St George’s Care Centre is a purpose built '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. St George’s is registered to provide care and support to 77 people. At the time of our inspection there were 76 people living there.

St George’s Care Centre is located in the residential area of Moorside, Oldham. It is approximately three miles from Oldham town centre and is situated close to local shops and amenities, with good access to local transport routes.

This was an unannounced inspection which took place on 22, 23 and 25 January 2019. The care Quality Commission (CQC) last inspected St George’s Care Centre in November 2017, when the service was rated as ‘Requires Improvement’ overall. At that inspection we found the service was in breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Safe care and treatment. This was because medicines were not always managed safely. Following our inspection, the service provided us with an action plan which described how they would make improvements. At this inspection we found improvements had been made and the service was no longer in breach of any of the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The service had an experienced registered manager, who was a registered mental health nurse. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The building was secure, clean and well maintained. There were effective infection control and prevention measures within the service. Checks and servicing of equipment, such as for the gas, electricity and fire-fighting equipment were up-to-date.

Staff had been recruited safely. The service had completed all the necessary checks to ensure that staff were suitable to work with vulnerable people. There were enough registered nurses, care workers and support staff to meet the needs of the people who currently lived at the home. There was an on-going recruitment drive with the aim of reducing the use of agency staff.

A safe system of medicine management was in place.

People had individual assessments in place which identified risks in relation to their health and wellbeing. These helped identify if people were at risk from everyday harms, such as falls. Where risks were found, there were plans in place to guide staff, so that people were kept safe.

Accidents, incidents and safeguarding concerns were recorded and managed appropriately. There was clear information detailing any remedial action taken to reduce the likelihood of similar events occurring in the future.

We observed that staff always considered people’s capacity and consent when supporting them with care tasks. People were given choices when making everyday decisions. When people were being deprived of their liberty the correct processes had been followed to ensure that this was done within the current legislation

People were supported by well-trained staff. New staff received a thorough induction to the service and the training matrix showed that all staff had completed face-to-face training in a range of topics. Senior nurses and management carried out regular supervision and observation of staff. This ensured the standard of their work was monitored and gave them the opportunity to raise any concerns or worries.

During our observations we found staff treated people with dignity and respect. Staff showed patience and understanding and interacted with people in a kind and caring manner.

Staff at St George’s monitored

Prior to this inspection we carried out recent checks on the home in February 2017 and October 2016. We carried out an unannounced comprehensive inspection on 4 and 5 October 2016. At that inspection we identified breaches of two of the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to safe care and treatment (Regulation 12) and good governance (Regulation 17). We identified concerns around the safe management of medicines, shortfalls in the maintenance of records, inconsistent recording of information around best interest decisions and failure of the auditing systems to pick up the issues we found. We took enforcement action against the provider and issued Warning Notices and asked them to make improvements to the service. We rated the service as ‘requires improvement’ overall.

We carried out an unannounced focussed inspection on 2 and 3 February 2017. That inspection was to check if the service had made the necessary improvements and also because we had been made aware of an incident which indicated potential concerns around the management of the risk associated with bed rails. At that inspection we specifically looked at the ‘safe’ and ‘well-led’ domains. We found that, although some improvements had been made, there was a continued breach of the regulations the service was in breach of at our October 2016 inspection. Namely, we again found concerns around the management of medicines. We also identified that where people were using bed rails, there was no risk assessment in place to identify if they were safe to use for each individual person. This demonstrated a continued breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also found a continued breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because the provider had failed to maintain the quality and safety of the service. At that inspection we rated the ‘safe’ domain as inadequate.

We carried out this inspection on 8 and 9 November 2017. This inspection was to check what improvements had been made and to rate the service. We found that overall the service had made considerable improvements since our last two previous inspections. However, we found that medicines were not always managed safely and there was therefore a continued breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the provider to take at the back of the full version of the report.

Medicines were not always stored at the correct temperature. Some medicines may become ineffective if stored above or below the recommended temperatures. We found eye drops for two people were past their recommended expiry date. This meant we could not be sure if they were still effective. Where people received their medicines covertly (hidden in food or drink) there was no record of any input from a pharmacist to advise the home how to disguise each medicine without reducing its effectiveness. We identified some issues around the recording of fluid thickeners.

There were systems in place to help safeguard people from abuse. Staff understood what action they should take to protect vulnerable people in their care. Recruitment checks had been carried out on all staff to ensure they were suitable to work in a care setting with vulnerable people. At the time of our inspection there were sufficient staff to respond to the needs of people promptly.

The home was clean, well-maintained and well-decorated. Procedures were in place to prevent and control the spread of infection. Maintenance checks on services, such as the gas and electricity supplies and checks on equipment, such as hoists were in date. There were systems in place to protect staff and people who used the service from the risk of fire.

