This inspection took place on 12 and 14 January 2016 and was unannounced. We last inspected St Georges Nursing Home on 22 January 2014 and found it was meeting all legal requirements we inspected against.St Georges Nursing Home is a care home without nursing and provides accommodation and support for up to 38 people. Since the last inspection the service is no longer providing nursing care but it retains the name St Georges Nursing Home. Of the 38 single bedrooms, 24 had en-suite facilities and there were several accessible toilets and bathrooms on each of the two floors. At the time of the inspection there were 31 people using the service, some of whom were living with dementia.
The service had a registered manager who had been in post since September 2015 and who has been registered with the Commission since December 2015.
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.
Care plans were in place and evaluated on a monthly basis. Changes in people’s needs which had been identified in the evaluations were not always updated in care plans so people may not have been receiving care that met their needs. Care plans did not always contain specific guidance for staff to follow, such as how to use the hoist when supporting a person with mobility needs. Detailed guidance on how to support people who were disoriented, distressed or confused was not always evident.
The registered manager was aware that care plans needed to be improved and this had been recognised in an action plan but there was no timeframe for completion. This meant there was an ongoing risk that people may receive inconsistent or inappropriate care.
Staff knew how to safeguard people from harm and abuse and how to report any concerns. They were confident that the registered manager would take action as required.
Accidents and incidents were recorded and action taken to minimise risks. Risk assessments were completed on a monthly basis and identified control measures to manage situations.
Risk assessments and contingency plans were in place in relation to the premises. Health and safety checks were completed and service contracts and maintenance plans were in place.
The registered manager had recently recruited a deputy manager and was waiting for pre-employment checks to be completed. These included references and a Disclosure and Barring Service check so they could be confident the person was suitable for the post. There were enough staff to meet people’s needs but recruitment was ongoing for additional care staff.
Medicines were stored, administered and managed in a safe way. The staff who were responsible for administering medicines were trained and completed a competency check on a six monthly basis.
Other training included mental capacity, safeguarding, dignity, dementia and person centred care. Staff champions were being identified so they could receive additional training and act as a point of contact for any queries. Training was discussed in each staff member’s supervision and in the team meetings. Staff said they felt well supported and well trained.
Authorised Deprivation of Liberty Safeguards were in place, and the registered manager and staff understood mental capacity principles. Staff included people in decision making at every opportunity.
People had access to health care services, with one relative saying, “They are very responsive to people’s health needs.” Where required people had been referred to the falls team and speech and language therapist, as well as having regular appointments for medicines reviews and sight check-ups.
People told us, “The food is lovely.” Staff were knowledgeable about people’s dietary requirements and ensured people were well supported. If people declined support with meals staff respected their wishes but remained observant in case the person changed their mind or was seen to be struggling.
Staff engaged with people in a warm and compassionate way, asking their permission and explaining what they were doing. Staff took time to answer people’s questions and did not rush them in any way. Staff were respectful and treated people with dignity. One staff member said, “I treat people how I would want to be treated.”
Activities were varied and, where possible, family members were invited to join in with bingo evenings and themed events such as pub lunches. The home was involved with the church next door and people could attend services at the church as well as services being held in the home. There were links with the local schools and amateur dramatics groups.
Staff were proactive in ensuring people maintained contact with family members and one person had recently used Skype to see and talk with their family who lived in Australia.
The registered manager had been in post since September 2015 and relatives and staff were very positive about the impact they were having on the service. Comments included, “The best manager I’ve had,” “They’ve made some really positive changes,” “They are always on the floor and know people really well.”
A range of audits were in place and there was a culture of working together to drive improvement.
You can see what action we told the provider to take at the back of the full version of the report.