Archived: St Georges Care Home

Updated 17 December 2019

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

Inspection team

The inspection was carried out by one inspector and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

St Georges Care Home is a care home for older people, the majority of whom were living with dementia. People in care homes receive accommodation and nursing or personal care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service had a manager who was in the process of registering with the Care Quality Commission. This means they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided in line with the Health and Social Care Act 2008 and associated Regulations.

Notice of inspection

The inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. This included notifications the service had made, and the details of concerns raised with us about the service. We used all of this information to plan our inspection.

We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections.

During the inspection

We spoke with three people who used the service and four relatives about their experience of the care provided. We spoke with seven members of staff including the manager, deputy manager and care staff.

We reviewed a range of records. This included eleven people’s care records and multiple medication records. We looked at three staff files in relation to recruitment. A variety of records relating to the management of the service were reviewed.

Updated 17 December 2019

About the service

St Georges Care Home is a care home registered to provide accommodation and personal care to a maximum of 35 older people. At the time of the inspection there were 24 people living in the service.

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

Risks to people had not always been identified and planned for. This meant staff did not always have access to information which could guide them on how to reduce risks.

There was a spate of chest infections and colds in the service, but no management plan to reduce the spread of this was in place. Infection control was poor, mattress covers were stained with a substance whose odour and appearance was consistent with urine and there were unpleasant odours throughout the service.

The support people needed to reach and maintain a healthy weight was not always documented.

People’s dignity was not always upheld by staff who were not discreet when providing people with support. The actions of care staff were not always caring.

Staff were disorganised, and this meant people were left in some communal areas with no staff presence for extended periods of time. People’s requests for support were not always met in a timely manner.

At the last inspection in February 2019 the service was rated requires improvement overall. At this inspection standards were found to have fallen and people were placed at risk of harm and receiving poor care. The quality assurance system in place had not identified all of the shortfalls we identified during our inspection. People, staff and professionals from external organisations told us the management team was not visible in the service. Concerns were raised with us about the effectiveness of the manager in driving improvement. External healthcare professionals told us the manager did not deliver on actions they told us they would take within the timescales specified.

Following our second visit, we wrote to the provider about our concerns and asked them what action they would be taking to address the immediate risks we had identified. We returned for a third visit to ensure that they had taken the action detailed in their response to our letter. We found they had mitigated our immediate concerns and we were reassured by plans in place to mitigate risks to other people.

People’s medicines were administered as per the instructions of the prescriber. However, some poor practice was evident with medicines records not always being signed.

Improvements had been made ensure that people’s views about their care were reflected in care planning. Care plans were more personalised to include information about people’s preferences and life history.

Improvements had been made to ensure that people’s capacity to make decisions was assessed under the Mental Capacity Act 2005 and that Deprivation of Liberty Safeguards (DoLS) applications were made where appropriate.

Despite the concerns we identified, people told us they felt safe and that staff were nice to them. Recruitment procedures were safe.

The overall rating for this service is ‘Inadequate’ and the service remains

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 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.

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

Rating at last inspection: The last rating for this service was requires improvement (published 11 April 2019).

Why we inspected

This was a planned inspection.

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.