sometimes there is nothing'.

People that used the service were also positive about the care they received. One person told us 'I get cross when I read in the paper about bad homes, I want to write to say it isn't like that where I am'. Other people's comments included; 'they are busy staff but they are lovely they always work very hard'. 'The food is nice I have a good choice'. 'I have been here a long time and would rather not be here, but they are all ok. Staff ask me if it is alright before they do things'.

Staff were positive about the care they delivered and felt they were supported well enough to provide a good standard of care. Some staff told us they would like more time to spend with people. We discussed this with the manager who confirmed they would discuss staffing concerns at the next team meeting.

The provider had systems in place to monitor the quality of the service that was provided.