St George's Nursing Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm.

At our last assessment we rated this key question requires improvement and we found a breach of legal regulation in relation to the safe care and treatment. At this assessment the rating has remained requires improvement. Improvements had been made to people getting safe care and treatment the provider was no longer in breach of safe care and treatment but we found a new breach of regulation as people’s care planning documentation and associated paperwork was not always accurate and up to date.

This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

This service scored 59 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service had a proactive and positive culture of safety, based on openness and honesty. They listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

The manager and the clinical lead were responsible for reviewing incidents and accidents. These were held electronically and were completed by staff. Daily meetings were an opportunity for staff to raise incidents with senior staff and for management to share any learning if needed. All staff we spoke with felt able to raise incidents or concerns with the management of the service and the manager spoke openly about their responsibilities in embedding good practices, so people received good care. Senior managers were sent a monthly report for the service so they could undertake any further analysis or investigation if needed.

The service worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

The manager confirmed how they liaised with health and social care professionals as needed. This included making referrals when required and supporting people with their transition to and from St George’s Nursing Home. There were weekly visits from a health care practitioner where people could have their medical needs reviewed and any referrals discussed. The manager completed pre-admission assessments where they liaised with people, their relatives and healthcare professionals. They felt this was important to ensuring they could meet the person’s individual needs prior to their admission to the service. Feedback from one professional confirmed there had been occasions when information provided to them had not always been accurate. Although they felt staff were caring and empathetic and improvements were being made.

The service worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Although some improvements were needed to ensure Mental Capacity Assessments and Best Interest Decisions were being completed and that all staff had received training in Deprivation of Liberty Safeguards. The service shared concerns quickly and appropriately.

People and their relatives described the support they received as safe. A person told us, “I feel safe here.” Another person told us, “I feel very safe here.” A relative we spoke with told us, “We know they are safe.”

We observed staff giving people choice during our visit and all staff had completed their training in Mental Capacity. However, some staff needed to complete their Deprivation of Liberty Safeguards training. The manager kept a log of pending and authorised Deprivation of Liberty Safeguards (DoLS) for people. People’s care plans confirmed when these had been granted although not what conditions had been authorised. We also found some people needed either a Mental Capacity Assessment and Best Interest decision for vaccinations and equipment or they needed specific information added to their best interest decision where specialist equipment was being used. We raised this with the manager for them to action these.

Staff were able to confirm who they would raise concerns with. All staff felt able to go to the manager or senior member of staff if needed. Some staff needed to complete refresher safeguarding training, the manager was aware of who these were. The manager had recently implemented a safeguarding report that logged all safeguarding concerns including any actions. This confirmed any relevant learning and any important information was shared with staff at their meetings. A member of staff told us, “Yes (people are) safe here.”

People’s care plans did not always contain important information about their individual care and support. At this inspection we found improvements were still needed to ensure people’s care plans contained important information about their individual care and risk assessments. For example, more information was needed in one person’s care plan on how staff were to support them with their repositioning as their care plan had no information on what support staff were to provide and why. Staff told us they supported the person with 4 hourly repositioning, their care plan did not confirm this. There was also no associated risk assessment in place to confirm this. Following our inspection action was taken to update this person’s care plan and associated risk assessment. People who were being supported by staff with their mobility had limited information within their risk assessment with how staff were to use their equipment and what equipment they needed. For example, one person’s care plan had information around specialist equipment they needed although there was no information of this equipment in the falls risk assessment. Risk assessments were also needed for people who had topical creams that contained paraffin. Action had been taken prior to our assessment to remove these topical creams. Although no associated risk assessment had been put in place so people could still use this cream. The provider confirmed risk assessments were completed following our inspection. People and relatives were happy with the care and support provided by staff. One person told us, “The staff are kind.” Another person told us, “I can’t fault the staff.” One relative told us, “The care is excellent.”

The service detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

People had personal evacuation plans in place however these contained minimal information about what support and equipment the person might need in the event of an emergency. We raised this with the manager so they could review people’s personal evacuation plans. Safety checks were undertaken when required, for example to equipment and to the building. The provider had certificates to ensure the gas, electric and fire safety had been reviewed and was compliant.

The manager was making improvements to recruiting care staff as there were some vacancies within the service; these were being covered by agency staff. Improvements were being made to ensure staff received supervisions, an annual appraisal and mandatory training. People and staff felt staffing levels might not always be adequate. The provider and manager were aware improvements were needed to ensure staff were up to date with their mandatory training. Some staff needed refresher training in the safe administration of medicines, food safety, first aid, safeguarding adults, deprivation of liberty safeguards and practical moving and handling. Following our inspection the provider confirmed training had now been provided to staff. Additional first aid at work training had also been provided to nursing staff. During our inspection we found two staff needed moving and handling practical training. Action was taken the same day to provide this training. Staff also needed training in how to support people with a Learning Disability and Autism. Although some staff had undertaken a training course, we found no practical training had been provided to staff. This meant staff might not have the knowledge and understanding to support people with these specific needs. The management of the service were making improvements to ensure staff had an annual appraisal and regular supervision as not all staff had been provided this. The provider had a dependency tool to determine the staffing levels for the service. However, we found the same staffing numbers were provided throughout the home even though some people had higher needs in certain areas. People and staff told us there were not always enough staff. For example, one person told us, “They are a bit short staffed sometimes.” Another person told us on occasions they have to wait depending on if staff were available. One member of staff told us that one person on occasions had to wait until staff are able to support them. They told us, “They had to wait.” The member of staff went on to say the person had to wait for two staff to be available as they needed assistance with personal care. Following our inspection the provider confirmed they had undertaken a review to ensure the staffing allocation was adequate.

The service needed to make some improvements to how it managed infection control. For example, we found some improvements were needed to ensure hot food was being handled as recommended within guidance from the Food Standards Agency. Some bins were not suitable, and one bathroom had no hand soap as the dispenser was not working. We also found people who lacked capacity did not always have a mental capacity assessment and best interest decision in place for vaccinations. Although, we found consent forms had been completed for people by their families. We raised these shortfalls with the manager who took action during our inspection to ensure hot food was served at the correct temperature and the handwash dispenser was replaced and suitable bins were put in place.

The home was clean and odour free and staff had access to personal protective equipment. The manager reported monthly on infections within the service. This information was shared with the senior management team. All staff had received training in infection control.

The service was not always ensuring all medicines were being managed as required. For example, some improvements were needed to the management of topical creams. We found there was no individual risk assessment in place for people where their topical cream posed a risk due to being flammable. This had been identified prior to our visit although a decision had been made to remove these topical creams due to them being a risk. This meant people had not had a topical cream or an alternative topical cream for two days since the service had identified this. Where people had their medicines administered covertly, we found this had not been agreed by the pharmacy team and their GP. Information needed documenting in one person medicines administration chart as their medicines needed administering at a specific time. Guidance for when staff are to administer medicines such as this is important. We also found improvements were needed to ensure the service was following the recommended guidance for managing Oxygen within a care home.

Following our inspection the manager confirmed they were taking actions to liaise with the GP and pharmacist for people who needed their medicines administered covertly and where people needed an individual risk assessment due to their topical cream being a fire risk.

Nursing staff had competency checks completed, and staff were provided with training in the safe administration of medicines. Where staff needed training and or a refresher the providers database held this information.