We conducted an unannounced inspection on 15 January 2019. At our previous inspection in August 2018 we found that the home was in breach of several regulations of the Health and Social Care Act (Regulated Activities) Regulations 2014. These breaches related to the need for consent for people’s care and treatment, the failure of the home to ensure the premises were safe, the failure of the home to display its most recent ratings and because of these breaches, the failure of the management team to completely improve the home. We had rated the service requires improvement overall.

Following the last inspection, asked the provider to complete an action plan to show what they would do and by when to improve the key questions, is the service safe, effective, responsive and well led, to at least good. We found that the home had addressed these problems and that the service had improved to good.

St George's Care Homes (St George’s) 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 building was converted from a community hospital which had been built about 50 years ago. It was over two floors and had single and double rooms. A lift connected the floors. The home was in a residential part of Liscard in Wallasey and shops and community facilities were nearby.

The home is registered to provide accommodation, nursing and personal care to up to 60 people. At the time of our inspection, there were 21 people in the home.

The home requires 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. There was a registered manager in post who had been there for most of 2018 but whose registration had become final in December 2018.

The provider had also commissioned a specialist service to support and maintain the improvement required in the home.

We found that the home was a safe environment for people, who were supported by properly recruited staff who administered their medication correctly and who followed the policies and procedures of the provider. There were appropriate staffing levels and people were treated without discrimination and their human rights were protected and promoted. Staff knew how to safeguard people from abuse and how to report any concerns about this or any other accident or incident.

The building had been purpose-built and it was safe and well maintained.

Staff were well-trained and supervised and had the skills and knowledge to deliver effective support to people living in the home. Staff understood the Mental Capacity Act 2005 and worked with other agencies to ensure that people had the right support. People were enabled 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.

Staff treated everybody with kindness and compassion and involved them in decision-making about their day-to-day lives. They promoted people’s equality and diversity, gave explanations and information in a way that people could understand and supported people’s well-being and right to privacy.

We saw that all the staff treated people as individuals. The records we saw demonstrated that each care plan was individual to the person it was about. However, whilst the care plans were person centred, the daily records lacked detail as they just gave bland statements. People and their relatives told us they were involved in any reviews about their family member’s care plans.

The people who lived in St George’s could join in with var

This unannounced inspection was carried out on 2 and 3 August 2018.

St George’s Care Home 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 provides accommodation for people who require nursing or personal care. The home can accommodate up to 60 people. At the time of our inspection there were 21 people living in the home.

There was no registered manager in post at the time of our inspection. However, a new manager had been recruited and had started working at the home shortly after our last inspection in February 2018. 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 carried out a comprehensive inspection of the home in January 2018. The home was rated inadequate because we found multiple breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At our last inspection in February 2018 we carried out a focused inspection assessing the home’s performance in the domains of safe and well-led. We found that the home remained inadequate in these domains and the overall rating for the home remained inadequate.

During these previous inspections we identified breaches of Regulations 9 (person-centred care), 10 (dignity and respect), 11 (consent), 12 (safe care and treatment), 13 (safeguarding of vulnerable adults), 14 (meeting nutrition and hydration needs), 17 (good governance), 18 (safe staffing levels) and 19 (safe recruitment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

During this inspection we found that the home had made improvements and was no longer in breach of Regulations 9, 10, 13, 14, 18 and 19. The home had made sufficient improvements since our last inspection which meant the home was no longer in special measures. However, the home remained in breach of Regulations 11, 12, 17 and 20A (display of ratings).

We saw that fire safety and firefighting equipment at the home had been regularly checked and maintained. Staff had received fire safety training, several of whom had received additional training to help take responsibility for making people safe in the event of a fire. However, during our observations of the home we found some potential environmental fire risks. We also found that the information detailed in people’s personal emergency evacuation plans (PEEPs) was not fit for purpose and out of date. We noted that the local Fire Service visited the home shortly after our inspection and confirmed that these issues had been addressed and people would be safe in the event of a fire.

We found that some parts of the home were unclean and in need of repair.

We found that the home did not always act in line with the requirements of the Mental Capacity Act 2005 (MCA) and the associated Deprivation of Liberty Safeguards (DoLS). The home did not always appropriately obtain people’s consent to their care and it had not acted in line with the MCA when people lacked capacity to consent.

Staff were not always sure where to find the most up-to-date information they needed to safely and effectively meet people’s needs.

People’s personal information was not always kept securely.

The home had failed meet its legal obligation to display its most recent CQC inspection report and rating.

