Archived: Georgiana Care Home

Georgiana Care Home is a residential care home providing personal and nursing care to up to 72 people. The service provides support to people who may be living with a physical disability, mental health needs or dementia. At the time of our inspection there were 54 people using the service.

Georgiana Care home is split across two floors and three wings. People have access to their own personalised bedrooms and en-suite toilets and share communal areas such as lounges, bathrooms, dining areas and a garden.

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

People were not always kept safe using the service. Risk assessments were not always completed for known risks to people or were not detailed to guide staff to support people safely. People’s medicines were not being managed safely and systems were not effective in identifying where errors were being made. Some information from staff recruitment checks were missing. Whilst there were enough staff to support people safely, staff did not spend time supporting people outside of essential care tasks.

Staff were not being supported with supervision and competency assessments to make sure their training had been effective. It was not always clear how people who required support to eat and drink were having this monitored effectively by staff. We have made a recommendation the provider ensures people are supported effectively with this. We could not be sure people were receiving support with oral care. People’s needs were assessed before they started living at the service, but these assessments did not always focus on people’s preferences, likes and dislikes. People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not always support this practice.

People were not always treated with kindness and compassion and staff did not always respect people’s privacy and dignity. Staff did not always support people in a person-centred manner in line with their preferences likes and dislikes. People’s support plans did not focus on how people would like to be supported as individuals with their own preferences. People were not being supported to take part in social pastimes or follow their interests and were not a part of the local community. People were not being supported in line with their communication needs. People did not always have detailed end of life care plans in place and we recommend the provider reviews these plans for people.

The management team were not effectively monitoring the quality of the service and audits were either not in place or did not pick up on areas where improvements were needed. People and relatives’ feedback was gathered but not used to improve the service. The provider did not visit the service to ensure people were receiving good quality care. There had been a failure to learn lessons from inspections of the providers other services meaning improvements could not be made or sustained at the service.

Despite our findings people and relatives were happy with their support. One relative said, ‘‘I cannot fault the staff team. [Family member] has gone from strength to strength and has their life back since they started living at Georgiana Care Home.’’

People and relatives felt they/ their family member were safe living at the service. The service looked and smelled clean and staff followed good infection control measures. People were supported to see health professionals if this support was necessary. Plans were in place to continue to improve the environment for people living at the service.

We also saw some kind and caring interactions between people and staff. Some staff knew people well and staff wanted what was best for people. People’s complaints were listened to and taken seriously. The manager was passionate about improving the service and took immediate action in areas identified as needing improvement at this inspection.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection (and update)

The last rating for this service was requires improvement (report published 16 April 2021). The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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.

Enforcement and Recommendations

We have identified breaches in relation to safe care and treatment, people not being treated with dignity and respect, person centred care, and good governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Georgiana Care Home is a two-storey residential care home which is registered to provide accommodation and personal care for up to 72 people. At the time of our inspection there were 52 people including some living with dementia and long-term conditions, living at the home.

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

One person said, “The staff are lovely here, they really look after those who can’t look after themselves. That carer you were just speaking with is particularly nice.” One person’s relative said, “My [Family member] would soon say if staff were not looking after them properly. [Family member] always looks clean and is well groomed.” Another relative told us, "[Family member] always has nice people [staff] around them. The home always smells fresh and [family member] is always well presented."

Care plans sometimes lacked enough details and further consideration was needed in the management of some people's risks. Staff were not always fully briefed on managing these risks.

The management carried out employment checks on new staff to ensure people were safe around new staff. However, some of these checks were not completed before new staff started working at the home. Staff did not spend meaningful time with people.

Staff and the management had worked hard to manage the pandemic. There had been no outbreak of COVID-19 at the home. However, we found some shortfalls with the management of infection protection control (IPC) and use of personal protective equipment (PPE). Increased management oversight was needed to support relatives to visit their family members in a safe way.

We found some shortfalls in how the management team and the provider monitored the quality of people’s care and experiences of day to day life at the home. For example, some rooms and lounges looked tired.

Relatives were confident the management and staff were actively keeping their loved ones safe. Staff knew how to promote people’s safety in terms of identifying potential signs of abuse or harm. The management team and the provider responded openly to the shortfalls we found.

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 (report was published on 18 May 2018).

Why we inspected

We undertook this inspection to follow up on specific concerns which we had received about the service. The inspection was prompted in part due to concerns received about whether the home had enough staff to manage the risk of people falling, a lack of supplies to meet people’s care needs, people were not given the time to have the care and attention required with their washing, dressing, and grooming.

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.

