St Georges Care Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

The overall rating for this key question is requires improvement and we reviewed all quality statements in safe; At our last inspection we identified people were not always being supported by enough staff to support people with their individual needs. At this inspection we found improvements had been made although the manager confirmed there were care staff, nursing staff and activities vacancies within the service they were using agency staff whilst undertaking recruitment to these vacancies. We identified a breach of Regulation 17 at this inspection as improvements were needed to accurate and complete care records in place. We also found improvements were needed to the recording of people’s individual support such as their personal care, oral care, incontinence care, re-positioning and how medicines were being recorded as administered. People were supported to have visitors and personal protective equipment was available to visitors and staff although some additional clinical bins and guidance was needed within the home.

This service scored 50 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Some people shared with us incidents that had occurred within the service. The manager confirmed the incidents had been investigated and reported to the appropriate agencies. Although there was an open and honest approach from the management of the service, people were not always receiving care that kept them safe although the management team was working with the various agencies so improvements could be made.

The manager confirmed they undertook daily walk arounds within the home. These were an opportunity to review staff practice and the care people were receiving. Staff were given the opportunity to raise concerns through staff meetings. The manager and deputy manager were observed being available to support staff during the day if needed. One member of staff told us, “Monthly meetings we raise it here or with (management)”. Clinical and safeguarding meetings also highlighted any organisational learning and actions taken. The management of the service were open about the continuous improvement they wanted to make. They confirmed recent changes had been made to increase the number of staff on duty during the day.

Although the service had a system where incidents and accidents were logged onto an electronic system, some people were not always receiving safe care. For example, there had been safeguarding incidents where people had received unsafe care from staff. The manager confirmed they were raising concerns where unexplained bruising was occurring, and follow up actions were taken such as referrals to falls clinics and safeguarding teams or where information was shared with professionals. Senior management could also review these incidents and there was an opportunity to discuss these at management meetings if needed.

Most people felt referrals were made when required. Although one person said they had been asking for a referral to the physiotherapist and dentist. We raised this with the manager who confirmed they were unaware of this person’s request. Following our inspection, they confirmed these referrals had been made. One relative during our inspection told us, “They know what they are doing”. Although most people and relatives said referrals were being made, improvements to people’s continuity of care and support had been raised by professionals. The management team were working with external partners and professionals to make these improvements.

Staff said people received safe care. One member of staff told us, “Safe care yes”. Another member of staff when asked if people get safe care told us, “Yes.”

Three health care professionals provided us with feedback about the service. They all confirmed improvements were needed to ensuring continuity of care is provided to people from staff. One professional told us, “Continuity of care is poor.” They said this was because staff had limited knowledge about people’s individual clinical needs.

The manager confirmed they were working in partnership with external agencies such as the dementia team, safeguarding team and local GP practice. This was to improve people’s care outcomes and to ensure they were getting the care and support they needed. Although the management were open and honest about the improvements needed, people did not always receive safe care.

People did not always feel safe in the service. One person told us, “I don’t feel very safe.” Another person told us of an incident involving a member of staff. When we raised this with the manager, they confirmed they had taken actions and had raised the concerns as safeguarding incidents to the local authority and to the Care Quality Commission (CQC), as required.

All staff had received an induction into safeguarding although some staff were due refresher training. Not all staff we spoke with were able to confirm the different types of abuse. We shared this feedback with the manager following our assessment. The staff training matrix confirmed 8 staff were due refresher training in safeguarding adults. Staff said people got safe care. One member of staff when asked if people get safe care, said, “Yes”. All staff we spoke with felt able to raise concerns with the management of the service.

We observed staff being responsive to people’s needs and offering choices such as what they would like to eat and drink for their lunch. People had visitors and they could spend time in their rooms and the communal areas within the home.

The manager completed all safeguarding referrals and Deprivation of Liberty Safeguards (DoLS) when required. There was a log of referrals made including any outcomes and actions taken. Notifications were made to CQC when required. The management of the service were working with partner organisations at the time of the assessment due to safeguarding concerns raised. They confirmed they were raising all concerns with the local authority safeguarding team such as when they found unexplained bruising. We observed improvements were needed to how people were supported by staff with their mobility needs. We shared this with the manager for the service as poor moving and handling can contribute to unexplained bruising and injuries to people. The service ensured people had mental capacity assessments and best interest decisions where people lacked capacity. Although not all best interest decisions confirmed who had been consulted with, as required.

