St George's House

St George’s House is a residential care home providing personal care to up to 19 people. The service provides support to people aged 65 and over. At the time of our inspection there were 13 people using the service.

St George’s House is a detached period property in the market town of Tiverton. The home has accessible access to the garden and communal areas. People’s bedrooms are on the ground and first floor, which people access using a stair lift.

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

People lived in a home where the providers system was not always effective to identify and address concerns and shortfalls in the service. During the inspection we identified issues relating to people’s records, policies and procedures and medicine management. The provider and registered manager took prompt action to resolve the concerns we found. We have recommended they continue to seek reputable guidance to continue to establish and maintain effective quality assurance systems to embed improvement into practice.

People had not always been protected from environmental risks at the home. The provider took prompt action to the concerns we found. We have recommended the provider continue to regularly monitor health and safety risks at the home.

People’s medicines were not always being managed in a safe way. Improvements were made during the inspection to make medicines safe regarding concerns we identified. We have recommended the provider continue to review their practice in relation to safe and effective use of medicines

People were protected from the risk of abuse because the provider had effective safeguarding systems in place. We observed kind, compassionate and caring interactions between people and staff. People looked comfortable and relaxed with staff who supported them. People spoke positively about the care provided.

Staff told us there were usually enough staff to safely meet people's needs. We identified concerns about the early evening staff levels which we discussed with the registered manager. They told us they would look into the staff levels at this time.

Infection control practice followed national guidance and sought to keep people safe from infection. We signposted the provider to resources to develop their approach further.

The provider worked well with healthcare professionals to ensure good outcomes for people.

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.

The providers policies and systems were being reviewed to ensure staff had clear up to date guidance. The registered manager welcomed support, advice and guidance to achieve compliance. They consented to being contacted by the local authority quality improvement team to continue to improve the service.

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 (published 22 May 2018).

Why we inspected

We received concerns in relation to the management of the service and risks to people. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

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.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for St George’s House on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

St George’s House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. St George’s House is registered to accommodate up to 19 older people in one adapted building. Nursing care is not provided at the home. This is provided by the community nursing service. At the time of this inspection there were 15 people living in St George’s House.

The home had a registered manager. A registered manager is a person who has registered with the Care Quality Commission 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.’

At our last inspection in 2017 we rated the Safe domain Good, at our previous inspection in 2016 we rated Effective, Caring, Responsive and Well led Good. At this inspection on 22 April 2018 we found the evidence continued to support the rating of good in those domains and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

At this inspection we found the service remained Good.

The people who lived in St George’s House were provided with high quality, caring support which was person centred and met their individual needs. We received and saw very positive feedback about the staff at the home and the quality of care being provided. Some of these comments included, “The care at St George’s is excellent”, “You couldn’t get a better home”, and “The staff are excellent.”

People who lived in St George’s House had a variety of needs and were protected from risks relating to their health, mobility, medicines, nutrition and possible abuse. Staff had assessed individual risks to people and had taken action to seek guidance and minimise identified risks. Staff knew how to recognise possible signs of abuse.

Where accidents and incidents had taken place, these had been reviewed and action had been taken to reduce the risks of reoccurrence. Staff supported people to take their medicines safely and staffs’ knowledge relating to the administration of medicines were regularly checked. Staff told us they felt comfortable raising concerns.

Recruitment procedures were in place to help ensure only people of good character were employed by the home. Staff underwent Disclosure and Barring Service (police record) checks before they started work. Staffing numbers at the home were sufficient to meet people’s needs. Staff had the competencies and information they required in order to meet people’s needs. Staff received sufficient training as well as regular supervision and appraisal.

Staff treated people with respect and kindness. There was a warm and pleasant atmosphere at the home where people and staff shared jokes and laughter. Staff knew people and their preferences well. People’s care plans contained detailed and personalised information about each person’s specific care needs, personalities, histories and interests.

Staff had a good understanding of the Mental Capacity Act 2005 (MCA) and put this into practice. Where people had been unable to make a particular decision at a particular time, their capacity had been assessed and best interests decisions had taken place and recorded. The registered manager had a thorough understanding of the Deprivation of Liberty Safeguards (DoLS) and nobody at the home at the time of our inspection was under these safeguards.

