The inspection took place on 6 March 2018, and the visit was unannounced.

St. Georges provides residential care to older people including people recovering from health issues and some who are living with dementia. St. Georges is registered to provide care for up to 36 people. At the time of our inspection there were 30 people living at the home. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

There was a registered manager was 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.

St. Georges Care Homes is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The provider used a wide range of quality monitoring checks. Quality monitoring had been carried out effectively. The provider had a clear management structure within the home, which meant that the staff were aware who to contact out of hours if an emergency arose, or an equipment repair was necessary. Staff had access to the maintenance diary to manage any emergency repairs. The provider had developed opportunities for people to express their views about the service. These included the views and suggestions from people using the service and their relatives.

We found that applications had been made to the local authority to legally deprive people of their liberty. The registered manager and care staff had been trained in the Mental Capacity Act (MCA) 2005. They were also aware of best interests meetings to ensure peoples treatment was in line with the MCA and Deprivation of Liberty Safeguards. People were asked for their written consent to care following their admission to the home. This was in addition to staff agreeing their actions prior to each caring intervention.

Staff were subject to a thorough recruitment procedure that ensured staff were qualified and suitable to work at the home. Following their recruitment staff received on-going training for their particular job role. Staff were able to explain how they kept people safe from abuse, and were aware of whistleblowing and what external assistance there was to follow up and report suspected abuse.

People were provided with a choice of meals that met their dietary and cultural needs. The catering staff were aware of people’s dietary needs, and sought people’s opinions about the menu choices to meet their individual needs and preferences. Staff and external agencies regularly provided a range of activities that were tailored to people’s interests. Staff had access to information and through this, developed a good understanding of people’s care needs. People were able to maintain contact with family and friends and visitors were welcome without undue restrictions.

Relatives we spoke with were complimentary about the provider, registered manager and staff, and the care offered to their relations. People or their relatives were involved in the review of their care plan. Staff had access to people’s care plans and received regular updates about their care needs. Care plans were updated to include changes to peoples care and treatment. People were offered and attended routine health checks, with health professionals both in the home and externally.

We observed staff interacted positively with people throughout the inspection, people were offered choices and their decisions were respected.

We received positive feedback from the staff at the local authority with r

The inspection took place on 6 December 2016, and the visit was unannounced.

St. Georges provides residential care to older people including people recovering from health issues and some who are living with dementia. St. Georges is registered to provide care for up to 36 people. At the time of our inspection there were 33 people living at the home.

St. Georges had a registered manager in post. The registered manager was also the provider, and he was supported by a care manager at the home. 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.

Care plans were personalised and each file contained information about the person's likes, dislikes, preferences and the people who were important to them, however some areas were not covered or planned for appropriately. We found the registered manager had not involved people or their relatives in the review of their care plan. Care plans also included information that enabled the staff to monitor the well-being of people. Staff had access to people’s care plans and received regular updates about people’s care needs. There were systems in place for staff to share information through detailed records for each person. Risk assessments and management plans covered relevant aspects of people’s needs and included finances, health and daily routines.

People felt staff were kind and caring, and their privacy and dignity was respected in the delivery of care and their choice of lifestyle. Relatives we spoke with were also complimentary about the staff and the care offered to their relatives. We observed staff offered people everyday choices and respected their decisions.

The environment of the home was not meeting the needs of people living with dementia. Heating was not available in some bathing areas and staff were not made aware of infection control issues to ensure people are protected.

There were appropriate arrangements for the storing, recording and checking of medicines to ensure people’s health and welfare was protected against the risks associated with the handling of medicines.

Staff worked as a team however they were not deployed to provide the appropriate level of assistance at meal times. People had mixed opinions of whether food was satisfactory and the registered manager had arranged a meeting to improve the variety on offer.

The provider had recruitment procedures that ensured staff were of a suitable character to work with people at the home. Most staff had received training in the areas the provider considered essential for meeting the needs of people in a care environment safely and effectively. Training was planned to update the remainder of the staff to ensure all staffs’ knowledge was up to date.

New staff received an induction prior to working with people. This helped them get to know people’s needs and establish a relationship with them before working with people on a one to one basis. Staff had been provided with safeguarding training and were aware and had an understanding of their responsibilities to protect people from harm. The registered manager understood their responsibilities to manage any safeguarding concerns raised by staff, and report any instances to the appropriate authorities.

Staff worked within the principles of the Mental Capacity Act 2005 and had a good understanding of their responsibilities in making sure people were supported in accordance with their preferences and wishes. Staff knew people's individual communication skills and abilities and showed concern for people's wellbeing in a caring and meaningful way. However they were observant of peoples dignity at all times.

