The Care Quality Commission
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Archived: St George Residential Care Home

Overall: Inadequate read more about inspection ratings

42-43 West Cliff, Whitstable, Kent, CT5 1DJ (01227) 280599

Provided and run by:
Kisskadee Enterprises Ltd

Important: The provider of this service changed. See old profile
Important: CQC has taken action against Kisskadee Enterprises Ltd to protect the safety and welfare of residents at St George Residential Care Home. We will update the information on this page as soon as possible.

All Inspections

26 January and 11 February 2015

During a routine inspection

This inspection took place on the 26 January and 11 February 2015 and was unannounced. The service provides accommodation for up to 18 older people who may also be living with dementia. There were 12 people living at the service when we visited.

Following an inspection on 17 September 2014 we found five breaches of Regulations and issued compliance actions which we asked the provider to take action on within an agreed timescale. The provider sent us an action plan telling us the action they would take to ensure they met the requirements of the law. They told us they would achieve compliance with the regulations by the end of January 2015.

At this inspection we found the provider had taken steps to make some improvements but these were insufficient to meet the areas of concern and were still not meeting the requirements of the regulations. In addition this inspection has highlighted further breaches of regulations.

At the time of our inspection the service had a manager who had just been registered by CQC. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 told us they felt safe and tolerated some of the shortfalls in staffing and a lack of activities, because they liked the small homelike atmosphere within the service and found it convenient for them, their friends and relatives. However, we found people’s safety was being compromised in a number of areas.

The arrangements that were in place to safeguard people from the risk of abuse were inadequate as not all incidents which should be reported to the local authority and CQC had been. The management of nutritional and skin integrity risks and for those living with dementia in regard to environmental risks, or those with other health conditions were inadequate. This put people at risk of serious harm.

The provider did not have a system to assess the number of staff needed and there were not enough staff at all times to meet people’s needs. Recruitment procedures did not ensure that all appropriate checks had been carried out or that staff had the appropriate skills to work with people living with dementia. Staff had not received the appropriate level of training to enable them to work confidently and with appropriate understanding of the needs of people living with dementia.

No one living at the service was currently subject to a Deprivation of Liberty Safeguards (DoLS) authorisation, and there was a lack of awareness shown by the registered manager that for some people who did not understand the need for staff to provide interventions in regard to their care and support, a referral to the Deprivation of Liberty safeguards team should have been made. The Care Quality Commission (CQC) monitors the operation of DoLs which applies to care homes and we found that the service was not meeting the requirement of the Deprivation of Liberty safeguards. Mental capacity assessments were not carried out although people who knew people well were involved in their care plans and in making some decisions about their care.

Systems were not in place to ensure that the registered manager and staff had a good understanding of whether people were eating and drinking enough, or steps taken to ensure those who could not be weighed were assessed in some other way. This put them at risk of malnutrition and dehydration.

Staff demonstrated kindness and compassion towards the people they supported, however short staffing led some staff to be less tolerant of those people who required more staff input and monitoring. This was evident in some of the poor practice we saw. There was an over reliance on other people in the service informing staff of the whereabouts of people who needed regular monitoring.

The location of some shared toilet facilities meant people’s privacy and dignity was not always maintained when receiving support in communal areas. Some staff attitudes in response to work stresses also compromised people’s dignity.

The registered manager had developed and updated 10 out of 12 care plans, those updated were individualised and had been developed with the involvement of people and their relatives however some gaps in regard to risks remained and life histories were still being developed with relative’s involvement. Staff did not always follow the care plans so that people could rely on care being delivered in the way they or their relatives had expressed their preferences for. Activity provision was inadequate for everyone but those people who remained in their rooms had very little engagement and mental stimulation and were at risk of becoming isolated.

There was a complaints policy and a system to record and investigate complaints. This was being used for some but not all complaints.

