This was an unannounced inspection that took place on 4, 5 and 7 September 2018. At the last inspection in June 2017 we looked at the five key questions and identified six breaches of the regulations. The overall rating was “Requires improvement”. The rating for safe, effective, caring, responsive and well-led was “Requires improvement”.

The breaches of the regulations were regarding, the care and treatment of people, staffing, nutrition and hydration, person centred care, dignity and respect and systems and processes. We also recommended that the home sought guidance in respect of The Mental Capacity Act 2005 (MCA). This recommendation was followed.

For four of the breaches, we issued ‘Warning Notices’ against the service and required the provider to ensure the breaches were met by 27 August 2017. These breaches were regarding the care and treatment of people, staffing, nutrition and hydration and person-centred care. The provider sent us a report to say how they had met these breaches and we checked that they had followed their action plan. At this inspection we found that the terms of the ‘Warning Notices’ and the breaches of regulations identified in June 2017 were met.

George Potter House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The home is located in Battersea, south London and registered to provide care and support for 69 people who require nursing or personal care support.

The home 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 and associated Regulations about how the service is run.

People said they experienced a pleasant, friendly and relaxed atmosphere at the home. This was created by the staff and people and their relatives were also satisfied with the care and support provided. They thought there were enough staff who met people’s needs in a thoughtful, kind way.

The home’s recording, auditing and quality assurance systems were kept up to date and now monitored and assessed the quality of the service provided. The information was clearly recorded, easy to understand and reviewed regularly.

People had access to community based health care professionals as required. Staff also discussed health needs with people and provided them with balanced diets and protected them from risks regarding nutrition and hydration. The meals served addressed people’s likes, dislikes and preferences.

Most people said they enjoyed the meals, which were of good quality and there was a variety of choices provided. People were supported, by staff to eat their meals and drink at their own pace and enjoy the experience.

The home provided a safe environment for people to live and staff to work in. It was clean and well-maintained.

Staff knew the people they supported well and were appropriately skilled and trained to meet people’s needs. They also understood their responsibility to treat people equally, respect their diversity and human rights and recognise and respect people’s differences. People said they were fairly treated.

The Mental Capacity Act and DoLS required the provider to submit applications to a ‘Supervisory body’ for authority. Appropriate applications had been submitted by the provider and applications under DoLS been authorised, and the provider was complying with the conditions applied to the authorisation.

Staff said the registered manager and organisation provided good support and they had opportunities for career advancement.

People said the registered manager and staff were approachable, responded to them and asked their opinions.

This inspection took place on 13 and 14 June 2017 and was unannounced on the first day; the provider knew we would be returning on the second day.

We last carried out an unannounced inspection of this service on 10 May 2016. Breaches of legal requirements were found regarding the assessment and management of risks, cleanliness of the premises, person-centred care, dignity and respect, complaints and good governance. After the comprehensive inspection the provider wrote to us to say what they would do to meet legal requirements in relation to these breaches. On 13 December 2016 we carried out an unannounced focused inspection, where we found the provider was now meeting these requirements.

George Potter House is a care home that provides nursing care for up to 69 older people. At the time of our inspection there were 47 people using the service. The ground floor is called Primrose Unit and has a large kitchen and dining area, garden, courtyard and lounge which serves as an activities room. The first floor of the building, called Rainbow Unit, provides care to people living with dementia, and contains a lounge, dining room and sensory room.

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.

We found that the provider had taken steps to improve the overall quality of the premises; this included replacing carpets and furniture, decorating communal areas and refurbishing bathrooms and toilets. However, areas of the building remained dirty and we saw some hazards such as trailing wires and unsafe filing cabinets. The provider carried out regular checks of some areas of safety such as electricity, gas and window restrictors and had evacuation plans in place in the event of an emergency. There were also regular checks of their fire safety systems.

We saw many instances of good and respectful interactions between people and staff, but we also saw examples of poor care. This included people not being seen to promptly when they needed support to be changed, and people did not always receive showers or oral care in line with their care plans. Some people complained of being handled roughly by staff, and some people told us they were put to bed too early. We saw some examples of poor infection control practice. The provider had measures in place to assess people's capacity and demonstrate how they were working in people's best interests, but these were not always applied effectively.

There were measures in place to assess and mitigate risks to people. People were assessed by the provider for their risk of pressure sores. However, measures were not always followed to prevent these, which included pressure relieving mattresses being placed on the wrong setting for the person’s weight and turning charts not being correctly completed. We also found that staff carried out weekly audits of whether existing pressure sores were healing but did not always record appropriate measurements of wounds which would help to measure if this was taking place.