We noted that in a relatively short period of time the new manager, with the support of consultants and some oversight from the registered provider, had made many improvements to the safety and quality of care being provided at the home. However, as we have explained in this report, the home

St George’s Care Home 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 provides accommodation for people who require nursing or personal care. The home can accommodate up to 60 people. At the time of our inspection, there were 32 people living in the home.

There was no registered manager in post at the time of our inspection. 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 2018, the home was rated inadequate. This was because the provider had breached multiple health and social care regulations which placed people at significant risk of harm. We undertook this visit because we had received information that people continued to be placed at significant risk because the service remained unsafe and poorly led. This type of inspection is called a focused inspection and this report will only cover our findings in relation to the domains of safe and well-led.

At our last inspection people’s needs and risks had not been properly assessed and managed. Information in relation to people’s care was confusing, contradictory and difficult to follow. At this inspection additional information had been added to people’s care plans but the information about their needs and risks was still insufficient and contradictory. People’s information was stored in two, sometimes three different places and records did not always correspond with each other or match professional advice given in respect of people’s care. This placed people at risk of unsafe and inappropriate support.

For example, one person’s care records indicated that they had pressure sores on their body. There was no adequate wound care assessment in place or clear information about the clinical care they required in respect of these wounds. Wound management is a basic aspect of good nursing care.

Nutritional information about people’s special dietary requirements was unclear. Some people’s records identified that they needed a specific diet to maintain their well-being or to prevent them from choking. Catering staff did not always have accurate information about these needs to ensure people received the diet they needed. This placed people at risk of harm.

The management of medication continued to be unsafe. One person’s records indicated that on an almost daily basis they had received too much of their medication and that the required time period between doses had not always been adhered to. Records relating to prescribed creams and other topical medications were inconsistent and did not show that people received the medicines they needed to maintain their skin integrity.

At the last inspection, accidents and incidents were occurring frequently and had not been appropriately reported. At this inspection, accidents and incidents were not being properly recorded or audited by the provider and it was difficult to ascertain the true number of accident and incidents that had occurred since the last inspection. This lack of adequate monitoring placed people at risk of continued accidents and incidents of the same nature.

We did not hear call bells ringing for long periods of time during our visit which would suggest that people’s needs were being met by sufficient staff. We observed however that at times a visible staff presence was sparse and some people who needed one to one support did not have this support at all times. We also found that there were gaps in people’s care records which indicated they did not always receive the care they

This inspection took place on 11, 12 and 15 January 2018 and was unannounced. At our last inspection in August 2017, we identified breaches of regulations 9, 10, 11,12,13,17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches related to most aspects of the care and treatment provided to people who lived in the home. At this inspection we followed up these breaches and found that the provider had not taken appropriate action to address our concerns. All of the breaches identified at the previous inspection remained and we also found an additional breach of Regulation 14 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 as the provider was not ensuring that people were provided with adequate nutrition and hydration to keep them safe and well.

St George’s Care Home 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 home can accommodate up to 60 people. At the time of the inspection there were 36 people living in the home.

The home requires a registered manager. The previous registered manager had left the home in the period after the last inspection. 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.

The home was being managed by two deputy managers and a care consultant who had only been in post for a limited time prior to the inspection. The staff trying to manage the home did not have the time or the resources necessary to make sustainable improvements to the service and staff did not have confidence in the provider’s ability to make improvements.

All of the concerns identified at the previous inspection remained. We found that medication was still not safely administered. Risk assessments were poor and did not safely identify or help to manage risk. Safeguarding concerns was still not being dealt with safely or appropriately and people who lived in the home were at risk from harm or abuse.

Staff were not adequately inducted, trained or supported to do their jobs safely. The Mental Capacity Act was not lawfully followed and people living in the home were at risk of having their rights not respected and their liberty deprived without due processes being adhered to.

Staff were not consistently caring and care plans did not fully describe people’s needs or how they wished to be cared for.

We also found at this inspection that people were not supported to receive adequate food and drink which placed them at further risk from harm.

The overall rating for this provider is 'Inadequate'. This means that it has been placed into 'Special

measures' by CQC. The purpose of special measures is to:

- Ensure that providers found to be providing inadequate care significantly improve.

- Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

- Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains 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 the service. This will lead to cancelling their registration or to varying the terms of their registration within six

St George’s Care Home provides accommodation for people who require nursing or personal care. The home can accommodate up to 60 people. At the time of our inspection, there were 45 people living in the home.

There was a registered manager in post at the time of our inspection. This registered manager had been employed by the provider for eight months at the time of this inspection. A different registered manager was in post at the time of our previous inspection in June 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.

