Archived: St George's Residential Care Home

We issued four requirement notices and asked the registered provider to tell us how they were going to make the improvements required. At this inspection on 21 November 2016, we found that the registered provider and registered manager had made the changes and improvements needed to meet the requirement notices from the previous inspection

St George's Residential Home provides accommodation and personal care for up to 41 older people. The home is in an older property, close to local amenities in the town of Millom and has been adapted and extended for its current use. The bedrooms in the home vary in size and layout. There is a garden to the rear of the home for people living there and this is private and has accessible outdoor seating. There is parking available at the front of the home for staff and visitors. There were 28 people living at the home at the time of our inspection.

The service had a registered manager in post. 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 and associated Regulations about how the service was run. We noted that there was a clear structure and lines of responsibility being promoted by the registered manager and deputy. A member of care staff told us, “It’s a very open and friendly place to work”.

People living in the home told us that they felt safe living there and relatives we spoke with told us they were satisfied and “more than happy” with the care being provided. Some people who were living with dementia could not tell us their views but those people who could told us they felt “safe” and “secure” living there. We were told by one person who lived there, “I am happy here”.

People confirmed they had a choice of meals and drinks and they told us the food was “good” and that they enjoyed their meals. People were involved in discussions and feedback about food at their ‘residents’ meetings.

We saw that the people who lived there were being well cared for and were relaxed and comfortable in the home and with the staff that were supporting them. The atmosphere was informal and inclusive and people told us that they would be comfortable raising any complaints or concerns with the registered manager. Everyone we spoke with praised the staff that supported them and the friendliness of the staff and management.

People told us that care staff were available to help them when they needed assistance and that staff respected their privacy. People living at St Georges told us they were able to see their friends and families as they wanted and go out into the community with support. There were no restrictions on when people could visit them in their home. People were able to follow their own interests, practice their religious beliefs and see their friends and families as they wanted. People commented positively on the range of activities available to them in the home and the social events arranged for them.

The registered manager had a system to calculate dependency and staffing needs which they reviewed at three monthly intervals. We could see that the home was being adequately staffed to meet people’s needs during the day. We have made a recommendation that the registered manager reviewed their dependency tool to consider the layout of the home and sought guidance on current best practice on risk assessing safe staffing levels at night.

The service had safe systems for the recruitment of staff to make sure the staff taken on were suited to working there. We saw that care staff had received induction training and training for their roles and development and had regular supervision and annual appraisal. Staff said they were well supported by the management team. There was an on call system for staff to access management support at night.

Staff had received training in safeguarding adults. Staff we spoke with knew the appropriate action to take if they believed someone was at risk of abuse. People knew how they could complain about the service they received and information on this was displayed in the home. People we spoke with were confident that action would be taken in response to any concerns they raised.

The service had followed the requirements of the Mental Capacity Act 2005 Code of practice and Deprivation of Liberty Safeguards. This helped to protect the rights of people who were not able to make important decisions themselves. We looked at people’s records and saw that the registered manager had applied to relevant supervisory authorities for deprivation of liberty authorisations for people.

During this inspection, we looked at the way medicines were managed and handled in the home. We found that medicines were being administered safely and records were being kept of the medicines in the home.

The service worked with local GPs, district nurses and health care professionals and external agencies to provide appropriate care to meet people’s different physical, psychological and emotional needs.

We looked at care plans and saw there were risk assessments in place and control measures to help minimise them. We looked at the risk assessments in place regarding how people would be moved in the event of fire or other emergency. These had been kept under review. We noted that risk assessments were not being formally carried out to assess the risks of choking for people. The registered manager knew this needed to be formalised and was addressing it as part of their care planning review. We made a recommendation that in their review of risk assessments the registered manager considers current guidance and best practice on assessing the specific risks of people choking.

From our observations and conversations with people living there we found they had received the support they needed and were being given choices about their care and their social activities. We observed that staff encouraged people to maintain their independence. We were told by people living there, "I find the staff are very good" and 'They (staff) will do anything for you, nothing is too much trouble'.

We did not receive any negative comments about the standard of care received, the food served and the cleanliness of the home. People said the food was "good" and 'excellent' and people told us that they were always given a choice. On our walk around the building we saw that the home was being maintained and was clean and tidy. People had been able to personalise their rooms with their own things.

The service had robust recruitment processes to help make sure the people employed were suited to the role. There was a clear training programme in place to help make sure staff had the right skills and knowledge to give the right care and support.

People we spoke with told us they knew who they could speak to if they had a concern or complaint and said they would be confident raising concerns with the manager

People also told us that they could decide how they spent their time and one person said, "There is always something going on if you want to join in". Several people told us about the organised social activities and the ones they had particularly enjoyed like trips out and visiting musicians. People also told us that they felt they did not have to join in any activity or outing if they did not want to. People we spoke with told us that they had not felt the need to complain about care and they expressed confidence in the staff and the manager to deal with anything that worried them.

We spent a lot of time talking to people living there and watching what was going on and received only positive comments about the "lovely" and "kind" staff and the individual attention people felt they got from them. People told us that they felt their home was clean and comfortable and, we could see as we walked around, that this was the case. People also told us how much they liked their gardens and spending time out there when the weather was good.