People were supported to have enough to eat and drink in ways that met their needs and preferences. Meal times were social events and people spoke highly of the food at the home.

People, relatives, staff and healthcare professionals were asked for their feedback and suggestions in order to improve the service. There were effective systems in place to assess, monitor and improve the quality and safety of the care and support being delivered.

Further information is in the detailed findings below.

St Georges House provides accommodation for up to 19 people who require personal care. There were 14 people living at the service during our visit. There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission 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.

We previously inspected the service on January 27 2016. A breach of legal requirements was found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for St Georges on our website at www.cqc.org.uk.

We found that people were safer because action had been taken to improve the management of health risks to people, including weight loss and pressure care. The registered manager had replaced some risk assessment tools with more effective ones. Refresher training had been given on the effective completion of all health risk charts to all staff. A new system was now in place which gave responsibility for checking the completion of all charts to a keyworker on each shift. These checks were then being monitored by the registered manager.

People living at the service appeared relaxed and content and said they felt safe. Healthcare professionals considered the service to be working safely with people living at the service. One of them said; “From observation during visits to the home …it appears that staff and management are highly aware of the level of need of patients that they can manage safely within the home.”

People were protected from potential abuse and avoidable harm. The provider had a safeguarding policy and staff had received training in how to protect adults from abuse and what to do if they had a concern.

There were sufficient competent staff on duty and robust recruitment systems in place in order to ensure the right staff were recruited to keep people safe.

Individual risk assessments and support plans were in place for each person living at the service which meant that risks for people were minimised. Premises and equipment were kept well maintained and regularly audited for safety by external contractors. The home was clean throughout.

There was a registered manager who left the service in December 2014. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. The Care Quality Commission (CQC) have recently interviewed a person for the registered manager’s post. The service is owned by a provider, who is a registered person. 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.

The Care Quality Commission (CQC) is required to monitor the operation of the Mental Capacity Act (2005) (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are put in place to protect people where they do not have capacity to make decisions, and where it is considered necessary to restrict their freedom in some way, usually to protect themselves or others. At the time of the inspection, an application had been made to the local authority in relation to one person who lived at the service. This meant people’s legal rights were protected.

People felt safe and well cared for. They told us care staff were “so nice”, “very good and helpful” and “wonderful”. They praised the standard of the food and the cleanliness of the home. They felt confident complaints and concerns would be addressed and said the manager and staff were approachable. Regular meetings were held for people to comment on their care and make suggestions for improvements. People were consulted about their care, and their wishes respected.

People told us about the skills of the staff who cared for them. They commented on their friendliness and positive approach. Staff said they were well supported and had access to a range of training and increased supervision.

Improvement was needed to ensure the tools necessary to measure risks to people’s health and safety were used correctly, with a clear action plan put in place. Health professionals were consulted when people’s care needs changed. Positive feedback was provided by visiting health professionals regarding the timeliness of referrals and the skills of the staff.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the provider to take at the back of the full version of this report.

We saw staff speaking with people in a respectful and friendly manner, offering support and advice, and also respecting people's right to refuse care. People told us staff understood their needs. On person told us 'The staff don't hassle me ' that's important to me.' A person also told us 'They will listen and adapt to your needs'.

We spoke to people about the meals and the support they had for food and nutrition. One person told us 'The food is excellent ' very good quality.' Another person said 'There is always a choice. They are very good at giving you what you want.'

People we spoke with praised the staff and said they were confident the staff were understood their needs. Comments included 'The staff are very good ' very quick to do anything you ask.' Another person said 'The staff are always pleased to help you.'

The home had created a friendly, open and welcoming atmosphere. We found that people were engaged in their surroundings, frequently having conversation with each other and with staff. People told us they had care plans and had been involved in making decisions about their care and said they were well supported. Relatives we spoke with were also very positive about the home saying comments such as, 'My relative feels safe and well cared for and treated with respect and affection." Another said, "Staff go the extra mile, I have been impressed with the professionalism of the staff, the younger ones included."

We found the home had staffing levels that allowed time for both the care and the social needs of people to be well met. There was a varied programme of group and individual activities. The staff team were experienced and well trained with expertise and skills in, for example, caring for people with dementia.