Archived: St Georges Hotel - Care Home

We found the following examples of good practice.

The home was visually clean and free from odours. There were procedures to ensure that infection control risks were reduced. For example, planned increased cleaning of communal areas and high touch areas such as door handles and light switches.

We observed staff donning and doffing PPE correctly. An area of the home was available for this purpose with plentiful supplies of PPE and handwashing facilities seen.

Procedures were in place regarding self-isolation for people who were admitted to the home from the community or other health care provision. The admission procedure had been reviewed and developed to reduce the risk of infection from COVID-19.

The home had a contingency plan to reduce the risk of cross infection should there be an outbreak of COVID-19 in the home. This included self isolation for residents who showed symptoms and separating staff teams so they cared for a reduced number of people and did not care for both symptomatic and non symptomatic residents.

The home advised visitors of the most appropriate entrance to use so that they accessed the home in the vicinity of the resident’s room. This helped to reduce the risk of infection being brought into the home.

Due to the current national lockdown, visiting was restricted. The registered manager said information had been provided to friends and families by telephone call and on the home’s social media page regarding the visiting arrangements. Where visiting was allowed for compassionate reasons (for example for people receiving end of life care), suitable infection control procedures were followed when visitors entered and moved around the building. Visitors were screened for COVID-19 prior to entering the home. Visitors were required to wear masks and, as necessary, other protective personal equipment (PPE).

The registered manager was in the process of developing plans and procedures for when visiting to the home is permitted in line with national guidelines. A room near to the front door was being considered to allow visitors without the need to access further into the home.

People were supported to speak with their friends and family using IT systems and the telephone as necessary.

Appropriate testing procedures for COVID-19 had been implemented for all staff and people who used the service following national guidance regarding the frequency and type of testing. Staff only worked at the home and no agency or bank staff were used. This reduced the risk of cross infection.

The staff monitored residents for symptoms of covid-19. This included daily monitoring of physical symptoms such as temperature checks.

Infection control policies and procedures had been updated in line with the national guidance relating to COVID-19. Staff had access to the policies and procedures including updates. The training for staff regarding infection control had been updated to include guidance relating to COVID-19.

The registered manager had completed risk assessments and audits / checks regarding the environment and risks to staff and residents.

The registered manager had discussed with the staff those who may be at increased risk from COVID-19. The registered manager planned to complete individual risk assessments for each member of staff to formally identify those who were at increased risk from COVID-19 and the measures that would be required to keep them safe, should there be an outbreak in the home.

Plentiful supplies of PPE were available in the home. This included masks, gloves, aprons, gowns, visors and goggles.

Staff breaks were staggered to reduce the risk of groups of staff congregating together.

This unannounced comprehensive inspection took place on 8 May 2018. The last comprehensive inspection took place on 18 February 2016 when we found the service was in breach of one of the legal requirements. The service was rated as Good at that time. On the 13 February 2017 we carried out a focused inspection to check on the action taken by the provider to meet the requirements of the regulations. We found the service had taken appropriate action and had addressed the concerns we had found in February 2016. The service was found to have remained Good at this inspection

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.

The service is required to have a registered manager and at the time of the inspection 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 and associated Regulations about how the service is run.

We spent time in the communal areas of the service. Staff were kind and respectful in their approach. They knew people well and had an understanding of their needs and preferences. People were treated with kindness, compassion and respect. People’s bedrooms were personalised to reflect their individual tastes.

People told us, “I am happy here and feel safe” and “I have two friends that visit each week. When we have visitors we see them in the quiet lounge or I could see them in my room if I wanted.” Relatives told us, “It’s a home from home here and feels like that from the moment you walk in; they’re all wonderful.”

The premises were well maintained. People’s bedroom doors held a number and their name in small print to help people identify their own rooms. The premises were regularly checked and maintained by the provider. The service was comfortable and appeared clean with no odours. Equipment and services used at St Georges were regularly checked by competent people to ensure they were safe to use.

