St Georges is a care home. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. St Georges care home provides accommodation with nursing and personal care for up to 68 people. At the time of our inspection 44 people were living in the home.

At the last inspection on 25 and 26 October 2017 the service was rated Requires Improvement. We found repeated breaches of the regulation relating to accuracy of records and quality assurance systems. We issued a requirement action. Following the inspection, the provider sent us an action plan telling us how they would make the required improvements.

We carried out a comprehensive inspection on 18 and 19 September 2018. At this inspection, we found significant improvements had been made and the legal requirements had been met.

The service has improved to Good.

There was a registered manager in post. 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.

Sufficient numbers of staff were deployed at the time of our visit. Staff performance was monitored. Staff received supervision and training to ensure they could meet people’s needs.

Medicines management shortfalls were promptly acted upon and actions taken to make improvements.

Staff demonstrated a good understanding of safeguarding and whistle-blowing and knew how to report concerns.

People were helped to exercise support and control over their lives. People were supported to consent to care and make decisions. The principles of the Mental Capacity Act (MCA) 2005 had been followed.

Risk assessments and risk management plans were in place. Personal and nursing care was delivered in line with assessed needs and accurate monitoring records were maintained.

Incidents and accidents were recorded and showed that actions were taken to minimise the risk of recurrence.

People’s dietary requirements and preferences were recorded and people were provided with choices at mealtimes.

Staff were kind and caring. People were being treated with dignity and respect and people’s privacy was maintained.

A range of activities were offered and provided people with entertainment in communal areas and in their rooms.

Systems were in place for monitoring quality and safety. Where improvements were needed the provider acted to address identified shortfalls.

We carried out a comprehensive inspection of St Georges Care Home on 6 and 7 January 2017. At that inspection we found multiple breaches of the Health and Social Care Act 2008. As a result of this the service was rated ‘Inadequate’ overall. The service was therefore placed into ‘Special measures’. Services in special measures are kept under review.

In addition to being placed in special measures, we imposed a condition on the provider’s registration relating to person centred care and treatment, dignity and respect, completion of statutory notifications, consent to care, risk management, administration of medicines, safeguarding people from abuse, complaints management, record keeping, quality monitoring and governance, staffing levels and staff supervision and training.

We carried out a comprehensive inspection on 25 and 26 October 2017 to review what improvements had been made at the service since they had been placed in special measures.

St Georges Care Home is a 68 bedded home that provides accommodation for persons who require nursing and personal care. At the time of our inspection there were 40 people living in the care home.

The manager in post received confirmation on 17 November 2017 that their application for registered manager had been successful. 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.

Overall, we found there had been significant improvements in all areas for the home to be taken out of special measures. Further work was needed to ensure that improvements were consistent and embedded throughout the home.

Sufficient numbers of staff were deployed. However, the home was only 59% occupied. Staff performance was being more effectively monitored. Staff had received supervision and training to ensure they could meet people’s needs. Additional support and training was provided by the NHS care home support teams.

Staff were kind and caring. We found people were being treated with dignity and respect and we found people’s privacy was maintained.

Systems were in place for monitoring quality and safety. However, further improvements were needed.

At this inspection we found a breach of one of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, relating to accuracy of records and quality assurance.

This inspection took place on 25, 26 and 27 January 2017 and was unannounced.

In April and May 2015 St Georges Care Home received its first ‘rating’ inspection and was rated requires improvement. We issued five regulatory requirement actions for regulatory breaches relating to safe care and treatment, person centred care, staffing, good governance and dignity and respect. After the inspection, the provider wrote to us to say what they would do to meet the legal requirements.

We undertook a focused inspection on 6 and 7 January 2016 to check the provider had followed their plan and to confirm they now met the legal requirements. We had also received information from the local authority that had concerns about the quality and safety of the service provided for people in the home.

We found insufficient actions had been taken in response to some of the breaches identified at the previous comprehensive inspection in 2015. There were five regulations breached at this inspection in relation to safe care and treatment, safeguarding service users from abuse and improper treatment, person centred care, staffing and good governance. A warning notice was issued in relation to safe care and treatment.