There was a clear management structure within the home, which meant that the sta

This inspection took place on the 19 November 2014 and was unannounced.

St Georges is registered to provide residential care for up to 36 older people, some of whom are living with dementia. At the time of our inspection there were 26 people in residence. It is purpose built with accommodation on two floors and a passenger lift for access. The service has a range of lounges, a dining room and a central courtyard garden.

St. Georges had a registered manager in post at the service 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.

At the last inspection of the 22 February 2014, we asked the provider to take action to make improvements to the recording and administration of medication for people using the service. The provider sent us an action plan which stated they had met the legal requirement. We also found that improvements were needed to reduce the risk and spread of infection and to maintain appropriate standards of cleanliness. The provider sent us an action plan which stated they would meet the legal requirement by 16 June 2014. We found these actions had been completed.

Staff demonstrated a good understanding of what abuse was and were aware of their role and responsibilities. The provider had notified relevant agencies where incidents had occurred consistent with legislation and local guidance.

People were safe at the service and staff knew what to do if they had any concerns about their welfare. Records showed staff had thought about people’s safety and how to reduce risk. They also knew how to protect people under the Mental Capacity Act Deprivation of Liberty Safeguards (MCA DoLs) and that appropriate referrals had been made to supervisory bodies where people were thought to not have capacity to make decisions themselves.

There were enough staff on duty to meet people’s needs and to spend time engaging people in group activities. Staff had the skills and knowledge they needed to provide care, however communication amongst the staff team was not always effectively managed, which meant people did not always receive the care as identified within their plan of care. Medication was kept and administered safely and in the way people wanted it.

People told us that they were mostly satisfied with the food provided and had independent access to snacks and drinks, however the dining experience did not promote people’s independence or choice as meals came pre-served on plates without them being asked what they wished to eat. Dieticians and other health care professionals were involved if people needed extra help with nutrition and hydration.

People told us that they were satisfied with the care and support the service provided. They had access to a range of health care professionals. Records showed that staff took prompt action if there were concerns about the health of people using the service.

Records showed complaints and concerns were recorded and that complainants were provided with a response. Quality assurance surveys conducted by the provider showed people were mostly satisfied with the provider’s complaints procedure.

Representatives of the provider regularly visited the service to carry out quality assurance audits to ensure the service was running well and that identified shortfalls were being addressed. However their visits did not include speaking with people who used the service or visitors to seek their views to develop the service. Some people told us that the registered manager was approachable, however not everyone knew who the manager was.

This inspection was carried out to see if improvements had been made following our inspections of 15 April 2013 and 9 July 2013. Additionally, we had recently received some concerning information about St Georges.

We spoke with four people using the service and two relatives visiting their family members. We also spoke to three members of staff and two visiting health care professionals. We looked at four people's care records.

People experienced care, treatment and support that met their needs and protected their rights. One relative told us: “The staff are compassionate, kind and caring, though they do not always recognise [relative’s] specific care needs and I have to prompt them”.

Whilst we found the provider had systems in place to reduce the risk and spread of infection, we found these systems were not effective. There were a number of issues relating to the overall cleanliness of St Georges.

We found that the provider did not have appropriate arrangements in place to manage medicines which meant that people may not be protected against the risks associated with medicines. We found issues with people receiving their prescribed medication and with the recording of the use of controlled drugs.

We did not speak with people using the service during this inspection, but we looked at the environment to check the provider had taken action to improve cleanliness and hygiene. We found the environment was generally clean, although we found some equipment was damaged so it could not be cleaned effectively. The provider's audits were not being used effectively to identify infection risks.

During our inspection, we noted the provider did not manage medicines effectively to avoid risks to people using the service and staff. We did not speak with people using the service about this, but from our observations, we found there were risks to people’s safety.

We spoke with three out of 35 people using the service. Several people using the service were unable to give us their views because they had dementias. We observed care closely and spoke with two visitors to the service to assess the care people received. They all told us that care workers were good. One person using the service told us: “These people here, they’re superb.”

The people we spoke with told us they were satisfied with the service. They told us they were involved in decisions about their care. We spoke with visitors to a person using the service. They told us the person’s views were respected and they were always involved in decisions about the person’s care. We saw that care workers treated people with respect and promoted their dignity.

They all said the food was good and there were sufficient amounts. We observed the lunchtime meal. People were given sufficient amounts of food. People we spoke with thought the service was clean. We found the provider did not have effective systems for ensuring cleanliness, particularly of bathrooms and toilets.

We spoke with one person using the service and observed care throughout the day. We used SOFI to observe the care of four people over lunch time. The person we spoke with was happy with the care they received. They told us most staff treated them with respect and promoted their dignity. We saw that care workers spoke with people courteously and were very warm and caring to people. There was a calm atmosphere at the service throughout our inspection visit. Care workers contributed to this by responding immediately when people were requesting support or appeared agitated.

