St Georges Park

St George’s Park is a residential care home providing personal and nursing care for a maximum of 70 people, including people living with dementia. At the time of our inspection there were 68 people using the service. Accommodation was provided in an adapted two storey building. There were communal lounges and dining rooms on each floor. There was a large enclosed garden for people to enjoy and an orangery was nearing completion.

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

Risks to people were managed, assessed and mitigated appropriately. Accident and incident forms were investigated by the management team. Lessons learnt were shared with the staff team.

Staff were recruited safely and received regular training, including safeguarding training.

Medicines were managed safely by suitably trained staff and people were offered and received pain relief medication. Staff used personal protective equipment (PPE) effectively and attended infection prevention control training.

Staff said they felt supported by the registered manager and attended regular meetings. Relatives told us they felt included in the service and felt confident to raise concerns.

The provider and staff worked in partnership with other health and social care agencies to deliver good outcomes for people and to ensure their needs were met and reviewed.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

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 good (published 18 June 2021). At this inspection we found the service remains good.

Why we inspected

We received concerns relating to infection prevention, staffing and risk management. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe and well led sections of this full report.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has not changed following this inspection and remains good, based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for St Georges Park on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

St Georges Park is a residential care home that was providing personal and nursing care to 65 people at the time of the inspection. The service can support up to 70 people across two floors. Accommodation on the ground floor specialises in providing care to people living with dementia.

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

People felt safe with the staff who supported them. People were supported by adequate numbers of staff who were safe to work with them. The provider’s systems protected people from the risk of abuse. People were protected from the risks associated with the control and spread of infection. There were safe systems for the management and administration of people’s prescribed medicines. People received their medicines when they needed them from staff who were trained and competent.

People were supported by a staff team who were trained and competent in their role. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. People lived in a comfortable and well-maintained purpose-built environment. People were able to personalise their bedrooms. People were provided with meals and drinks which took into account their needs and preferences. People saw healthcare professionals when they needed. Before moving to the home people were assessed to ensure their needs and preferences could be met.

There were effective systems in place to monitor and improve the quality of the service people received. People’s views were valued and responded to. The provider worked in partnership with other professionals to ensure people received a service which met their needs and preferences. People were cared for by a staff team who were well supported in their role.

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 good (report published 19 May 2018).

Why we inspected

We received concerns in relation to staffing levels, people’s nursing care needs, diet and hydration, infection, prevention and control and the general management of the home. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

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 coronavirus and other infection outbreaks effectively.

We found no evidence during this inspection that people were at risk of harm from these concerns. Please see the safe, effective and well-led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for St Georges Park on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

St Georges Park 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. St Georges Park accommodates up to 70 people in one adapted building. At the time of the inspection there were 55 people living in the care home.

There was not a registered manager in post at the time of the inspection. The provider had appointed a manager and they planned to make an application to register. 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.

People were protected from abuse and had their risks assessed, identified and managed appropriately. The home and equipment were maintained to minimise the risk of cross infection. People were supported by sufficient safely recruited staff. People received their medicines as prescribed and there were systems in place to learn when things went wrong.

People had their needs assessed and care plans were in place which staff followed to provide consistent care, with access to relevant health professionals as required. Staff had their competency checked and received updates to their training. People had a choice of meals and were supported in an adapted environment. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People received support from caring staff. People were supported to make choices and retain their independence. People were treated with dignity and respect.

People received personalised care and support from staff that understood their needs. Peoples life history and interests were understood and they had access to activities which were of interest to them. People were supported at the end of their life. People understood how to complain and these were responded to.

People and their relatives had the opportunity to share their feedback. Staff felt supported by the management team and there were systems in place to monitor the quality of the service people received.

On 6 and 9 February we carried out an unannounced focussed inspection to check on the safety and wellbeing of people living at the service. This was because an unannounced comprehensive inspection of the service on 31 October and 1 November 2016 found there were breaches of legal requirements and the overall rating for the service was 'Inadequate'. This meant the service was placed in 'special measures’; services in special measures are kept under review. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for St Georges Park on our website at www.cqc.org.uk

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

During this inspection we found the provider had made the required improvements and met the regulations. However there were areas which still required improvement, for example quality checks were in place and had identified areas for improvement but these had not been fully delivered at the time of the inspection. There were improvements required in peoples experience at meal times, the delivery of person centred care, and the provision of activities required further improvements.

There was not a registered manager in post at the time of our inspection, however the provider had made an appointment to the manager post and there was a plan in place for them to register. 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.