The last comprehensive inspection took place in July 2016; the service was rated requires improvement. We found that sufficient action had been taken in relation to the warning notice we had issued following the previous inspection. Improvements had been made since the last inspection however further improvements were needed to embed the changes. There were two breaches of regulations in relation to staffing and good governance at this inspection.

At this inspection (January 2017) we found nine breaches of regulations. Both of the previous breaches from the last comprehensive inspection in July 2016 had been repeated. We also found seven further breaches in relation to safe care and treatment, person centred care, safeguarding people from abuse and improper treatment, consent, complaints, dignity and respect, and statutory notifications.

St Georges Care Home is a 68 bedded home that provides accommodation for persons who require nursing or personal care. At the time of our inspection there were 50 people living in the care home.

At this inspection the overall rating for the service is 'Inadequate' it will therefore be placed into special measures. The commission is now considering the appropriate regulatory response to resolve the problems we found.

There was a registered manager in place 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.

There were widespread and systemic failings identified during the inspection. Overall we found that quality and safety monitoring systems were not fully effective in identifying and directing the service to act upon risks to people who used the service and ensuring the quality of service provision. The failings included issues around staff management and staff cohesiveness that impacted on service delivery.

The registered manager and provider had failed to make appropriate statutory notifications; notifications tell us about significant events that happen in the service. We use this information to monitor the service and to check how events have been handled.

There was a failure to safeguard people. The registered manager had failed to report and take appropriate action regarding adverse incidents. The registered manager had failed to recognise the inappropriate restraint of people.

The registered manager had made applications for Deprivation of Liberty Safeguards (DoLS ) where they had been assessed as being required. These safeguards aim to protect people living in care homes

We carried out a focused inspection of St Georges Care Home on 6 and 7 January 2016. At that time, we found insufficient actions had been taken in response to some of the breaches identified at the previous comprehensive inspection undertaken in April and May 2015. We issued a warning notice for three regulatory breaches relating to safe care and treatment. We issued five regulatory requirement actions for regulatory breaches relating to deprivation of liberty safeguards, staff supervision and training, record keeping and quality assurance.

After the inspection, the provider wrote to us to say what they would do to meet the legal requirements. You can read the report from our last inspection by selecting the ‘All reports’ link for ‘St Georges Care Home’ on our website at www.cqc.org.uk.

We carried out a comprehensive inspection on 19 and 20 July 2016. St Georges Care Home is a 68 bedded home that provides accommodation for persons who require nursing and personal care. At the time of our inspection there were 56 people living in the care home.

There was no registered manager in place at the time of our inspection. The manager in charge of the home had submitted an application to the Commission to become the registered manager and this was being processed. 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.

At our inspection on 19 and 20 July 2016, we found that sufficient action had been taken in relation to the warning notice we had issued following the previous inspection. Overall, although we found improvements had been made, further improvements were needed to embed the changes. We found two breaches of the legal requirements.

Sufficient numbers of staff were not always deployed to meet the needs of people living in the care home. Care was sometimes rushed and monitoring charts were not always completed.

Staff received appropriate training to carry out their roles and staff performance was monitored effectively. Staff had received training to ensure they could meet people’s needs and care for them in a safe way. For example, staff had received training in how to care for people living with dementia.

People were protected from the risks of unsafe care because care plans reflected current health care needs.

Systems were in place for monitoring quality and safety and actions were taken when improvements were needed. Further improvements were needed to make sure shortfalls in care monitoring records were identified and acted upon.

Staff were kind and caring. We found people were being treated with dignity and respect and we found people’s privacy was maintained.

We found two breaches of the regulations at this inspection. You can see what action we told the provider to take at the back of the full version of the report.

At the time of our inspection there were 59 people living in St Georges care home. All those living in the home required nursing care support.

During our inspection we spoke with eight people who lived in the home, six staff including registered nurses, four visitors/ relatives, the manager and the deputy manager.

We examined six personal care files and associated records for people who lived in the home. We observed how staff interacted and supported people in communal areas.

We were supported on this inspection by an expert-by-experience. This is a person who has personal experience of using or caring for someone who used this type of care service. This person gained the views of people living in the home and their experiences.

