This inspection took place on 14 February 2018 and was unannounced.

St George's Nursing Home - Royston accommodates up to 24 people in a traditional 'Town House'. People are accommodated in a range of single and sharing rooms. St George's Nursing Home - Royston 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 service had a 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 last inspection in January 2016 we had rated the service as good. At this inspection we continued to rate the service as good however, we found that some improvement was required in relation to the management of people’s medicines. We shared our concerns with the management team who put further checks and monitoring in place to help support safe practice in this area.

People told us that they felt safe living at St George's Nursing Home. Staff had been trained in how to safeguard people from avoidable harm and were knowledgeable about the potential risks and signs of abuse. Where potential risks to people's health, well-being or safety had been identified, these were assessed and reviewed regularly to take account of people's changing needs and circumstances. Staff helped people to move safely using appropriate moving and handling techniques. People, their relatives and staff all told us that there were enough staff available to meet their needs. Safe and effective recruitment practices were followed to help ensure that all staff were of good character and suitable for the roles they performed at the service. The provider had worked closely with the Hertfordshire Fire and Rescue Service to help ensure people’s safety was promoted. The provider had systems in place to help promote infection control.

People and their relatives told us that the care and support provided was effective and appropriate to meet people's needs. Staff received training and supervision to support them to be able to care for people safely. The service was working within the principles of the Mental Capacity Act 2005 (MCA). All staff had completed relevant training and understood their role in protecting people's rights in accordance with this legislation. People were provided with a good choice of food. Assessments had been undertaken to identify if people were at risk from poor nutrition or hydration. People’s health needs were met in a timely way and they had access to health care and social care professionals when necessary.

People, and their relatives, told us they were happy with the staff that provided their care. Staff respected people's dignity and supported people in the way they wished whilst enabling them to remain as independent as possible. People's individual bedrooms were personalised with many items that had been brought in from their home such as cushions and pictures. Staff had developed positive and caring relationships with people they clearly knew well. People's care records were stored in a lockable office in order to promote their dignity and confidentiality. Visitors were encouraged at any time.

People and their relatives where appropriate had been involved in developing people's care plans which were reviewed regularly to help ensure they continued to meet people's needs. Staff were knowledgeable about people's preferred routines, likes and dislikes, and used this to good effect in providing them with personalised care and support. Regular meetings were held to support people and their relatives to give feedback about the service and facilities prov

The inspection took place on 05 January 2016 and was unannounced. At our last inspection on 25 April 2014, the service was found to be meeting the required standards in the areas we looked at. St Georges Nursing Home provides accommodation and nursing care for up to 24 elderly people. At the time of our inspection 18 people lived at the home.

There was a manager in post who had registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the CQC 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 and associated Regulations about how the service is run.

People told us that they felt safe, happy and well looked after at the home. Staff had received training in how to safeguard people from abuse and knew how to report concerns, both internally and externally. Safe and effective recruitment practices were followed to ensure that all staff were suitably qualified and experienced. Arrangements were in place to ensure there were sufficient numbers of suitable staff available at all times to meet people’s individual needs.

Plans and guidance had been drawn up to help staff deal with unforeseen events and emergencies. The environment and equipment used were regularly checked and well maintained to help keep people safe. Trained staff helped people to take their medicines safely and at the right time. Identified and potential risks to people’s health and well-being were reviewed and managed effectively.

People and their relatives were positive about the skills, experience and abilities of staff who worked at the home. They received training and refresher updates relevant to their roles and had regular supervision meetings to discuss and review their development and performance.

People were supported to maintain good health and had access to health and social care professionals when necessary. They were provided with a healthy balanced diet that met their individual needs.

Staff made considerable efforts to ascertain people’s wishes and obtain their consent before providing personal care and support, which they did in a kind and compassionate way.

Staff had developed positive and caring relationships with the people they cared for and clearly knew them very well. People were involved in the planning, delivery and reviews of the care and support provided. The confidentiality of information held about their medical and personal histories was securely maintained throughout the home.

Care was provided in a way that promoted people’s dignity and respected their privacy. People received personalised care and support that met their needs and took account of their preferences. Staff were knowledgeable about people’s background histories, preferences, routines and personal circumstances.