People told us that they felt safe living at the service and we found staff that could recognise any potential signs of abuse and protected people from harm. Staff managed risks to people and the registered manager had effective reporting and monitoring of accidents in place. The provider had recruitment practices, which kept people safe, and there were sufficient staff to meet people’s needs. People received their medicines as prescribed. Medicines were stored appropriately and there were systems in place to monitor people’s medicine administration.

People received support from a staff team who received the training and support they needed to carry out their roles. People were asked for consent to the care they received, where people lacked capacity the principles of the Mental Capacity Act 2005 were followed. People told us they enjoyed the food and drink they received which met their nutritional needs and preferences. People had access to health care and received support to maintain their health.

People received support from a staff team who were kind and caring and helped them understand and make choices about their care and support. People had their privacy and dignity respected and were encouraged to maintain their independence. People were supported to maintain relationships that were important to them.

People received the care and support they needed and however staff did not always demonstrate a good understanding of people’s preferences or personal histories. People and their relatives were involved in the development and review of their care plans. People did not always have access to leisure opportunities of their choice or access to meaningful activities.

The manager had quality assurance systems in place which had identified some of the areas which required improvement; however improvements had not been fully implemented. People, relatives and staff were involved in the development of the service. The manager had developed an open and honest culture. Staff told us they felt the service was well led by managers that made themselves visible and available to people, relatives and staff.

On 6 and 9 February we carried out an unannounced focussed inspection to check on the safety and wellbeing of people living at the service. St George’s Park is registered to provide residential accommodation for people who require nursing or personal care or the treatment of disease, disorder or injury. They provide care for up to 70 older people with dementia and nursing needs. At the time of the inspection there were 44 people living at the service.

A manager was in post at St Georges Park; however they had not registered at the time of the inspection. The provider was planning to register the manager with CQC. A registered manager is a person who has registered with the Care Quality Commission (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 2008 and associated Regulations about how the service is run.

The provider had made significant improvements and had met the requirements of the law for providing safe care and treatment and having sufficient staff. There were sufficient staff to meet people’s needs and staff were safely recruited. People were supported to manage risks to their safety and were safeguarded from abuse. Staff did not always use the systems in place to ensure people were receiving their medicines as prescribed and there had been some medicine errors, however the provider was working to ensure these issues were addressed.

The provider had made significant improvements to the leadership and management of the home. They had improved staff knowledge of safeguarding procedures and reassessed risks to people’s health and wellbeing. The provider had notified us of significant incidents and events as required by law. The services last inspection rating was on display in the home as required by law.

However further improvements were required to the governance arrangements in order to meet the requirements of the law. Staff did not always recognise where their practice created a risk to peoples safety. Systems in place to check on the quality of care people received were not always used effectively to drive improvements. Staffing levels were not routinely assessed to ensure there continued to be enough staff to meet people’s needs. People’s feedback was not routinely sought.

St Georges Park is residential accommodation for people who require nursing or personal care or the treatment of disease, disorder or injury. They provide care for up to 70 older people with dementia and nursing needs. At the time of the inspection there were 60 people living at the service.

The registered manager had resigned from their post in August 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.

People were not protected from the risk of abuse. Staff did not always identify potential abuse, which meant incidents were not investigated and reported to the local safeguarding authority. People did not always receive their medicines safely. Medicines were not always available to people. Where people were at risk, staff did not understand how to manage the risks to keep people safe. People did not always have their needs met, as there was not enough staff to meet people’s needs.

People received support from staff that did not have the knowledge to support people safely. We found not all staff understood how to provide some aspects of people’s care. People were not always supported in a way that protected them from unlawful restrictions. Principles of the Mental Capacity Act had not been followed when people lacked capacity to make specific decisions. Care was not always provided in a ‘least restrictive’ way. People did not always have their food and fluid intake managed safely. Staff did not always make sure people had enough to eat and drink. Staff did not always seek support for people from health professionals when they needed it.

People did not have meaningful relationships with staff. Although some staff were seen engaging with people positively, in a most staff were too rushed to speak with people and sometimes missed the opportunities for interaction. People were not involved in making decisions about their care and support. Staff did not always treat people with respect and ensure their dignity.

People did not have their needs met in the way they preferred and choices they had made were not met. Staff did not always understand people’s needs and preferences. People had access to group activities, but there was little evidence of people being able to follow their individual interests. Some people did not know how to make a complaint.

People did not always feel they had an understanding of who was leading the service. Staff did not have clear leadership and were unsure who was in charge. The provider had failed to monitor the quality of service provided and to ensure people were protected from risks to their health, safety and well-being. People told us they had meetings to raise concerns; however, it was not always clear what happened as a result. The provider did not always notify us of incidents, which occurred at the service.

During this inspection we identified 8 breaches of the of the Health and Social Care Act 2008. You can see what action we told the provider to take at the back of the full version of the report.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.”