This inspection took place on 14 and 15 May 2018 and was unannounced. Georgian 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.

Georgian House was previously inspected in August 2017; we found the provider had not taken sufficient action to ensure people received safe and high quality care from well-trained and competent staff. The quality monitoring systems were not effective and had failed to identify and address the concerns we had found. Following that inspection action was taken to support the home to improve by the local authority and any safeguarding concerns were addressed.

Following the inspection in August 2017, Georgian House was placed in ‘Special Measures’. Homes that are in Special Measures are kept under review and inspected again within six months. We expect homes to make significant improvements within this timeframe. During this inspection in May 2018, the home demonstrated to us that improvements had been made and it is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of ‘Special Measures’.

Georgian House is registered to provide personal care and accommodation for up to 43 people who may have needs associated with their physical and/or mental health. At the time of this inspection, there were 33 people living at the home. Georgian House is also registered to provide personal care to people in their own homes. This was referred to as 'the step-down service' during the inspection. At the time of the inspection, the provider confirmed the ‘step down service’ was not providing a regulated activity and as such was not included as part of this inspection. This was because we only inspect services where personal care is being provided.

The home had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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 home is run.

Following the inspection in August 2017, Georgian House appointed a new senior management team and worked with the local authority's Quality Assurance and Improvement Team, (QAIT) to improve the quality of the care and support provided by the home. Although the home had made a number of significant improvements, some improvements were still needed.

We checked whether the home was working within the principles of The Mental Capacity Act 2005 (MCA). We found the home was not always taking appropriate action to protect some people's rights. For example, where the home held or managed some people’s money or tobacco there were no mental capacity assessments to show that people did not have capacity to manage their own finances or cigarettes. There were no records to show the rational for these decisions, or whether this was being managed in their best interests.

Where monitoring arrangements had previously failed, we found improvements had been made. These included the auditing of medicines, care plans, risk assessments, people’s nutritional and hydration needs, weights, recruitment, inductions, infection control, health and safety as well as all aspects of the maintenance of the building. We found the new management team had a good understanding of how to improve people’s lives and they had a clear vision of how to achieve this.

In August 2017, we found some people’s care and support plans lacked sufficient detail and did not always give staff the information they needed to meet people's needs in a person-centred way. At this inspection, in May 2018, we found the process of reviewing and updating people’s care records was ongoing and needed to be completed.

This unannounced inspection took place on 8, 9 and 10 August 2017, following concerns about the management of the home. We last inspected this service in April 2016 when it was rated as ‘Good’ overall.

Georgian House is registered to provide personal care and accommodation for up to 43 people who may have a physical and/or mental health needs. At the time of the inspection, there were 41 people living at the home. Georgian House is also registered to provide personal care to people in their own homes. This was referred to as ‘the step down service’ during the inspection.

At the time of the inspection, the provider confirmed the step down service was providing support to two people. However, neither was receiving personal care therefore, this part of service was not included in this inspection. This was because we only inspect services where personal care is being provided.

The home had a registered manager in post. 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 always protected from the risk of abuse. Georgian House did have in place a policy and procedures to follow if staff suspected someone was at risk of abuse or harm and staff had received training in safeguarding adults. Upon reviewing people’s records, we identified two incidents of alleged abuse and one of abusive practice, which had not been reported to the local authority safeguarding team. For example, one person’s records showed staff had documented on the 1 June 2017, during an altercation between two people living at the home, that one had punched and pushed the other. Records for another person showed on the 4th July 2017, staff had stopped a person’s cigarettes due to their violent behaviour. Staff had not recognised these incidents as abuse or matters they needed to refer to the local authorities safeguarding team.

During the inspection, we made three safeguarding referrals to the local authority and asked the provider to make another, which they did.

Some risks to people health and wellbeing were not always managed safely. Where staff had been provided with guidance by health and social care professionals, this was not always followed.

People were not always supported to have sufficient to eat and drink, and to maintain a healthy weight. For example, where some people had been identified as being at risk of malnutrition, food and fluid charts were not always completed. Records we saw did not demonstrate that some people did not receive their nutritional supplements as prescribed.

People received most of their prescribed medicines on time and in a safe way. However, some improvements were needed in the storage arrangements for people medicines as well as the management of topical applications.

Systems in place had not identified that the home was not always taking appropriate action to protect people's rights. For example, where the home held or managed one person’s monies and/or bankcards, there were no mental capacity assessments to show that people did not have capacity to manage their own finances. There were no records to show the rational for these decisions, or whether this was being carried out in their best interests.