People and relatives provided us with mixed feedback about their care and support and how staff provided this. Some people shared with us incidents that had occurred and that they felt improvements were needed to ensure there were enough staff throughout the day to support them with their individual needs.

Daily clinical meetings were held so staff had the opportunity to raise any changes to how people were each day. These meetings were an opportunity to discuss any referrals such as if the person needed a medical review.

We observed staff supported people in a relaxed manner asking them if they would like support and assistance. People were seen independently walking around the home along with using walking aids such as a walking frame. However, people who needed support with their diabetic care were not offered healthy snack options as they were only being offered biscuits. We shared this with the management of the home as they could review people being offered healthier snacks.

The recording of people’s care and support received required improving. For example, we were not always assured people received incontinence care, oral care, personal care and re-positioning in line with their care plans as this was not always being documented in people’s daily notes. People were not always being supported with their diabetes care as needed. One person’s care plan needed more information around what support they needed from staff with their diabetes. We observed them being offered biscuits rather than a healthier snack option. Although they were able to make their own decisions about if they wanted the biscuit or not, by having a healthier option offered this would support them in the management of their diabetes care. This person was under a specialist review for their diabetes. Records confirmed a diabetic specialist was visiting so that guidance and support could be provided to the service around their diabetes care. Professionals told us people were not always being supported with their diabetes care as needed. These concerns were being reviewed through professional’s meetings, local authority safeguarding meetings and through people’s individual reviews. The service had risk assessments for moving and handling, choking risks and skin integrity. How to support each person with their care was recorded in their care plan and people had individual personal evacuation plans to ensure they could safely leave the building in the event of an emergency.

Some people told us on occasions they had to wait for support from staff when they called for assistance. One person told us, “Sometimes I have to wait and wait.” During the inspection, there were occasions when call bells were ringing. The management team confirmed they monitored calls bells and if needed they would support people if staff were busy. They confirmed regular reviews were being undertaken of what support needs people had along with reviewing how quickly calls bells were answered.

The management of the service confirmed they were undertaking a refurbishment plan within the service and they would be liaising with specialists before making any changes to the environment and décor this was so it was suitable for people living with dementia.

The environment was clean although it was not always odour free. The manager confirmed they were looking at ways to improve the home was odour free. Dining areas were well presented with tablecloths, fabric flowers and condiments for people to use.

The provider kept a log of safety checks within the premises. This included checks to the water, gas, electrical safety and portable appliances. Improvements and recommendations to the décor and specialist equipment had been identified. The manager confirmed improvements were still needed from the last inspection. This included making the environment suitable for all people living in the home. They had purchased some equipment which was available in rummage boxes in the communal areas of the home and some people’s bedroom doors were identifiable with their picture. The provider had a system that updated the manager to any safety alerts. Environmental risk assessments were in place and checks were completed of people’s rooms so any safety issue could be identified, and actions taken.

People and relatives did not always feel there were enough staff although some said there had been recent improvements to the number of staff within the service. One person said, “Sometimes you have to wait.” Another person told us, “We sat in the dining room from 7:45 to 8:45 this morning, waiting for breakfast. We didn’t get it until 9am.” One relative told us, “Never enough staff”. Although they did then say there had been an improvement over the last couple of weeks.

Staff shared with us mixed feedback about there being enough staff. For example, 1 member of staff said it can be difficult to always provide continuity of care due to the amount of agency staff being used. Another member of staff said mornings can be busy as it depends on how many staff are working that day. Staff told us they had access to training, supervision and support. One member of staff told us they had received their mandatory training in, “Safeguarding adults, mental capacity, dementia, moving and handling, first aid and diabetes”.

We observed on occasions call bells ringing for some time before they were answered. Some people told us on occasions they had to wait for assistance from staff. The manager confirmed they were available to support people should a call bell be ringing for longer than a few minutes and they confirmed they undertook reviews of how long it took for staff to answer call bells.