All new staff received a thorough induction and regular refresher

St George’s Nursing Home is a purpose built nursing home which provides nursing and personal care for up to 77 adults. It is divided into six units, caring for people living with dementia, older adults, younger adults, people with physical disabilities and mental health needs.

We carried out an unannounced comprehensive inspection of this service on the 4 and 5 October 2016. Breaches of legal requirements were found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to safe care and treatment and good governance. We took enforcement action against the provider and issued Warning Notices and asked them to make improvements to the service.

We undertook this unannounced focused inspection on 2 and 3 February 2017 to check that they had followed their plan and to confirm that they now met legal requirements. We had also received a notification of an incident at the home involving a person who used the service. The information shared with CQC about the incident indicated potential concerns about the management of risk around the use of bed rails. As part of this inspection we examined those risks. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for (location's name) on our website at www.cqc.org.uk.

At the time of this inspection there was a registered manager in post who had registered with the Care Quality in June 2016. 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.

During this inspection we identified that the registered provider had not notified the Care Quality Commission of an incident that had resulted in a person sustaining a serious injury. The registered provider has a legal responsibility to inform the CQC of notifiable incidents. Failure to notify the CQC of this incident was a breach of Regulation 18 of the Care Quality Commission (Registration) Regulations 2009.

We found that although some improvements had been made in relation to the concerns we identified in October 2016, these had not yet been fully rectified. In addition, at this inspection we identified concerns around risk assessments, in particular that the provider was not completing bed rail risk assessments.

We identified there were continuing breaches of Regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Safe care and treatment and Good Governance. These were in relation to medicines management and lack of appropriate risk assessments; and failure to monitor the quality and safety of the service. You can see what action we told the provider to take at the back of the full version of the report. We are currently considering our options in relation to enforcement in relation to some of the breaches of regulations identified. We will update the section at the back of the inspection report once any enforcement work has concluded.

At our inspection in October 2016 we found shortfalls in the administration of medicines as policies and procedures for the safe storage, administration and recording of medicines were not always followed. At this inspection we found that although some improvements had been made, there continued to be problems with the safe administration and storage of medicines.

At our inspection in October 2016 we identified that hazardous substances such as fluid thickening agents were not stored securely. At this inspection we found this concern had been rectified and all hazardous substances w

St George's Nursing Home cares for up to 77 people who require nursing and personal care. The service was divided into six specialist units caring for people living with dementia, older adults, younger adults, people with physical disabilities and mental health needs. There were 71 people using the service at the time of the inspection. The service had re-registered with a new provider in July 2014 and this was the first time we had inspected the service since then.

The inspection was carried out on 4 and 5 October 2016 and was unannounced. The inspection was carried out by two inspectors and a specialist advisor.

A registered manager was in post and had registered with the Care Quality Commission in June 2016. 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.

We found shortfalls in the administration of medicines as policies and procedures for the safe storage, administration and recording of medicines were not always followed. We also found that some areas of the home were not kept satisfactorily clean, and that hazardous substances were not always stored safely. The registered manager had addressed some of our concerns by the second day of the inspection.

Staff had received training in the safeguarding of vulnerable adults and the service followed the protocols set out by the local authority for the recording and reporting of incidents of a safeguarding nature.

There were suitable numbers of staff on duty, and safe staff recruitment processes were in place which helped to protect people from abuse. There were some staff vacancies and recruitment was in progress to fill these. Where agency staff were being used, the registered manager tried to book the same agency staff to provide consistency and continuity of care.

Systems were in place to assess and monitor the safety of the premises and equipment. Individual risks to people were also assessed and plans were put in place to mitigate these.

Staff received regular training, supervision and appraisals. A new system had been put in place to ensure these were brought up to date by the new registered manager, as a number had been out of date. We found that progress was being made in this area and staff told us they felt well supported. A training facilitator worked in the service and was responsible for planning and delivering training. Specialist trainers were brought in to provide training related to specific needs, such as particular medical conditions or specialist equipment. There were some gaps in training but there were plans in place to address these. The standard of training materials and resources was high.

The service was working within the principles of the Mental Capacity Act and applications had been made to the local authority to deprive people of their liberty in line with legal requirements. Decisions taken in the best interests of people were not always appropriately recorded or reviewed on a regular basis.

People were supported with eating and drinking, and special diets were catered for. Nutritional assessments were carried out, and where people were found to be losing weight, specialist input was sought. There were mixed views about the quality of the food, and we were told that the contract with the external catering company was due to end, and that catering would be provided by the provider’s organisation in the near future. We reviewed food and fluid records and observed staff completing these. We found that they were not always completed accurately and that there were some gaps in records.

The premises were generally clean and tidy, and there was access to outdoor space with supervision. Gardens were well maintained and tidy. There was a rehabilitation k