All the visitors we spoke with were positive about the care their family member received. One relative told us “they are helpful and if I had a problem I know who to go to”. Another person told us “activities could be a bit more plentiful. Sometimes there is nothing”.

People that used the service were also positive about the care they received. One person told us “I get cross when I read in the paper about bad homes, I want to write to say it isn’t like that where I am”. Other people’s comments included; “they are busy staff but they are lovely they always work very hard”. “The food is nice I have a good choice”. “I have been here a long time and would rather not be here, but they are all ok. Staff ask me if it is alright before they do things”.

Staff were positive about the care they delivered and felt they were supported well enough to provide a good standard of care. Some staff told us they would like more time to spend with people. We discussed this with the manager who confirmed they would discuss staffing concerns at the next team meeting.

The provider had systems in place to monitor the quality of the service that was provided.

We carried out a comprehensive inspection of St Georges Care Home on 28, 30 April 2015 and 1 May 2015. Breaches of the legal requirements were found. The breaches related to the care and safety of people using the service, as well as matters relating to staffing and the running of the home.

After the inspection, the provider wrote to us to say what they would do to meet the legal requirements.

We undertook an inspection on 6 and 7 January 2016 to check the provider had followed their plan and to confirm they now met the legal requirements. This report only covers our findings in relation to these areas. You can read the report from our last comprehensive inspection by selecting the ‘All reports’ link for ‘St Georges Care Home’ on our website at www.cqc.org.uk

We had also received information from the local authority that had concerns about the quality and safety of the service provided for people in the home.

St Georges Care Home is a 68 bedded home that provides accommodation for persons who require nursing and personal care. At the time of our inspection there were 56 people living in the care home.

There was no registered manager in place at the time of our inspection. The manager in charge of the home told us they planned to submit an application to the Commission to become the registered manager. 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.

At our inspection on 6 and 7 January 2016, we found that insufficient action had been taken in relation to the breaches found at the comprehensive inspection. This was a focused inspection and in line with our procedures we have not changed the overall rating of the location.

People did not receive care and treatment that was safe and were at risk from poor hygiene practices. Action had not been taken to ensure hoist slings were used safely and to reduce the risk of the spread of infection. The kitchen was still not suitably clean.

We identified additional concerns. Equipment was not safely maintained. For example, hoists continued to be used when they were faulty. Pressure relieving mattress settings were sometimes incorrect. The call bell system had not been working reliably for over one year. This all meant people were not protected from the risks to their health and safety.

People were not fully protected when they were unable to provide consent to care and treatment. The Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which apply to care homes. This is to make sure people are not deprived of their liberty unless authorisations are in place. We made a recommendation following our comprehensive inspection because we identified a risk of people’s rights not being upheld in line with DoLS requirements.

At our focused inspection we found action had not been taken in response to the recommendation we made and applications in line with DoLS requirements had not been made.

Staff had not received appropriate training to carry out their roles and staff performance was not monitored effectively. Staff had not received training to ensure they could meet people’s needs and care for them in a safe way. For example, staff had not received training in how to care for people living with dementia.

People were not always protected from the risks of unsafe care because care plans did not always reflect current health care needs. Care records did not always confirm why some decisions were made. For example, when some people were taken into communal areas, they spent the day sitting in wheelchairs. Standard wheelchairs are usually used to move people from one area to another and are not suitable or comfortable for sitting in for long periods of time. The reasons were not identified in people’s care plans.

Staff performance was not being monitored effectively. This meant people were at risk of receiving inappropriate care.

Systems in place to monitor the quality and safety of the service were not effective. Some risks to people were not identified, and some were identified and not acted upon.

Actions had been taken to address the issues we identified regarding safe administration and storage of medicines. However, we found medicines were still left unattended on occasions. This meant people were still at risk of harm and further actions were required.

The layout of the laundry had been improved to ensure separate areas were provided for clean and dirty laundry.

We found improvements with regard to people being treated with dignity and respect. However we found further improvements were needed to ensure staff were consistent in their approach.

We found eight breaches of regulations at this inspection. You can see what action we told the provider to take at the back of the full version of the report.