At the last inspection, people were not supported by enough staff. At this inspection people shared mixed experiences of staff levels. For example, 1 person told us, “Always have a staff problem trying to recruit”. Other comments from people included them having to wait for call bells to be answered and to be supported with their breakfast. The management team confirmed they regularly reviewed the staffing levels in the home to ensure there were enough staff to meet people’s needs. This was done at least monthly. The service had a number of vacancies at the time of the assessment. This included 136 hours of care staff vacancies, 76 hours of nursing staff vacancies and 2 activities co-ordinator vacancies. The manager confirmed some vacancies had been filled and these staff were due to start in the next few weeks. Following our assessment a new registered manager had started working in the service. The provider needed to ensure all staff had the skills and competency to support people who had a learning disability or autism. Staff had undertaken online training but had not received a practical session. Providers who support people with a learning disability and or autism are expected to train staff in both to ensure staff are competent to support people with additional needs. Additional training was due to be delivered to staff over the next few weeks. This included training staff in dementia care. The manager confirmed staff were supported to complete the Care Certificate. This is an agreed set of standards to ensure staff have the knowledge and skills specific to their job role in health and social care. People were supported by staff who had suitable checks completed prior to working in the service. This included reference checks, identification checks and a disclosure and barring service check on their suitability to work with vulnerable adults. Staff were supported through staff meetings, individual supervisions and an annual appraisal.

People and relatives were given the opportunity to raise any concerns they had with the environment such as the décor and cleanliness of the home. This was through relative’s meetings and resident surveys. Relatives and residents had raised with the management team about unpleasant odours within the home and where improvements could be made to the environment. The provider and management were aware improvements were needed; they confirmed this included replacing carpets, the purchase of new furniture and the home being re-decorated.

The manager confirmed they sought advice through appropriate agencies so they could assess and manage the risk of an infection. Staff had access to personal protective equipment such as gloves and clinical face masks. Staff had received training in infection control. Although we observed staff not wearing clinical face masks as per national guidance. We raised this with the manager so they could review this.

The home was clean although not always odour free. The manager confirmed actions they were taking to address this. We observed during an infection outbreak staff not always wearing clinical masks as per government guidance. Improvements were needed to ensure information was easily accessible to visitors such as handwashing guidance and the use of clinical masks. Not all areas within the home had clinical bins available so staff and visitors could safely dispose of used personal protective equipment, as required.

The manager sought advice from appropriate agencies when needed and they assessed the risks implementing interim arrangements to support the control of any infections spreading. However, we observed staff not always wearing clinical masks as per government guidance. The provider and staff were supporting people to have visitors. However, improvements were needed to providing information to visitors around hand washing and providing staff and visitors access to somewhere they can dispose of used personal protective equipment.

People had their medicines administered by nursing staff. Where people needed their medicines reviewed the manager confirmed they liaised with the local GP practice, pharmacy or other health care professional, as needed. Although we observed some staff were inaccurately signing medicines as being administered when the person had been left their medicines to take themselves. We raised this with the manager.

The deputy and manager confirmed visits were provided to the service twice a week from the local GP practice. The outcome of these visits were recorded including if any referral was discussed or made. Advice was sought when people needed their medicines administered in a certain way. The service had guidance to support this.

Most staff had received training in the safe administration of medicines. Although feedback we received from professionals highlighted some staff were unfamiliar with people’s individual needs such as how to manage their diabetes and if they became unwell for any reason. These concerns were being reviewed through the local authority safeguarding team and professionals to ensure people were getting the support they needed. Daily and weekly clinical meetings were an opportunity to check any changes to the person along with any medication issues. People were administered their medicines by nursing staff and most medicines were administered safely with staff signing to confirm the person had received their medicines safely. Although some medicines were being signed as administered prior to the person taking their medicines. This was medicines put into drinks. We raised this with the manager so they could review the safe administration of this medicines. The provider had identified improvements were required to ensure pain assessments were completed for people. We found improvements were still needed around this. Medicines were stored safely and body maps were included in people’s care records where people had been prescribed creams and pain patches administered. People had risk assessments where people were independent with their medicines.