Archived: St George's Nursing Home

Updated 27 January 2017

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

The inspection took place on 29 and 30 November 2016. The inspection visit was unannounced on 29 November 2016 and we informed the manager two inspectors would return on 30 November 2016. The inspection team consisted of three inspectors and a specialist advisor who was an advanced nurse practitioner. They had the knowledge, skills and experience of managing people’s health needs.

We looked at the information we held about the provider and the service. This included information received from the statutory notifications the provider had sent us. A statutory notification is information about important events which the provider is required to send to us by law.

We asked the local authority and the clinical commissioning group, who purchases care and support from the provider on behalf of people who lived at the home for their views. We did this to obtain their views on the quality of care provided at the home. In addition to this Healthwatch who are an independent consumer champion who promote the views and experiences of people who use health and social care were asked if they had any information to share with us.

We spoke with five people who lived in the home, one visiting relative and a further four relatives by telephone. Additionally, we spent time looking at how staff provided care for people to help us better understand their experiences of the care they received.

We spoke with the manager, the operational manager, clinical lead, four members of the care staff team and two nurses, the housekeeper, maintenance person, and agency chef. We looked at a range of documents and written records including sampling five people's care records and medicine records, the staff training document and the recording of incidents and accidents. We also looked at information relating to the auditing and monitoring of service provision.

Updated 27 January 2017

The inspection took place on 29 and 30 November 2016. The inspection visit was unannounced on 29 November 2016 and we informed the manager we would return on 30 November 2016.

St George's Nursing Home is registered to provide both nursing and residential care with accommodation for up 43 people. People who live at St George's Nursing Home all had needs relating to their health, and some people were also living with dementia. At the time of our inspection there were 11 people living at the home.

A registered manager was not in post at the time of our inspection. 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 recruited to the role of home manager and this manager was in the process of registering with the Care Quality Commission [CQC].

At our previous inspection on 20 and 21 April 2016, we found five breaches in the legal requirements and regulations associated with the Health and Social Care Act 2008. These breaches were in relation to person centred care, safe care and treatment, premises, staffing and good governance. The home was placed in 'Special Measures.' The special measures framework is designed to ensure a timely and coordinated response where we judge the standard of care to be inadequate. Services in special measures are inspected again within six months.

We also took enforcement action by imposing a condition on the provider’s registration to restrict admissions to the home. This was because of the significant concerns about the safe care and treatment of people who lived at the home.

At this inspection we looked to see if the provider had responded to make the required improvements in the standard of care to meet the regulations. Whilst we found areas of improvement had been made to meet some of the regulations the provider continued to be in breach of the legal requirements and regulations associated with the Health and Social Care Act 2008. These were in relation to safe care and treatment and good governance.

The overall rating for this service is ‘Requires improvement’. However, we are placing the service in 'special measures'. We do this when services have been rated as 'Inadequate' in any key question over two consecutive comprehensive inspections. The ‘Inadequate’ rating does not need to be in the same question at each of these inspections for us to place services in special measures.

The provider had management procedures in place but these were not consistently effective. Where improvements were required these had not always been assessed for their effectiveness and sustainability. At this inspection we found there was a continued lack of a consistent strong vision and oversight of the service to support people in receiving safe, effective and responsive care which was well led.

We found there were inconsistencies in the provider's systems and staff practices to provide assurances that all risks to people were safely and effectively managed. We found the management oversight of incidents did not provide confidence in how these were consistently followed through. There were aspects of staff practices which did not assist in the prevention of reducing cross infections and accessible items could place people at risk of harm.

The provider had employed a maintenance person who had assisted in the improvements in the repairs within the home. Since our previous inspection work had been carried out on the water supply so the risks to people of scalding and/or their personal care needs neglected had been reduced. The temperature of the hot water supply had been regularly tested by the maintenance person.

People’s medicines were stored securely and made available to people as prescribed. Safety measures had been put in place to make sure staff no longer carried used needles around the home environment. Further improvements were required to ensure the practices adopted when administering medicines was consistently undertaken in line with the provider’s medicine policies and procedures.

People had different reasons for feeling safe whilst living at the home which included feeling having staff available so they could request support. Staff told us they understood how to recognise abuse and would report concerns to the manager.

We saw staffing arrangements made sure staff were available to assist people in meeting their needs at times they required. The provider employed agency staff to fill any gaps in the daily staff rotas. There was some inconsistencies in the arrangements to make sure there was a cook in the kitchen to make sure people’s nutritional needs were effectively met although the manager had undertaken recruitment to fill this post.

Staff training continued to require improvement to ensure all staff had the opportunity of receiving regular training. We saw staff did not always apply their knowledge into their daily practices to effectively meet people’s needs. Although there were some measures in place to check the effectiveness of staff’s competencies these needed to be embedded into all aspects of staff’s nursing and caring roles.

Health and social care professionals were involved in people's care to ensure they received the care and treatment which was right for them. This included nutritional advice and support where required to meet people’s needs.

People were asked before support was provided and their wishes were respected. We saw people were given choice about day to day decisions such as what they would like to wear and where they would like to sit. However, there were inconsistencies in assessing people's ability to make their own decisions. Where decisions had been made on people's behalf the records did not always reflect whether best interest decisions were made by people who had the authority to do this.

The manager was aware staff’s caring practices required further improving to make sure people’s dignity was maintained. The manager and staff had made improvements to the home environment. They recognised there was more to do, such as signage to further support people’s independence and meet the needs of people with dementia. There were no plans in place to progress these improvements. These would need to be implemented and caring practices sustained over time.

Work was in progress to update people’s records so they accurately reflected their individual needs to assist in guiding staff’s daily practices. Record keeping required further strengthening so there were assurances these would be met at the right time and in the right way. There were inconsistences in how people’s care and health needs were accurately recorded especially where people’s needs had changed.

The activities co-ordinator employed by the provider was assisting in the improvements for people to have fun and interesting things to do. Opportunities for people to follow their own interests and socialise was continuing to be embedded into daily life.

At the last inspection in April 2016 the home had an overall rating of inadequate and the provider was placed into special measures by the Care Quality Commission. After six months we have re-inspected and one key question remains as inadequate. As a consequence the service remains in special measures.

This service will continue to be kept under review and, if needed we will take further action in line with our enforcement procedures preventing the provider from operating this service. Where necessary, another inspection will be conducted within a further time period, and if there is not enough improvement and there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.