The staff team did not feel well supported through the changes the registered manager was trying to make. Staff meetings were held but staff did not feel these were arranged for the benefit of staff or a forum where they could raise issues important to them. There was a lack of a clear staffing structure in the absence of the registered manager and senior carer with staff unclear who was the shift lead and responsible for decisions within the service.

The provider carried out regular visits to the service and completed visit reports but these were not effective had not identified the shortfalls we have found through inspection and were not being used to drive improvement. The registered manager had implemented a robust medicine audit and also a catering audit and we could see where shortfalls were being highlighted but actions taken to address these were evident in records seen. People were asked for their views about the service but did not receive feedback on what the analysis of surveys had shown and how was used to influence service development.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, which correspond to the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

17 September 2014

During a routine inspection

We considered our inspection findings to answer questions we always ask:

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well led?

Below is a summary of what we found. The summary is based on our observations during

the inspection, speaking with people living at the service and speaking with staff.

Is the service safe?

We found that there were some risks associated with infection control. This was because of the layout and lack of maintenance in the laundry. The service had not been provided with appropriate bins to reduce the risk of cross infection. The Health and safety of the premises had not been fully assessed, this meant that risks arising in communal areas had not been recognised or acted upon. We found that staff were carrying out potentially dangerous moving and handling practices because they had to negotiate the step down to the dining room.

People living at the service felt safely cared for and we found that staff received regular training updates to maintain their knowledge about safeguarding. The home policies and procedures in place in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards, although no applications had needed to be submitted. Staff had been trained to understand when an application should be made and how to submit this.

The manager had made a reciprocal arrangement with a care home nearby. So that in the event of an emergency people could be temporarily looked after at this home. However, Personal Emergency Evacuation Plans (PEEP's) were not in place. In addition there was no equipment available to evacuate people down the stairs should there be an interruption to the function of the stair lifts.

Is the service effective?

People's needs were assessed before they moved into the home.

The manager was in the process of writing detailed and comprehensive care plans but most people's care plans had not been updated yet. The staff knew the people living at the home well and there was a stable staff team. This meant that despite the lack of guidance in the care plans that staff understood people's individual needs and preferences.

Whilst care records were kept securely care plans lacked detail and did not describe peoples individual preferences. There was a lack of documented risk assessments.

Is the service caring?

People living at the service told us that the staff were kind and considerate, they told us that staff took time to chat with them and that when helping with personal care they were treated with dignity and respect.

We observed how people were cared for and spoken with throughout our inspection. We found that staff interacted with people in a positive and reassuring way. Staff frequently checked that people were okay, had everything they needed, and offered their help regularly.

Is the service responsive?

We found that when people living at the home became unwell or their health deteriorated staff took action promptly and contacted the GP or other relevant health professional. We saw that when advice was given by health professionals, this was followed by staff.

The complaints procedure was displayed on a notice board. The manager told us about a minor complaint she had resolved recently to the satisfaction of the complainant.

People told us that staff knew what time they liked to get up and go to bed and would make an effort to assist them at their preferred times so they were not left waiting too long. People told us that when they rang for help, staff did not leave them waiting.

Arrangements for organising activities that met peoples expectations and interests were not in place. Two people commented that there was a lack of activities that interested them. The manager showed us that the activity coordinator was in the process of gathering information about people's interests and hobbies. However a new activity plan to encompass people's individual preferences had not yet been put in place.

Is the service well led?

The manager was new in post having joined the service at the end of May 2014. The manager was introducing changes to the home gradually and had prioritised the order in which the changes were to be made on a risk basis.

The manager confirmed and people living at the home told us that they had not formally been asked to give any feedback about how they thought the service was run or what was good or could be improved.

There were not effective systems in place to monitor the quality of the service, because of the changes being made to practices and a lack of an established system prior to the manager joining. The manager told us about her future plans to conduct regular surveys and to establish an effective auditing system.

We have asked the provider to tell us how they will make improvements and meet the requirements of the law in relation to care and welfare, infection control, provision of equipment, and quality assurance.