St Georges Court Care Home

Updated 14 September 2023

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 Health and Social Care Act 2008.

As part of this inspection, we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

This inspection was carried out by 4 inspectors, 3 of whom carried out the site visits. A 4th inspector spoke with relatives by telephone. The inspection team also included 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 Court Care Home is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. St Georges Court Care Home is a care home with nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was a registered manager in post.

Notice of inspection

This inspection was unannounced.

Inspection activity started on 28 June 2023 and ended on 26 July 2023. We visited the service on 28 June 2023 and 11 July 2023.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and Integrated Care Board who have worked with the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke with 7 people who used the service, and 12 of their relatives about their experience of the care provided. We spoke with 12 members of staff including care workers, nurses, catering staff, housekeeping staff, representatives from the provider’s quality team, the care manager, and the registered manager.

We reviewed a range of records at the service. This included training and competency documentation for staff, and staff recruitment records. We also reviewed care records for 11 people during the inspection and some medicines records. We asked for other records to be sent to us, which we reviewed away from the care home. These records included quality monitoring documentation, accidents and incidents, utilities and safety checks, surveys, and the service improvement plan. Additionally, we looked at some policies and other records including the Care Operations Continuity plan.

The chief operating officer for the provider sent us an update regarding the medicines cabinets concerns found during the first site visit. The update included prompt actions taken at the service and throughout the provider’s organisation.

Updated 14 September 2023

About the service

St Georges Court Care Home is a ‘care home’ providing personal and nursing care to up to 76 older people. At the time of our inspection there were 67 people using the service, some of whom were living with dementia. The service has 3 floors and has its own adapted facilities and shared areas for people to use.

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

The provider’s quality monitoring systems had failed to identify that safeguarding processes were not always followed by staff to keep people safe from poor care. Staff had training but they did not always have the skills and knowledge to promote people’s nursing needs, health and well-being. Risks to people were not always considered. People’s care plans and risk assessments were not updated quickly enough when there were changes in people’s needs, nor did they always contain enough information to guide staff to support people effectively and safely.

Checks for medical devices were not always being completed in line with the manufacturer's directions. Medicines were not always managed safely, and people’s privacy and dignity was not always promoted by staff. Lessons were not always learnt. Internal investigations into incidents and accidents failed to identify outcomes, actions and learning to help reduce the risk of harm to people’s well-being.

Clinical areas within the service were not always kept clean to promote good infection control practices. Areas of flooring throughout the service were cracked and damaged. This included the laundry room. This meant that the cleaning of these areas to promote good infection control would be more difficult. The layout of furniture and furnishings of the floor that housed people, including people with complex dementia and nursing needs, was not conducive to supporting people who may be noise sensitive. The registered manager told us they wanted to put specialist signage in the service. This would help people who were sensory impaired or were living with dementia find it easier to orientate themselves around the building.

The provider’s governance, systems and audit processes were not robust enough. This was recognised by the provider's senior leadership team who told us they were committed to making and sustaining ongoing improvements required. The registered manager and the provider’s senior leadership team were responsive to our feedback and engaged with the CQC inspection team fully during the inspection process.

Despite our inspection findings people and their relatives told us they and their family member felt safe at the service. Whilst we observed missed opportunities for staff to meaningfully engage with people, we also saw some kind and considered interactions.

People's needs were assessed prior to them moving into the service. However, people, and their relatives, gave mixed feedback for their involvement in the care planning process. Activities happened at the service, however people living with dementia were not always given enough stimulation to help them spend their day meaningfully. Staff reacted to people’s anxieties rather than being proactive to try to reduce the number of incidents that occurred.

People, and their relatives told us they knew how to raise a complaint. However, verbal complaints were not always formally documented by staff.

The provider undertook safe recruitment procedures. Staff supported people in the main to receive a balanced diet and have enough to drink. However, people’s care records contained conflicting information to guide staff. People and their relatives had mixed opinions on whether they were involved in care decisions and reviews.

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.

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 (report published 16 December 2017).

Why we inspected

The inspection was prompted in part due to concerns received by the CQC about safe care and treatment, safeguarding, infection prevention and control, promoting dignity, safe medicines management, and good governance.

We found evidence during this inspection that people were at risk of harm from these concerns. Please see the safe, effective, caring, responsive and well-led sections of this full report.

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.

Enforcement and Recommendations

We have identified breaches in relation to safeguarding people from abuse, person-centred care, suitably skilled staff, promoting people’s dignity and respect, safe care and treatment, premises and equipment, and good governance at this inspection.

We wrote to the provider during our inspection due to our extensive concerns of people receiving poor quality care. The provider told us they had not been aware of the significant failings at the service and risks posed to people's safety and well-being. The provider submitted a robust action plan to the CQC in response to those concerns.

We have made a recommendation for the provider to review the accessible information available for people. We have also recommended the provider reviews the UK resuscitation council guidelines regarding end of life care information to guide staff.

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.

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 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.