The provider carried out assessments of people’s nutritional needs and monitored people’s weights. However, dietitian referrals were not always followed up, and although many people received suitable support to eat, some people did not. We found that food and fluid charts for two people contained misleading information about what people had actually eaten.

The provider had measures that ensured staff were suitable for their roles, which included providing regular training and supervision and carrying out suitable pre-employment checks. However, we found that staffing levels were frequently far below what the provider told us were required; some people and relatives to

We carried out an unannounced inspection of this service on 10 May 2016. Breaches of legal requirements were found regarding the assessment and management of risks, cleanliness of premises, person-centred care, dignity and respect, complaints and good governance. After the comprehensive inspection the provider wrote to us to say what they would do to meet legal requirements in relation to these breaches.

We undertook this focused inspection on 13 December 2016 to check they had followed their plan and to confirm they now met legal requirements. 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 George Potter House on our website at www.cqc.org.uk.

The service had a new manager who had applied to become the 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 previous inspection we found that building was unclean. We found that the provider had taken steps to improve the environment, including implementing a cleaning schedule and replacing old carpets and furniture. The environment was substantially improved since our last visit. We found that there were not suitable checks in place to address some safety hazards within the building.

At our previous inspection we found that risks to people around pressure care were not always suitably addressed and that care plans were not person-centred. In some cases plans were not in place for when people were dying. At this inspection we found that suitable measures were in place to address the risks of pressure sores and that care plans recorded people’s needs, life stories and wishes for the end of their lives were on people’s care plans.

At our last inspection we found that people were not always treated with dignity and respect and that there were not suitable activities in place for people. At this inspection we saw that people’s dignity was protected by staff and promoted by managers and we observed kind and friendly interactions with staff. Activities programmes had improved, but information about activities was not always accurate and some people were not always included in activities.

At our last inspection we found that complaints were not addressed by managers and that managers were not carrying out the right checks to ensure that staff received training and supervision. At this inspection we found that complaints were recorded and that these were appropriately investigated by managers and action taken in response. People told us that they could speak to the manager if they had a complaint or a concern, and they were approachable and helpful. Managers now had systems in place for monitoring staff training and checking the quality of the care people received. Staff received supervision which was used to improve standards of care.

Managers had a detailed plan in place for delivering improvements to the service, which was monitored and reviewed regularly. This had brought about significant improvements in the care that people received.

We have made two recommendations about how the service carries out checks of the safety of the building and how people are included in activities.

This inspection took place on 10 May 2016 and was unannounced. At our last inspection on 23 November 2013 the service met all the regulations we checked.

George Potter House is a care home with nursing which provides accommodation for up to 64 older people, including people with nursing needs and dementia. At the time of our inspection there were 57 people living in the service. The building was divided into two units, with the first floor providing care to people with dementia. Each floor had a dining room and lounge, and the first floor had communal bathrooms, whilst rooms on the ground floor had en suite bathrooms.

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.

We found that the building did not meet the needs of people with dementia and was in need of redecoration. Chairs in particular were dirty and urine stained, and in some cases bin liners had been used to protect furniture. There was a pervasive odour of urine throughout the service, audits had identified this but no action had been taken to improve the environment. Many people told us that call bells were not responded to in a timely fashion, and we found that several bells were broken at the time of our inspection. Risks to people were not always adequately assessed, for example with regards to pressure area care, although when people had pressure sores, measures were in place to treat these.

Staffing levels were adequate to meet people’s needs and were regularly reviewed. The provider followed safer recruitment measures to ensure that staff were suitable for their roles. However, we did not always see positive interactions between staff and people who used the service, and did not find that there was a culture of protecting and promoting people’s dignity. The two units in the service were known as “Elderly Mentally Infirm (EMI)” and “Elderly Frail Unit (EFU)”, even though it was noted at our last inspection that these were outdated and needed to change.

Staff did not receive enough supervision from managers, staff training was not well recorded and in some cases staff had not received essential training. People’s nutritional needs were assessed and people were monitored for weight loss, however there was limited choice with food and the support people received to eat was not always appropriate.

Medicines were safely stored and administered by staff with the correct skills to do this. The provider had carried out suitable checks on the safety of the building and equipment. However, we noted that the front door was at times left open and unattended, which could compromise the safety of people who use the service and staff. Care plans adequately described people’s care needs and these were regularly reviewed, however they did not give detailed information on people’s wishes and preferences. In some cases people did not have care plans in place to meet their needs at the end of their lives. We saw that there were good links with a hospice that provided this support. Activities were limited and not always suitable for people with dementia, there was limited evidence of community involvement.