Whilst some premises checks had been completed, risks to people's health, safety, and wellbeing had not always been identified, assessed, or mitigated. We noticed two windows on the first floor were not properly restricted or had safety film applied to the glazing to protect people from accidental injury if the glass were to be broken. In one of the first floor bathrooms, the casing to a waterproof electrical supply box was cracked. We brought this to the attention for the provider they took immediate action and arranged to

Georgian House is registered to provide accommodation for up to 43 people of all ages, who may have physical and mental health needs. Georgian House is also registered to provide personal care to people in their own homes. This ‘step down care’ is provided to people leaving the service who no longer need residential care. At the time of the inspection the step down service was providing support to two people in their homes. However, neither was receiving personal care, therefore this part of service was not included in this inspection. This was because we only inspect services where personal care is being provided.

This unannounced inspection took place on 19 and 22 April 2016. On the day of the inspection there were 43 people living at the service. The service was last inspected on 7 and 18 July 2014 when it was rated as ‘Requires improvement’ overall. Following the inspection in July 2014 we asked the provider to take action to make improvements to the way medicines were managed, the way meal times were managed, the quality assurance systems and the attitudes of some staff. At this inspection in April 2016 we found improvements had been made and sustained.

A registered manager was employed. 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.

Risks to people were assessed and plans put in place to minimise and manage any identified risks. Risks included choking, epilepsy, and pressure areas.

People were supported by staff that knew them well. Staff were kind and caring and ensured people’s privacy and dignity was respected. When addressing people staff used people’s preferred names and appropriate language that was not patronising. One staff member said “there’s no ‘hi darling, hi babe’ here!” We observed positive relationships between staff and the people we met at the service. There was much fun, laughter and appropriate banter between staff and the people they supported. Throughout the inspection people approached staff in a relaxed manner, smiling and laughing. This indicated they felt safe in the company of staff.

People’s needs were met in a safe and timely way as there were enough staff available. Support staff were employed to provide individual support and activities for people. We saw people enjoying varied activities throughout the inspection.

Care plans were detailed and gave good information to staff about people’s needs. People were supported to be involved in making decisions about their care. One person told us they had attended a meeting to review their care the day before our inspection. They told us they had been able to invite anyone to the meeting and a relative had attended. We spoke with a visiting community care worker who was completing a review of one person’s care. They said “it’s all very positive [person’s name] is happy and well supported”. They told us the person’s care plan included clear objectives, which were being met.

People living at the service told us they liked the food and it had improved. One person said “There is good food and plenty of it”. However, some staff and visitors told usthe quality of food provided could be improved. We discussed this with the cook and the management team who told us they had checked each item of food for quality. Menus showed a good variety of food provided.

People were supported to maintain good health from a number of visiting healthcare professionals. Records confirmed people received regular visits from GPs and community nurses. One person told us “if I need a doctor a visit is arranged for me quickly”.

Regular meetings were held for people to discuss any issues. People were involved in planning future social and fund raising events and deciding which charit

The Care Quality Commission (CQC) last visited the home in December 2012 following the receipt of anonymous concerns. We found no evidence to support those concerns.

Prior to this scheduled visit on 29 July 2013we received concerns that related to staffing levels, recording on care plans, staff attitudes, choice of food and the personal care of people who lived at the home. We found no evidence to support these concerns.

We saw that staff supported people to make choices. People confirmed they were able to make choices about how they wanted to spend their time. People also told us they could have a choice of food at meal times.

We found that care was planned and delivered to ensure people's welfare and safety. Records showed that risks had been identified and planned for. A range of risk assessments had been completed including those for pressure areas, falls and moving and handling.

We found that the home managed the medication for people who lived there in an appropriate manner.

We looked at four staff files which showed us there were effective recruitment procedures in place. We saw that criminal record checks had been obtained. These checks helped to reduce the risks associated with staff who may be unsuitable to work with vulnerable people.

People who lived at the home told us that staff were sometimes busy, but always had time to talk to them. Comments included “whether it’s late at night or anytime they always have time to talk with me”,

We carried out a responsive inspection visit on 28 December 2012. A full scheduled inspection had found the home to be compliant on 31 May 2012.

We visited this service in response to anonymous information. This included allegations that a person was made to sit in a chair, that people were shouted at and were unkempt, that drugs were left on the floor and that staff were working very long hours.

We spoke to people living at the home, all of whom told us that they were happy there and that they felt safe in the home. Many people told us that they had had a great Christmas at the home and were well cared for.

We looked at the assessments for the people and saw that they contained detailed information about individual likes and dislikes. They were clear about the level of support people needed and what they could manage on their own.

Our observations showed that staff interacted well with the people in the home. Staff spoke to people in a respectful manner and responded to people's requests and listened to what they had to say.

