Georgina House

Updated 26 September 2023

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. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

This inspection was carried out by two inspectors and two Experts by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service

Service and service type

Georgina House is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Georgina House is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was a registered manager in post.

Notice of inspection

This inspection was unannounced. Inspection activity started on 21 December 2022 and ended on 1 February 2023. We visited the location’s service on 21 December 2022 and 8 January 2023. We spoke with relatives, professionals and staff and reviewed further documentation submitted to us between 23 December 2023 and 31 January 2023.

What we did before the inspection

We used information gathered as part of monitoring activity that took place on 18 October 2022 to help plan the inspection and inform our judgements.

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority, Healthwatch England and professionals who work with the service. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England.

We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke with 3 people and 4 of their relatives. We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us. We spoke with 10 staff members including the registered manager and an acting operations manager. We spoke with one professional who works closely with the service.

We reviewed 4 people’s care records and 2 staff recruitment records. We also reviewed a variety of policies and organisational records such as audits and reports.

Updated 26 September 2023

About the service

Georgina House is a residential care home providing personal care and accommodation to up to 4 people. The service provides support to autistic people and people with a learning disability. At the time of our inspection there were 4 people using the service.

Georgina House is a two storey house with a garden and communal spaces. There are two ensuite bedrooms downstairs and two bedrooms upstairs with a shared bathroom. There is a small open plan lounge and diner and a small kitchen. Laundry facilities are located in a shed in the garden and are shared by everyone living at the service.

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

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

Right Support:

The service (or staff) did not support people to have the maximum possible choice, control and independence be independent and they did not had control over their own lives. Some people had personal items locked away without any reasonable rationale for this. Staff used a stairgate for another person to block their access to the kitchen, this had not been reviewed to look at less restrictive options. People were unable to pursue choices for how they spent their time as there was not enough staff deployed to meet these preferences.

We have made a recommendation about the management of restrictive practices and consent.

Staff did not focus on people’s strengths or promote what they could do, so people did not have a fulfilling and meaningful everyday life. People were not encouraged to do things for themselves or learn new skills to empower them to have ownership over their home. This included areas such as cooking, cleaning and laundry.

People were not supported to identify their dreams and aspirations. People had no meaningful goals in place and goals that were in place showed no evidence of how they would be achieved or any progress and outcomes.

The service gave people care and support in a safe, clean and well-maintained environment. However, the environment size and layout meant people’s sensory needs were not always met. People personalised their rooms.

Staff enabled people to access specialist health and social care support in the community. Staff supported people with their medicines in a way that promoted their independence and achieved the best possible health outcome.

Right Care:

Staff did not promote equality and diversity in their support for people. They understood people’s cultural needs and provided culturally appropriate care. However, they did not understand how to safely and appropriately support people’s needs in relation to preferences about how people chose to express themselves sexually or in relationships.

People who had individual ways of communicating, such as, using body language, sounds, Makaton (a form of sign language), pictures and symbols could not interact comfortably with staff and others involved in their treatment/care and support because staff did not have the necessary skills to understand them.

People did not always receive kind and compassionate care. Staff did not always protect and respect people’s dignity. People unable to communicate easily were often ignored and one person was left wearing odd shoes.

Staff had training on how to recognise and report abuse and they knew how to apply it. However, staff struggled to recognise how poor practice could result in the less visible forms of abuse.

The service did not have enough appropriately skilled staff to meet people’s needs. People did not always receive care that supported their needs and aspirations, was focused on their quality of life, and followed best practice. The service did not give people opportunities to try new activities that enhanced and enriched their lives. People were not supported to take positive risks.

Right Culture:

People did not lead inclusive and empowered lives because of the ethos, values, attitudes and behaviours of staff. People did not always receive good quality care, support and treatment because staff did not have the right training and support to meet people’s needs and wishes.

People were supported by staff who did not understand best practice in relation to the wide range of strengths, impairments or sensitivities people with a learning disability and/or autistic people may have. This meant people did not always receive empowering care that was tailored to their needs.

People’s relatives were involved in planning their care. However, people who were unable to communicate easily were not involved in these reviews and did not have their views sought about the service generally.

Staff did not evaluate the quality of support provided to people, involving the person, their families and other professionals as appropriate. Staff and the provider had not ensured risks of a closed culture were minimised so people did not receive support based on transparency, respect and inclusivity.

The registered manager was new to post, had made some progress with improvements and had plans to improve the culture and ethos of practice further. The provider did not offer sufficient training and support to the registered manager and staff team to ensure they had the knowledge and skills to apply learning and promote a quality of life for people that empowered them and promoted valuing people and equality.

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 requires improvement (published 26 February 2021). The service remains rated requires improvement. This service has been rated requires improvement or inadequate for the last two consecutive inspections.

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 personalised care, the environment, upholding people’s dignity and respect, staff training and provider oversight at this inspection.

We have imposed conditions on the providers registration to ensure the provider makes the required improvements.

Follow up

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 alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.