People were supported to pursue social interests and take part in meaningful activities relevant to their needs, both at the home and in the wider community. They felt that staff listened to them and responded to any concerns they had in a positive way. Complaints were recorded and investigated thoroughly with learning outcomes used to make improvements where necessary.

Relatives and staff were complimentary about the registered manager and how the home was run and operated. Appropriate steps were taken to monitor the quality of services provided, reduce potential risks and drive improvement.

We gathered evidence to help answer our five key questions; is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?

Is the service safe?

People’s care plans and risk assessments had been reviewed monthly and sooner if required. This meant people’s needs were being met and risks were being managed because the provider had systems in place to review their plans.

People were cared for in a clean and hygienic environment. There were daily hand overs for staff. That meant staff would be aware of any changes to individual needs. One person who used the service said, “I have been very impressed with my personal care”. A relative said, “When I go home I can relax and know [my relative] is safe.

Is the service effective?

People told us they were happy with the care that had been delivered and their needs had been met. We observed good interactions between staff and people who used the service. We found that people were cared for in a person centred way. This was reflected in their care plans. One person who used the service said, “I am supported as much as possible to help myself”.

Is the service caring?

We observed that people were supported by kind, caring staff, and relatives were supported because the manager had an open door policy. This meant people could visit the home around their busy schedules. One relative said, “I am really happy, this is a good home. My relative’s needs are being met”. Staff we spoke with had a good understanding of people’s needs, one staff member told us. “They need help to support their independence”.

Is the service responsive?

People were assessed to ensure their care needs could be met before they moved into the home. All people had a key worker and a named nurse. The care plan records were person centred including areas such as, ‘my life story’, ‘this is what I can manage myself’, and ‘this is how you can help me’, a personal history, hobbies and interests and likes and dislikes. People had input into their personal care, one person who used the service said, “I had input into my care, the nurses are respectful”.

Is the service well led?

There were good quality assurance processes in place. We saw evidence of customer survey’s and resident meetings. For example, a resident survey was completed about activities the residents liked and disliked, and any suggestions for future activities. This survey was used to improve the activities that were available. There was good communication between staff and one staff member said, “I love it here, [there are] good supporting staff”.

As the purpose of this inspection was to assess improvements made in relation to shortfalls identified during our previous inspection on 18 October 2013, we did not request information directly from people using the service on this occasion.

Overall, we found that the provider had taken sufficient action to improve the home’s medicine management procedures so that people were protected from harm.

We spoke with seven of people who lived at St George’s. People told us they were extremely happy with the service being provided. One person said, “It’s very nice here. Everyone’s very friendly and we’re looked after well. It really is lovely and I’d recommend the home to anyone.”

On the day of our inspection there was a relaxed, homely atmosphere at the home. We saw that people who lived there got on well with staff and enjoyed each other’s company. We found that staff treated people with respect and supported them to remain as independent as possible.

Care records were personalised and gave staff clear guidance on meeting each person’s individual needs. Potential risks to people had been assessed and plans put in place to minimise the risks.

Medicine Management requires minor improvements.

The provider had a recruitment procedure in place to ensure that staff employed were suitable to work at the home.

There were enough staff on duty who had been appropriately supervised and were able to provide the care and support that people required.

There was a complaints procedure in place and a record kept of the outcome and any action taken. People told us they knew how to complain, but had never had to.

During our inspection on 26 October 2012, we spoke with six people who lived in the home. They all said that they were involved in the planning of their care. They also told us they were asked their views about the care provided at their meetings and through questionnaires. One person told us, "the girls (staff) are great, they are like my family". They all told us they felt safe and would raise any concerns with the manager.

We observed staff supporting people in a kind and calm manner. Communication was positive and staff spoke respectfully with people. Staff were provided with appropriate training to enable them to meet the needs of the people who lived in the home.

The organisation had systems in place to monitor the quality of the service provided and action was taken to address any issues that were highlighted as needing improvement.

However, we found that the provider had not introduced a more formal process to ensure that all staff were formally supervised and appraised.

People we spoke with told us that staff respected their privacy and dignity and that they were able to make decisions about their care and treatment. They also said that their views were listened to and acted upon. They told us that they were very happy with the care, treatment and support they received and they were complimentary of the staff and the food provided for them. People who use the service said that they felt safe and protected and that they did not have any concerns or complaints about the service provision.