The soap dispensers in all bathrooms were open topped and being regularly topped up as needed. This posed a potential infection risk as the residual soap in the dispensers was not being regularly emptied and filled entirely with new soap. Best practice is for soap to be dispensed from sealed cartridges. The provider addressed this issue immediately and ordered sealed dispensers for all bathrooms.

Care plans were well organised and contained accurate and up to date information. Care planning was reviewed regularly and people’s changing needs were recorded. Records of care and support provided were completed regularly by staff. Risks in relation to people’s daily lives were identified, assessed and planned to minimise the risk of harm whilst helping people to be as independent as possible.

The service had identified the minimum numbers of staff required to meet people’s needs and these were being met. The service had one staff vacancy at the time of this inspection and this was being covered by existing staff. The service had a calm and relaxed feel throughout with staff having time to sit and chat with people regularly. Staff were supported by a system of induction, training, some supervision and appraisals.

There were systems in place for the ordering, storage, management and administration of medicines. The system for monitoring people who self-administered their own medicines was effective. It was clear that people had received their medicine as prescribed. Regular formal medicines audits were not being carried out, however, checks on medicine administration records (MAR) were identifying if any error occurred such as gaps where staff should have signed to evidence they had given prescribed medicines.

Meals were appetising and people were offered a choice in line with their dietary requirements and preferences. Where necessary staff monitored what people ate to help ensure they stayed healthy.

People had access to activities. An activity co-ordinator was not in post but staff and external entertainers provided activities for people regularly. People went out in to the local area and attended appointments supported by staff.

The use of technology to help improve the delivery of effective care was limited. However, people had access to call bells to obtain assistance when needed.

Risks in relation to people’s daily life were assessed and planned for to minimise the risk of harm. People were supported by staff who knew how to recognise abuse and how to respond to concerns. The service held appropriate policies to support staff with current guidance. Mandatory training was provided to staff with regular updates provided. The manager had a record which provided them with an overview of staff training needs.

People's rights were protected because staff acted in accordance with the Mental Capacity Act 2005. The principles of the Deprivation of Liberty Safeguards were understood and applied correctly.

The registered manager spent much of their time working alongside care staff and with people living at St Georges. This meant they did not always have sufficient time to complete some of the managerial tasks needed, such as robust auditing of the service provided and formal staff supervision. The registered manager was supported by the provider and a team of motivated and long standing staff. An external agency was supporting the service to implement appropriate systems and processes to enable them to continually monitor and improve the service it provided.

The staff team felt valued and morale was good. Staff told us, “I am very happy here, we are a good team and it is a relaxed place” and “We all help each other out here, it is good.”

The service had sought the views and experiences of people and their relatives in order to monitor the standards of the care provided to people. The service was being supported by an external agency to begin robust audits of many areas of the service such as infection control and medicines management.

We have made recommendations in this report that the service take advice and guidance on the prevention and control of infection in care homes and involving people in their own care plans.

Following the comprehensive inspection the registered provider wrote to us to say what they would do to meet the legal requirements in relation to the breach. As a result we undertook a focused inspection on the13 February 2017 to check they had followed their plan and to confirm they now met legal requirements.

This report only covers our findings in relation to the question ‘is the service safe?’ You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for St Georges Hotel Care Home on our website at www.cqc.org.uk

St Georges Hotel Care Home provided accommodation and personal care for up to 22 elderly people. There were twenty people using the service at the time of this inspection. The service was situated in the centre of Truro. St Georges Hotel Care Home is required to have a registered manager and there was one 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.

The service had taken action to improve risk assessments so the directive was clear and all staff had access to the information. Risk assessments identified potential risks to people and provided instructions for staff members as to how to manage and minimise individual risk.

The registered manager had taken steps to improve how it recorded staff supervision. This was an ongoing process with all staff now having a supervision record and dates set for regular one to one support with the registered manager.

All policies and systems in place had been audited in October 2016. The registered manager was aware information needed to be accurate so some of the procedures had been changed to reflect this.

The registered manager had increased the access to training for staff. Updates had taken place for medicines administration and safeguarding. The certificates were in place for staff who had attended these training courses but the training record required updating to reflect this. This was pointed out to the registered manager who agreed to address this immediately.

