St Georges Ltd

Updated 23 March 2019

The inspection:

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. This inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Act, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

Inspection:

This announced inspection took place on 15 February 2019. We gave 48 hours’ notice as we wanted to make sure the registered manager was in the office when we visited. When we rang to arrange our office visit, the registered manager told us they were on leave on the planned date, so we rearranged our visit as we wanted to make sure we met with them. The inspection team consisted of two inspectors. An expert by experience also carried out phone calls to people and their relatives to ask for their views about the service. These calls took place on 13 February 2109. An expert by experience is a person who has had personal experience of using or caring for someone.

Registered manager:

The service is required to have a registered manager. The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

What we did:

As part of the inspection, we reviewed a range of information about the service. This included safeguarding alerts and statutory notifications, which related to the service. Statutory notifications include information about important events, which the provider is required to send us by law. Safeguarding alerts are information we received when there are concerns about a person’s safety.

Providers are required to send us a Provider Information Return (PIR) in which they tell us about their service, what they do well, and improvements they plan to make. This information helps support our inspections. The registered manager had completed a PIR which provided us with information for our inspection.

We spoke with the registered manager and deputy manager, and two care staff. We had contacted staff by email and had three responses. We reviewed the care records of three people who used the service. We also looked at a range of documents relating to the management of the service, including staff files and a range of quality audits.

We had contact with three health and social care professionals who were involved in the support of the people at the service.

Updated 23 March 2019

About the service:

This service is a domiciliary care agency based in Witham. It provides personal care to 30 people living in their own houses and flats. It mainly provides a service to older adults but also to adults with other support needs.

People’s experience of using this service:

When we last inspected the service we found staff were caring but rated the service requires improvement because we had concerns about how the service was assessing need and managing risk. We found the service was in breach of regulation as improvements were needed in the management of risks associated with people's specific health conditions, daily living and administration of medicines. At this inspection we found the registered manager had made significant changes and people received safe and person-centred care from skilled staff who knew them well.

The registered manager was passionate about the service and introduced innovative and practical solutions which made a difference to the support people received. The new deputy manager worked well the registered manager and we receive feedback from people, families and staff that the service had improved since our last visit.

Feedback from key professionals about how the service worked with them was not consistently positive. The registered manager did not always respond openly and effectively when they received feedback from external organisations. They had also not notified CQC following a safeguarding incident, as required. We made recommendations about improving how the service communicated following mistakes and how they responded to stakeholder feedback.

The registered manager had implemented a new electronic system which they used effectively to improve all areas of the service. Senior staff could check what support staff provided and the system highlighted any concerns around late visits or delayed medication.

There had been improvement in the safeguarding processes at the service. Staff knew what to do when they had concerns about a person’s safety. There were enough well-deployed staff to meet people’s needs.

Senior staff had revised care plans to ensure they were more detailed and person-centred. The improvements since our last inspection meant people now received their medicines safely. Staff had detailed guidance about individual needs and knew how to minimise risk to people’s safety.

The registered manager had adapted the new electronic system creatively to ensure it was tailored around people’s personalised needs. Staff provided support flexibly and adapted it when peoples’ needs changed. Staff supported people holistically and promoted their physical and emotional wellbeing. People received support to eat and drink in line with their preferences and needs. Staff were alert to any changes in people’s health and circumstances and referred people to professionals for support as required.

Staff were caring and attentive to the needs of the people they supported. People received dignified respectful care and were encouraged to remain independent. At the time of our inspection all the people at the service had capacity to make decisions. Staff supported them to make choices about the care they received.

People had access to a complaints process and office staff communicated well with people and their families and usually resolved concerns informally and promptly.

Staff were enthusiastic and told us they were well supported. They benefitted from the improved communication and morale was good. Senior staff ensured care staff had the skills to meet the needs of the people they supported. Training was varied, and senior staff provided additional guidance when there were gaps in staff skills.

Rating at last inspection: Requires improvement (Last report published 1 March 2018)

Why we inspected: This was a planned inspection based on previous rating.

Follow up: We will continue to check St Georges Ltd to ensure people receive care which meets their needs. We plan our inspections based on existing ratings and on any new information which we receive about each service.