We inspected and found there was a concern with other aspects of people’s safety and how effective the oversight of the quality of the service was being monitored, by the registered manager and provider. This prompted us to widen the scope of the inspection to become a focused inspection which included the key questions of safe and well-led.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection. We have found evidence that the provider needs to make improvements. Please see the safe and well led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Georgiana care home on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified a breach in relation to the quality of the governance and oversight of the service by the registered manager and provider at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

We found the following examples of good practice.

¿ The service was clean and hygienic. Robust cleaning schedules were in place, which were methodically completed throughout the service. Senior staff completed daily checks and ‘walkarounds’ of the building, alongside regular infection prevention and control audits. Action was promptly taken to address any issues identified.

¿ Staff were provided with a designated preparation area on arrival to and departure from the service. Personal Protective Equipment (PPE) donning and doffing stations were available throughout the building with guidance and signs displayed. Staff were seen to be adhering to the PPE guidance and protective measures in place.

¿ The service had been providing ‘garden visits’ with robust infection control procedures in place. Visits were by appointment only, with times allocated to avoid potential infection transmission with other visitors. Visitors were provided with guidance and PPE and the visits were conducted in a designated external area where social distancing could be maintained. The registered manager was in the process of adapting a garden building to facilitate future visits which would not be weather dependent. They explained how they had assessed the building for safety and was awaiting the delivery of a Perspex screen which would be placed between people and their visitors, whilst also maintaining social distancing.

¿ Risks to people and staff in relation to their health, safety and wellbeing had been thoroughly assessed. There was support for staff in place which included provision of training, uniform and laundry service, management support and financial assistance should they become unwell.

¿ A robust package of policies, procedures and guidance had been developed which the registered manager had successfully implemented at the service.

Further information is in the detailed findings below.

Georgiana accommodates up to 72 people in one adapted building. The home provides support and personal care for people who may have a range of care needs, including physical disabilities and dementia.

At the last inspection, the service was rated good. At this inspection we found the service remained good.

People were safe because there were effective risk assessments in place, and systems to keep them safe from abuse or avoidable harm. There was sufficient numbers of staff to support people safely. Staff took appropriate precautions to ensure that people were protected from the risk of acquired infections. People's medicines were managed safely, and there was evidence of learning from incidents.

People's needs had been assessed regularly and they had care plans in place that took account of their individual needs, preferences, and choices. Staff had regular supervisions and they had been trained to meet people's individual needs effectively.

The requirements of the Mental Capacity Act 2005 were being met, and staff understood their roles and responsibilities to seek people's consent prior to care and support being provided. People had been supported to have enough to eat and drink to maintain their health and wellbeing.

People were supported by caring, friendly and respectful staff. They were supported to have maximum choice and control of their lives, and the policies and systems in the service supported this practice. Staff regularly reviewed the care provided and were guided through regular input by the person receiving care to ensure the care provided continued to meet their individual needs, in a person centred way.

The provider had an effective system to handle complaints and concerns. People on end of life care were supported by the home and staff to remain comfortable and have a dignified and pain-free end to their lives.

The service has a registered manager .The service was well managed and the provider's quality monitoring processes had been used effectively to drive continuous improvements. The registered manager provided stable leadership and effective support to the staff. They worked well with staff to promote a caring and inclusive culture within the service. Collaborative working with people, their relatives and other professionals resulted in positive care outcomes for people using the service.

Further information is in the detailed findings below.

The service provides care and support to people with a variety of care needs including those living with dementia, physical disabilities, mental health needs and chronic health conditions. On the day of our inspection, there were 53 people being supported by the service.

There was no registered manager in post. However, a new manager who had started in December 2015 was in the process of registering with the Care Quality Commission. 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 provider had effective systems in place and staff had been trained on how to safeguard people. There were individual risk assessments that gave guidance to staff on how risks to people could be minimised. People’s medicines had been managed safely and administered in a timely manner. The provider had effective recruitment processes in place and there was sufficient numbers of staff to support people safely.

Staff had received effective training, support and supervision that enabled them to provide appropriate care to people who used the service. The manager and staff understood their roles and responsibilities in ensuring that people consented to their care and that it was provided in accordance with the requirements of the Mental Capacity Act 2005 (MCA) and the associated Deprivation of Liberty Safeguards (DoLS). People had nutritious food and they were supported to have enough to eat and drink. They had access to other health and social care services when required in order to maintain their health and wellbeing.

Staff were kind and caring towards people they supported. They treated people with respect and supported them to maintain their independence as much as possible.

People’s needs had been assessed and they had care plans that took account of their individual needs, preferences and choices. Care plans had been recently reviewed and they now contained sufficient information to enable staff to support people well. Staff were responsive to people’s changing needs and where required, they sought appropriate support from other health care professionals. A variety of activities had been planned and provided to occupy people within the home, and trips organised to visit places of interest for people who used the service. The provider had a formal process for handling complaints and concerns.