Quality assurance measures were in place, however these did not always identify concerns or take adequate steps to address these. The service did not adequately monitor and respond to complaints.

We have made two recommendations concerning providing suitable person-centred activities and the suitability of the premises for people with dementia. We found a number of breaches of regulations relating to the assessment and management of risks, the cleanliness of the premises, person-centred care, dignity and respect, complaints and good governance. Yo

We spoke to twelve people who use the service, five family members or visitors and five staff members during our unannounced visit to George Potter House.

All of the people who use the service spoken to said that they were treated with dignity and respect. Feedback about the staff included 'they are very good people', 'not bad' and 'very good staff'. One person told us 'they're a nice bunch, you would like them'.

Feedback from visitors and family members included 'very nice staff, you've only got to call and they will come', 'terrific', 'they have what they want here', 'the staff are very friendly' and 'they love them here'.

People who use the service told us that enjoyed the food provided to them. Comments included 'the food is excellent', 'I like it', 'good food' and 'I'm happy'.

An acting manager was in charge at the time of this inspection. We were informed that a new manager had been recruited and was expected to commence work in January 2013.

Overall we noted the improvements that had been made by the service since our last visit in February 2012. One person using the service told us 'it has got better here, slowly and surely' and a staff member reported 'it's getting better here - we are doing well'.

People were positive about the care and treatment they received at George Potter House where they spoke about the good attitude of the staff and of getting the support they wanted for their needs.

People told us that following recent improvements at the service the staff have more time to spend with them, and we saw this happening at the service.

The staff we spoke to said that they were positive about the changes that had taken place at the service, and of how these improved teamwork and the quality of life of the people who lived at George Potter House.

However, during this visit to the service we found concerns where medication is not always dispensed and administered safely to people who use the service.

Throughout our visit we saw examples where people did not receive the care and treatment they needed. Their privacy and dignity was not upheld. People were not given choices and the staff spoke to people in an abrupt and sometimes rude manner.

Some people have healthcare needs which meant that they have to eat at specific times and this needed to be monitored. We saw that the staff did not always give them the support they needed.

Some visitors told us that they would like more attention paid to the privacy and dignity of their relatives. They said that their relative would like to receive personal care from staff they want, as they do not like receiving this intimate care from younger staff members. The people receiving the service confirmed what their relatives told us.

Some visitors said that they would like people to be supported out of bed more, for short walks, or to be assisted to use the toilet instead of the commode.

We saw that some people were given meals to eat when they were asleep.

This visit was to follow up the Compliance Actions we made as a result of our visit to the service in July 2011. The findings from this inspection highlight a number of concerns about the service. Some of these concerns were the same as ones we had in July 2011, in addition we found new areas of concern.

In view of the major concerns identified regarding this service the Care Quality Commission has served a Warning Notice on the Registered Provider on 6th December 2011.

People told us that they generally like living at the home.

Relatives said that the staff are friendly towards them and their relative.

However, a number of people who use the service and their relatives spoke about the concerns they have about the staffing levels at the home and the staff morale. A number of people and relatives gave us examples of where they saw very few staff on duty, and incidents where they saw staff being reprimanded.

We saw examples where people's dignity was not respected, and where people were not being stimulated and left in their rooms for long periods, with no interaction from staff, and no activities to do.

We spoke with twelve people using the service, seven relatives or friends, eight staff members and the manager during our two unannounced visits to George Potter House.

Overall comments about George Potter House from people staying there included “I like it here, it’s quite nice and the nurses are very friendly”, ”I like it here very much, especially after the hospital, they are all so friendly” and “I can’t live at home so it’s good to be here”. Relatives or friends told us "“I think they look after her very well as she likes to look good all the time” and “the staff are very caring”. One person said “our relative was here for respite and liked it so much we decided to let them be here”.

Feedback about the staff included "very polite and caring", "good, they pop in and check on you", “the staff do all sorts, we would not cope without them” and “they have been good to me and I appreciate that”.

Most people spoken to said they were happy with the food provided saying “the food is OK but I am not a big eater”, “they do me a tomato soup if I don’t fancy the meal”, “the food is quite nice, but if I don’t like anything, they give me a choice” and "the food is good".

Further work could take place to enhance the first floor environment for people living with dementia and provide more opportunities for meaningful interaction and engagement. Activities could also be reviewed on this floor to further develop this provision. The manager told us that plans were already in place to improve the signage and to introduce the Namaste program which is designed to improve the quality of life for people with advanced dementia.