At our last inspection in June 2016, we identified breaches of regulations 10, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches related to dignity and respect, the management of the service and staff training and support. At this inspection we followed up these breaches and found that the provider had not taken appropriate action to address all of our concerns. Breaches in respect of regulation 10, dignity and respect and regulation 17, good governance had not been addressed and we also identified additional breaches of Regulations 9, 11,12,13,17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We looked at seven care plans. We found people’s needs and risks had not been properly assessed and managed. Information in relation to people’s care was confusing, contradictory and difficult to follow. It was difficult to determine from people’s care plans what their needs and risks were and the care they required. When we looked at the records in relation to people’s daily care we found gaps in the care people received. This meant there no consistent evidence that people received the support they needed.

The management of medication was not always safe and records showed that people did not always receive the medication they needed to maintain their well-being.

Accident and incidents records showed that support was not always provided in a safe way. Some people sustained injuries during the delivery of personal care and some accidents occurred as a result of faulty equipment. This did not show that the service provided safe care at all times.

We found that some incidents of a safeguarding nature had not been appropriately identified, responded to, documented or reported in accordance with local safeguarding procedures and the legal requirements of CQC. This meant the provider did not have a robust system in place to protect people from the risk of abuse.

Some of the people and the relatives we spoke with told us that there were not enough staff on duty to meet their needs at all times. We found that multiple incidents of a safeguarding nature and a significant number of accident and incidents had occurred as a result of people not receiving the level of support they required. This indicated that the number of staff on duty was not sufficient to ensure people were kept safe and well.

People’s ability to make decisions about their care had not always been assessed in accordance with the Mental Capacity Act 2005. For instance some people shared a bedroom with no evidence that they had consented to or had their capacity to consent to this living arrangement assessed to ensure it was in their best interests. We also saw that people had bed rails on their beds without evidence that they had consented to this or their capacity to consent to this decision explored. We found evidence to show good practice with regards to the application of the Mental Capacity Act for those people who needed to be deprived of their liberty to keep them safe.

Staff were observed to support people in a kind, patient manner but we f

The inspection took place on 27 June 2016 and was unannounced. The home is an adapted former hospital building situated close to Liscard town centre. The home is registered to provide accommodation and nursing care for up to 60 people and 46 people were living there when we visited. On the ground floor, care was provided for people who required general nursing or personal care. The first floor accommodated people who were living with dementia.

The home had a manager who was registered with the Care Quality Commission. 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.

During the inspection we found a breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we asked the provider to take at the end of this report.

During the day of our visit we saw that there were enough staff on duty and people did not have to wait for staff to attend to them. The rotas we looked at confirmed that these staffing levels were maintained by using agency staff as needed. Records we looked at did not show that new staff had received training before they started providing care for people. This meant that they may not know how to provide care in a safe manner.

The environment was light, spacious and airy. All parts of the premises were clean, hygienic and safe.

Deprivation of Liberty Safeguards (DoLS) had been applied for appropriately and were awaiting authorisation by the local authority.

We observed that staff members spoke to people in a polite and respectful way, however they did not always promote people’s dignity when they were providing care or in the language that was used in people’s care documents.

Family members visited during the day with no restrictions. Staff we spoke with had a good understanding and knowledge of people`s individual care needs. People we spoke with said that they were happy living at St George’s.

Care records we looked at showed that people’s care and support needs were assessed and planned for and the plans were reviewed monthly. However, care documentation was lacking in detail and the confidentiality of personal information was not always maintained.

We saw evidence that regular staff meetings and resident and relatives meetings took place. A significant number of satisfaction questionnaires had been circulated and returned during 2015. We saw records of a series of quality monitoring audits that were carried out. Although these systems were in place to find out people’s views and to monitor the quality of the service, there was no evidence to show how the information gained was used to identify and address any areas requiring improvement or to take the service forward.

The inspection took place on 29 September 2015 and was unannounced. The home is an adapted former hospital building, situated close to Liscard town centre. The home was registered to provide accommodation and nursing care for up to 60 people and 50 people were living there when we visited. The people accommodated were older people who required 24 hour support from staff. On the ground floor, care was provided for people who required general nursing or personal care. The first floor accommodated people who were living with dementia.

The home had a manager who was registered with the Care Quality Commission. 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. The registered manager was not at work on the day we visited.

During the inspection we found a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 ‘Safe care and treatment’. You can see what action we asked the provider to take at the end of this report.

During the day of our visit we saw that there were enough staff on duty and people did not have to wait for staff to attend to them. The rotas we looked at confirmed that these staffing levels were maintained by using agency staff as needed. We found that safe recruitment processes had been followed before new staff were employed at the home and the required records were all in place.