The provider encouraged feedback from people or their representatives, and acted on the comments received to improve the quality of the service. Changes in managers had meant that quality monitoring processes had not always been used effectively to drive improvements. Any improvements made had not always been sustained and this put people at risk of not receiving good quality care. However, the manager had worked closely with the local authority to make the necessary improvements to the service, but a longer period of stability was required to ensure that these had been embedded in the culture of the service.

However, during this inspection we found that there were other areas within the home where acceptable standards of cleanliness and infection control had not been maintained. We found that chairs in the lounge areas and some bedrooms were dirty. We saw that some floors and doors were damaged and could not be cleaned effectively. In addition, we found that the surfaces of some furniture around the home had been damaged and this also could not be cleaned effectively. This meant that people were not cared for in a clean, hygienic environment.

We had previously inspected Georgiana Care Home and found that they were not meeting the regulations in relation to infection control and the keeping of accurate records. We told the provider they must make improvements. They sent us a plan of action telling us that they would be complaint by 22 August 2014.

An inspector from the Care Quality Commission (CQC) returned to the home on 09 September 2014. We found that the provider had made some improvements, however we had continued concerns regarding infection control practices. Some areas of the home were not clean and did not protect people who used the service against the risk of harm and injury or infection. Furthermore members of the public were also at risk because the home's clinical waste bins were found to be unlocked and located next to a public footpath.

We looked at five care records and spoke with three people who used the service. We also spoke with relatives that were visiting the home and four staff. We observed the care that was being provided to people around the home. We reviewed cleanliness throughout the home.

We considered our inspection findings to answer questions we always ask;

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well-led?

This is a summary of what we found.

Is the service safe?

People had up to date risk assessments in place to enable them to be as independent as possible and these were reviewed regularly by staff to ensure that they correctly reflected the needs of the person.

Most areas of the home were clean. However we noted that in the two communal bathrooms for the home, razors had been left either inside or around the bath. We also noted that the level of cleanliness within these bathrooms did not meet the regulations. This meant that people were not always being cared for in a safe environment. Hazardous waste was also kept in bins which had not been secured and meant that the public could gain access to them.

Is the service effective?

People's care needs were assessed before they came to live at the care home and these were reviewed regularly to ensure that any changes in a person's individual needs were identified. We observed that people had their personal care needs met and that they were free to move around the home, although most people had chosen to go into either of the two communal lounges. Although we were told that people were provided with activities during the day, we did not see evidence of this. We noted that for most of the time during our inspection, although some people were attending the hair dressing salon, most were left sitting in the lounge areas with no stimulation and were noted to be asleep in their chairs. .

Is the service caring?

We observed that staff were caring and compassionate towards people. One person told us, 'The staff are nice." We saw that when one person entered the room, staff greeted them and said, "Good morning, how are you today? I have a lovely cup of tea waiting for you." We observed that staff were chatting with the person and the person seemed happy and comfortable talking and laughing with the staff.

Is the service responsive?

The service was responsive to people's needs as we found that they kept accurate records that reflected the care people required to maintain their health, safety and well-being.

Is the service well led?

The service had a new manager in place. We were told that the new manager was experienced and had worked for the provider's other homes. They had recently moved to the Georgiana to aid with improvements. We also saw that the regional manager was available in the home. Staff we spoke with told us that the management of the service was 'good' although they found it too early to comment about the new manager, they told us that the regional manager was 'very good' and was 'always approachable'.

The purpose of this inspection was to follow up on those concerns. We gathered evidence against the outcomes we inspected to help answer our five key questions: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read our full report.

Is the service safe?

The Georgiana Care Home is a large home for up to 72 people. In addition to people's bedrooms, the accommodation includes a significant amount of communal rooms, bathrooms, corridors and stairways.

We spent time walking round the building and checking a number of rooms, including bedrooms, to see how clean they were. It was clear from our observations and from speaking with a number of staff working in the home, that the cleaning staff did not have enough time to maintain required standards of cleanliness in all parts of the home. We saw dust and / or evidence of liquid spillages in many areas including communal corridors and people's bedrooms. In one person's room we found two arm chairs that were significantly stained, the lounge carpet in one area of the home was heavily soiled with food debris and we found two bedrooms with offensive odours coming from the mattresses. This was a concern because some infections have the capacity to spread within environments where susceptible people share eating and living accommodation.