The service had carried out a survey in April 2016 to seek the views of people using the service. The responses were positive. In addition to surveys the registered manager and staff regularly sat down with people to chat with them. Also, relatives were spoken with when they visited the service. This was seen during the inspection with a family talking with the manager about how their relative was doing.

At this focused inspection we found the registered provider had taken effective action to meet the requirements of the regulations and the breach had been met.

The service is a care home which offers care and support for up to 22 predominantly older people. At the time of the inspection there were 20 people living at the service. Some of these people were living with dementia. The service is based in a detached house over two floors. There was a main staircase and short runs of steps in other areas of the service. There was no lift at the service but stair lifts were in place to support people using the stairs.

The service had 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.

The service held a supervision policy which stated; “St Georges Hotel firmly believe that workers should expect regular supervision” and “To ensure both work related and career development issues are thoroughly dealt with supervisors are expected to follow the guidance below. Monthly – concentrates on tasks/work and quarterly – more in depth career development.” There were no records in staff files of any formal supervision having taken place. Staff confirmed they did not have formally recorded supervision. One staff member had received an appraisal. However, staff told us they received day to day support from the registered manager who could be contacted at any time if needed. The registered manager worked alongside them regularly. Staff were very positive about the registered manager and told us they were very approachable and supportive.

Staff were supported by a system of induction and training support when they began their care worker role. Staff knew how to recognise and report the signs of abuse. Staff received training relevant for their role and there were opportunities for on-going training and support and development. Some staff had attended more specialised training specific to the needs of people using the service such as dementia care.

Formal staff meetings were not held regularly. However, staff told us they discussed matters with the registered manager all the time and felt well supported and informed.

Care plans contained the assessed needs of people living at the service. The care plans were not always individualised and did not always contain specific guidance and information for staff to help ensure care was provided in a personalised and consistent way. Care plans were reviewed regularly by the registered manager until August 2015, when a new model of care planning was started. Since August 2015 daily notes had been kept by the registered manager and care staff, regarding any changes in people’s care needs. Formal review of people’s care plans and risk assessments had not taken place since August 2015. However, we found the registered manager and staff were well informed about people’s care needs.

We walked around the service which was comfortable. People’s bedroom were personalised to reflect people’s individual tastes. People were treated with kindness, compassion and respect.

We looked at how medicines were managed and administered. We found it was always possible to establish if people had received their medicine as prescribed. Creams were dated when opened to help ensure staff knew when an item would no longer be effective and need to be discarded.

The service had identified the minimum numbers of staff required to meet people’s needs and these were being met.

Meals were appetising and people were offered a choice in line with their dietary requirements and preferences. People told us they really enjoyed the food at the service.

Where appropriate, relatives were included in the care plan creation and subsequent reviews.

Activities were provided at the service twice a week. Staff told us some people were not keen on taking part in activities and preferred to chat informally and read or watch TV.

The registered manager was supported by the provider. They did not have a deputy manager or any dedicated administration support. The registered manager told us they were; “Struggling to keep up with it (paperwork) all.”

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) 2014. You can see the action we told the provider to take at the end of this report.

We saw people's privacy and dignity was respected and staff were helpful. We found peoples' views had been taken into account in the way the service was provided and delivered.

People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan.

People were protected from the risks of inadequate nutrition and dehydration.

People were cared for by staff who were properly supported to deliver care and treatment safely and to an appropriate standard.

People were aware of how to complain if necessary, and the service responded effectively to any concerns raised.

People said the food was to a good standard. People said they were encouraged to make choices regarding what they wanted to do and what they wanted to eat.

When we inspected the home was clean and odour free. The home was well maintained, well furnished and decorated to a good standard. Medication procedures were managed to a satisfactory standard.

Staff recruitment and staffing levels were to a good standard. Staff had received some training but improvements were required in this area as staff had either not received some training which was required by law and/ or updates were required. However staff were observed working professionally and doing their best to meet the needs of the people that lived in the home. Quality assurance systems were adequate.