We found the environment to be light, spacious and airy. Toilet and bathroom areas were clean and hygienic. Hand cleanser, paper towels and pedal bins were provided. We had some concerns regarding fire safety and referred our concerns to the fire service. Maintenance records showed that up to date certificates were in place for lifting equipment, the fire alarm system, fire extinguishers, emergency lighting, nurse call system, portable appliance testing and microwave emissions, boiler maintenance, and gas safety.

The home used an e-learning training system that included 12 subjects. We found that the training modules were not in depth. In particular, the dementia awareness training was very basic which meant that staff lacked the skills to provide care in a way that best met the needs of people living with dementia. There were induction training programmes for new care and nursing staff.

Deprivation of Liberty Safeguards (DoLS) had been applied for with respect to most of the people who lived on the first floor and some who lived on the ground floor. These were awaiting authorisation by the local authority. Applications made were for supervision, safety and being behind locked doors. We looked at a DoLS authorisation that was in place for one person and found this to be in order.

We observed many times when drinks and snacks were offered and encouraged throughout the day; these included fortified milk shakes, biscuits and cakes. We looked at weight records and noted that everyone was weighed monthly. We saw that nutrition and fluid charts were maintained for people who had lost weight and were at risk. There was also evidence of external agencies such as speech and language therapist and GP being involved and their recommendations were being followed.

We observed that staff members responded to people in a polite, well-mannered way. They were patient and supportive, and knocked on doors before entering people`s rooms. We observed family members visiting during the day with no restrictions. Staff we spoke with had a good understanding and knowledge of people`s individual care needs.

We looked at care records for six people who lived at the home. These showed that people’s care and support needs were assessed and planned for and the plans were reviewed monthly. However, we were concerned that care documentation was fragmented with three different systems running concurrently.

There were no social activities taking place on the day we visited. The activities organiser had left the home and the manager was trying to recruit a replacement but was finding the post difficult to fill.

The service’s complaints procedure was displayed on a wall in the entrance area. The complaints procedure was concise but provided enough information for people to be aware of who they could contact, both internally and externally, with any complaints or concerns. We found complaints records detailing three issues that had been dealt with during 2015. These showed that the manager had responded appropriately to concerns that had been raised.

We saw evidence that regular staff meetings and resident and relatives meetings took place. A significant number of satisfaction questionnaires had been circulated and returned during 2015. We saw records of a series of quality monitoring audits that were carried out. Although these systems were in place to find out people’s views and to monitor the quality of the service, there was no evidence to show how the information gained was used to address any areas requiring improvement or to take the service forward.

The name of the registered manager shown on the report refers to the previous manager, who is no longer employed in this role.

The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led? Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

Is the service safe?

The premises were adequately maintained and regular health and safety checks were carried out. Robust recruitment procedures were followed to ensure that new staff were safe and suitable to work with vulnerable older people. Enough qualified and experienced staff were provided to ensure that people were kept safe.

Is the service effective?

People told us that they were happy with their care and that their needs were met. Staff we spoke with had a good understanding of people's care and support needs.

Is the service caring?

We observed that staff were kind and patient with the people who lived at the home and spoke about them in a positive and respectful manner.

Is the service responsive?

People's needs were assessed before they moved into the home. Care plans recorded people's personal preferences and interests, and care was provided in accordance with people's wishes. People had access to social activities.

Is the service well led?

The home had a new manager, who was a registered mental health nurse. The person who had previously been registered as manager of St George’s had been promoted to an operations manager role and was supporting the new manager and visiting the home between two and four days each week. The home owner visited monthly and spoke with staff and people who lived at the home.

One visitor told us that St George’s was “absolutely brilliant”. She had chosen to move her relative here from another care home after having “a good look round” and following an assessment of her relative’s needs by staff from St George’s. She considered that her relative had really settled in well, always looked clean and well cared for, and sometimes joined in social activities. She had no concerns about the care and support provided.

Another relative said that the staff were "smashing" and the new manager was “very approachable”. She considered that the home was improving but she would not hesitate to raise any issues of concern.

One of the people we spoke with said “I like the manager, she’s nice, nothing is too much trouble. She mixes in with the staff and she has made a big difference.” Since our last visit to the home a relatives committee had been formed and one of their functions was supporting the families of people new to the home. The manager told us that she was keen to “get everyone involved”.

The home owner visited the home at least once a month and spoke with the people who lived at the home and the staff during his visits. Since taking up post the manager had developed a series of audits covering all aspects of care and safety. These included monthly audits of medicines, care plans, wound care, weights, accidents and incidents, and complaints. We also saw records of fire safety audits, kitchen checks, and infection control audits.