Following feedback to a senior member of staff during this inspection, we were told that arrangements were being made to address the concerns we had found by bringing in additional domestic staff. Although this was positive and showed that the provider had taken our concerns seriously, we were concerned that this had not been put in place prior to our inspection. This showed that improvements are required to ensure adequate systems are in place to consistently provide a clean and safe environment for people living, working and visiting the Georgiana Care Home.

We have asked the provider to tell us how they will make improvements and meet the requirements of the law in relation to providing a safe, clean environment for people to live and work in.

Is the service effective?

During the inspection, we found evidence that another person had raised concerns about records maintained by staff because they were not detailed enough to show how much their relative had been given to eat and drink.

We checked a number of people's care charts and found that entries had been made in respect of people's fluid and food intake during the day on a regular basis. However, we found a small number that raised concerns about whether people were being provided with enough to drink during the evening and night.

We spoke to someone living in the home who asked for a drink. They were confused about when they had last had a drink, which demonstrated the importance of maintaining accurate records. A hot drink was provided as requested, but we observed a member of staff completing the person's care records at that point, to record that the person had drunk 180 mls of tea. We spoke with the member of staff who told us the person liked their drinks and was likely to drink it all. However, this raised concerns about the accuracy of the records being maintained, if they are completed in advance. This meant that care records could not be relied upon to establish how much people living in the home had actually had to eat or drink in a day.

We have asked the provider to tell us how they will make improvements and meet the requirements of the law to ensure records maintained by the home are accurate and fit for purpose.

Is the service caring?

We observed some positive interactions between staff and people living in the home and it was clear that staff knew the people they were providing care and support to.

Is the service responsive?

We observed that one person could not reach their call bell to summon assistance. We rang their call bell for them because they wanted a drink. It took 18 minutes for a member of staff to arrive. We brought this to the attention of a senior member of staff before we left the building.

Is the service well-led?

We were told that since our last inspection in May 2014, a new manager had started, but had since resigned and was no longer working there. Although there was evidence that the provider had arranged for managerial oversight of the home during this period, and another new manager was due to start the following week, it was clear from speaking with staff that the home had been without consistent managerial direction for some time.

If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

People were protected by effective staff recruitment systems. Records showed that staff had received Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS) training. This meant that staff were provided with the information that they needed to ensure that people were safeguarded.

Is the service effective?

People were satisfied with the care and support they received. No one raised any concerns with us. This was consistent with the positive feedback received from people as reported in the provider's own quality assurance survey. All of the staff we spoke with were knowledgeable about individual people's care needs, and this knowledge was consistent with the care plans in place.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. We spoke with four people who used the service. People commented, 'I never feel rushed by the staff that help me, they don't do everything for me and help me to do things for myself'. One person said to us, "I am very happy here. Everyone is very kind." Another person said, "The staff are very helpful and this is a beautiful place to live." We observed the care and attention people received from staff. All interactions we saw were appropriate, respectful and friendly and there was a relaxed atmosphere throughout the home.

Is the service responsive?

We saw that care plans and risk assessments were informative, up to date and regularly reviewed. The registered manager responded in an open, thorough and timely manner to complaints. This meant that people could be assured that complaints were investigated and action was taken as necessary. Staff told us the manager was approachable and they would have no difficulty speaking to them if they had any concerns about the home.

Is the service well led?

Staff said that they felt well supported by the manager, the team worked well together, and they were able do their jobs safely. The provider had a range of quality monitoring systems in place to ensure that care was being delivered appropriately by staff.

Records we looked at reflected that the home worked in collaboration with other professionals and providers. One visiting relative said, 'I'm always kept informed, staff are really lovely, it's very reassuring.'

We noted that the older part of the building was being redecorated and found that the building as a whole was safe and adequately maintained. One visiting relative said, 'It's nice to see they are doing something about the d'cor.'

Regular safety checks were carried out and recorded in relation to the building, including fire evacuation procedures.

Staff were supported to gain further qualifications from time to time and records maintained by the home were securely stored and accurate.

We observed that people were offered care and support at a level which encouraged independence and ensured their individual needs were met. There was a relaxed atmosphere in the home, staff were friendly and courteous in their approach to people and interacted confidently with them. We spoke with ten people who lived at the Georgiana Care Home, and the relatives of four others. All commented positively about the quality of care and the conduct of the staff. One said, "... is fantatically happy here, I'm over the moon. Number one is the staff."

We noted people were encouraged to express their views and were involved in planning their care and making choices and decisions about their care and support and how they spent their time. One person said 'I have my paper every morning, I get my specialist magazine too as I've ordered it.'

Within the care files we saw care documentation had been signed, or was ready to be signed, by the individual or their representative to confirm their involvement and agreement with their particular care needs. Someone told us 'They involve the whole family and me in my care.'

There were robust systems in place to promote quality assurance in this home.