We spoke to staff about their hours worked and examined staff rotas.

We toured the communal areas of the home and looked in some of the bedrooms. We saw that many rooms in the home had been refurbished to a high standard. We saw that the home was clean and had been decorated for Christmas.

We found that there was no evidence to support any of the allegations made.

We (the Care Quality Commission) carried out an unannounced visit on 31 May 2012.

The home was last visited by the Commission for Social Care Inspection (the predecessor organisation of the Care Quality Commission) in June 2008.

Prior to this visit we had received several concerns about the care and treatment of people at the home. These included staff not having access to care plans, poor hygiene and cleanliness. Also that the home moved people to other bedrooms without the agreement of the Commissioners, who were paying the fees for people to live at the home.

People we spoke with all told us that they were supported to make their own decisions and were able to make choices about how they spent their day. They told us about the different things that they did including reading and going out with staff.

We looked at the assessments for the people who lived in the home. We saw that they contained detailed information about individual likes and dislikes. They were clear about the level of support people needed and what they could manage on their own. There was information in a document titled 'My Brief History' about people's backgrounds which meant that staff were aware of events in people's lives that could impact on the care they provided.

We looked at the care records for three of the people who lived in the home to find out how the home had assessed their health and personal care needs, and how they planned to meet those needs. Each person had a care file that contained a wide range of documents relating to their care and support needs. A range of risk assessments had been completed including those for pressure areas and nutrition. However, we found that because the files contained such detailed information it was not easy to find essential information within them.

When we spoke with people they told us that they felt safe in the home and one person told us they felt "Secure and safe here". Another person told us if they were worried or upset about anything they would talk to staff and "They would deal with it for me".

Our observations showed that staff interacted well with the people in the home. They spoke to people in a respectful manner and responded to people's requests and listened to what they had to say.

People told us that staff supported and helped them when they needed assistance. They said that they felt well supported by staff and that there was always someone around to help them if they needed anything. Everyone we spoke to was happy in the home. One person's representative told us that they visited every day and the staff kept them informed about their relative's care.

People that we spoke with praised all the staff who worked at the home. One person told us "Staff are very kind without their help I wouldn't be where I am". Another person told us "They have been really good to me" and another person said we are "Not told what to do, always treated with respect".

People told us that they felt well supported by staff. We were also able to talk to staff and observe them while they provided care and support to people who used the service. We heard staff speaking with people in a kind and respectful manner and they responded promptly, discreetly and sensitively to people when they asked questions or needed help.

We toured the communal areas of the home and looked in some of the bedrooms.

We saw that many rooms in the home had been refurbished to a high standard and that there was a programme to upgrade all areas throughout the home. We saw that everywhere was clean and tidy and there were no unpleasant smells. One person told us they thought the environment was "Pleasant, rooms clean".

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service.

The inspection was unannounced. We last inspected the service on the 29 July 2013. We raised no concerns at the time.

Georgian House is run by Georgian House (Torquay) Limited. The home is registered to provide care for up to 43 people. It is also registered to provide care for people in their own homes. The provider stated this service was developed to provide care for people in the community when they no longer required the residential service. This was referred to as ‘the step down service’ during the inspection.  The step down service was supporting one person in the community but this service was not providing any personal care that would require CQC to inspect it. It was not possible therefore to inspect this part of the service.               

On the first day of the inspection, there were 36 people resident in the home. On the second day there were 37 people. People in the home had a number of complex needs. They were of differing ages commissioned by both younger and older adult social care services. Several people in the home had a diagnosis of multiple issues. For example, some people had a single or a mixed diagnosis of dementia and/or mental health.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

Prior to the inspection, concerns were raised about how the home ensured there were enough staff, with the right expertise, to meet the complex needs of the people living in the home. The provider demonstrated they used a local formula to assess they had the right number of staff. Records relating to giving medicines covertly (without the person’s knowledge) were not robust, which meant there was a risk they were no longer appropriate. We also found the arrangements about when and how people received “when required” medicines had not ensured they received them when needed.

The majority of staff were caring however at one lunchtime we observed some staff to be less so. Some people were not having their nutritional requirements met because they had not received the correct support or had their food prepared in line with their assessed needs.

People told us they felt safe at the home and felt they were well cared for. They could access their GP when they wanted and felt able to discuss any concerns with staff. There were detailed records about people based on their history, likes and dislikes to ensure staff had the information they needed to care for people appropriately. Staff were also well trained and supported to help understand and meet people’s needs.

An appropriate complaints procedure was in place and people told us they would be happy to raise any concerns if necessary and felt confident they would be dealt with.

We found Breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, which correspond to regulations 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 end of the full version of the report.