We spoke with two care workers, who were competent in describing how they met people’s needs. Care workers did not all receive regular formal feedback on their performance. The registered manager told us they planned to introduce regular supervision and appraisals for all staff.

Medication was administered, stored and recorded properly so that people were protected from risks associated with medicines.

People told us they liked living at St Georges. One person said, “This is one of the happiest places I’ve ever been in. I’ve got a lovely room, my own TV, and everything else I want. The food’s good and it’s plentiful.” Another person commented, “I’m very happy here and wouldn’t want to move anywhere else. It’s a lovely home.”

People said the care was good. One person told us, “We’ve all got different problems here – dementia or physical problems – and the staff can cope with it all. And if I need a doctor the staff will get one for me.” A relative said, “My relative has settled in well here. She lost motivation when she was at home but the staff are getting her doing things now.”

People told us they were satisfied with the way staff managed their medication. One person said, “The staff do my tablets and bring them to me at the right time. I’d rather leave it to them to sort out as they know when I should have them.” Another person commented, “I’ve never had any problems getting my medication here and they’ve never run out of what I need.”

People said they liked the staff and there were enough of them on duty to meet their needs. One person told us, “The staff are brilliant. They are well-trained and wise about people’s care. They know what to do if you have any medical problems.” Another person commented, “There’s always staff around and they are always helpful. If you pull the emergency cord in your room they come in minutes.”

St George’s was purpose built and is well-suited to people with dementia and/or limited mobility. The interior is light and airy, and corridors are wide with handrails. There is a range of communal areas which gives people choice as to where to sit and with whom. The home’s gardens are spacious and professionally landscaped. One person told us, “The gardens are lovely in summer. I can’t wait for the nice weather to come.”

Care has been taken to make the environment suitable for people with dementia. Colour schemes are simple and bright and laminate flooring is used which is smooth and easy to clean. All the bathrooms and toilet doors have pictorial signs on them and are painted blue so they are easy for people to find.

St George’s is run flexibly to fit in with the routines of the people who live there. There are no set bedtimes or getting up times, and meal times last for as long as people want them to. Activities provide a focus for those who want them, visitors can come and go at any time, and there is a range of communal areas where people can sit and socialise, or spend time on their own if they wish.

During our visit the atmosphere was generally happy and relaxed. People popped in and out of the manager’s office for a chat, and were always made welcome. One person told us, “It’s quite jolly here.” And a visitor said, “I love it here – it’s such a cheerful place. I wouldn’t want my (relative) to be anywhere else.”

The home’s large dining room was a centre of activity, both during and after mealtimes. Although busiest when food was being served, at others times it remained in use for socialising and as a place for people to meet their visitors. The atmosphere was lively, with tea and coffee ‘on tap’, people playing cards, chatting, feeding a visiting baby, or just watching what was going in. It provided a stimulating environment for those who enjoy activity.

People told us they mostly liked the food at St George’s. Comments included, “The food’s nice and you always get a choice.”, “There’s always plenty of fruit around in bowls.” and “You never go hungry.” One person said “The food can get monotonous, but it’s alright.” Visitors praised the food. One told us, ‘The food is wonderful. My (relative) has put on weight since he’s been here and he’s enjoying his meals.” Another said, “We can eat with the residents if we like. You often see relatives doing that.”

.Relationships between the people who use the service and the staff who care for them were good. The staff were warm and caring in their approach, and calm and professional at all times. We saw they made an effort to chat to people, and socialise with them, while carrying out their care duties. People responded well to the staff and seemed to trust them.

We saw that staff respected people’s privacy, knocking on bedroom doors before entering and providing personal care discreetly. People were encouraged to make choices about all aspects of their lives. For example, at lunchtime people had a choice of two main dishes. Some could say verbally which one they preferred, others were shown two plated options and were able to point to the one they wanted.

We also saw that the staff got on well with visitors to the home and made them welcome. And the visitors we spoke to all praised the staff. One told us, “They have the patience of saints.” Another said, “The staff are wonderful.”

We asked staff how they knew what was the best way to meet people's needs. One told us, ‘It’s in their care plans and also we get to know them quite well.” Another said, “They’re all different, with different personalities, what works for one won’t necessarily work for another.” This shows that staff appreciate there is no ‘one size fits all’ method of providing care, and that they must work flexibly with people if they are to meet their needs effectively.

The people who use the service and their relatives are consulted on all aspects of the care and support they receive. This is achieved in a variety of ways, including reviewing their care plans with their key worker, participating in meetings, and talking to the manager and staff on a one-to-one basis.