We visited St George’s on 10 October 2012 to check what improvements had been made. We found that people’s care needs were met. All of the people we spoke with on both the ground floor and the first floor told us that they felt well looked after. Two relatives we spoke with on the first floor, which is the dementia care unit, were very happy with the care of their relative and described the staff as ‘wonderful’.

There were 46 people living at the home. The number of care staff on duty had been increased to eight in a morning and six in an afternoon. This accommodated one to one support between 8am and 8pm each day for one person, and one to one support for two other people for three hours each day. The nurses we spoke with considered that this was adequate, however some of the care staff felt that they were very busy at some times of the day.

There was no senior person with a nursing or medical background to oversee the care of the people living at the home or to monitor the quality and relevance of the care plans. There was minimal evidence of any consultation with staff or people using the service and their families.

We found that the staff working at the home had received training to enable them to work safely and that a programme of staff supervision and appraisal had been initiated. The care plans had been replaced with an electronic system and records were more detailed and accurate.

During our visit we spoke with two district nurses and a community psychiatric nurse who were visiting people living at the home. They all told us that the staff at the home are friendly and helpful and they had no concerns about the care of the people they were visiting.

We spoke with one visitor to the dementia care unit. He told us that he was “more than happy” with the home. He was confident that his relative’s needs were met and said that he was always kept informed of any incidents or accidents.

We spoke with a number of people who were visiting relatives living on the ground floor of the home. The son of one person told us that “nine times out of ten things are OK, but there are little things that annoy you”. He considered that most of the staff are “great, absolutely fantastic”.

The spouse of a person living at the home told us “some staff are A1 but others are slightly lacking”. There have been improvements since he made a complaint but there are still little things that are wrong.

The daughter of another person told us that the family chose this home because they found it friendly when they came to look around in February 2012. She considered that the home was “OK, not 100%”. The family had not seen the care plan and appreciated the opportunity to have a look at it during our visit and to discuss the person’s needs with one of the home’s nurses.

We spoke with the son of a person who has lived at St George’s for several years. He told us “she loves it here”. The family feel able to raise any concerns they have with the management and staff, and when they have raised issues, these have been addressed “if I mention anything it is done”. They have not heard any staff being unpleasant “they are all very good and patient with them”.

One person who lives at the home told us that the staff are careful when they transfer her using the hoist, the food is OK and she gets plenty of drinks.

A relative told us that the home sometimes seems to be short of staff with buzzers ringing for a long time.

We have received a number of concerns from Wirral Council regarding poor record keeping at the home.

We spoke with a number of people living in the home including a number of visitors and relatives on the day we visited.

One person told us that they felt safe living in the home and glad they had made the decision to move there.

People we spoke with told us that they were often bored during the day.

People told us that staff were good, people told us that staff were helpful, kind and considerate to those living in the home.

The expert by experience who took part in this visit reported that:

“One relative, visiting her father who had only recently arrived at the home, was very pleased with the few days experience of this care home. Herself and the rest of her family were not happy with the treatment her father was receiving at another care home and were very pleased in the way the manager of St George’s accommodated the transition making the move less stressful for both the father and his family.

Activities taking place appeared to lack some co-ordination with residents’ needs. “Old songs” were played very loud and staff danced to music encouraging the residents to clap hands and do the actions of the songs.

Staff were made easily aware of that particular resident’s needs by the “Individual Preference Record” pinned up in the room. This identified needs and choices including what clothing she liked to wear. She appeared to have views on which carers were more suited to her.”

A “very poorly”, resident confined to his room appeared to have been made very clean and comfortable, and a nice touch of soft background music being played.”

Lunch on the day, at 12.45pm, was a choice of steak pie, mashed potatoes and peas, which appeared to go down very well. Most plates were actually clear when collected from residents. Also chicken curry and rice, which one resident said was very good. An alternative was a sandwich and soup which was enjoyed by two residents. Three residents confirmed that they always enjoyed their food, and felt that they were well looked after.

In the dining room which was used by residents with extreme health issues, three carers gave assistance and necessary encouragement to ensure that these particular residents had received some nourishment."

In total we spoke with eight people who live at the home and two family members. All people spoken with were asked permission to view any and all of their records and all agreed. No professionals were visiting.

We spoke with the four people who were living in the dementia care unit and all said that they were happy and they thought that the staff were really nice. The maintenance person was helping one person to hang pictures in his bedroom. He particularly liked Liverpool, tigers, and The Beatles and his room had large pictures of these. The decoration of bedrooms in the dementia care unit is colourful with bright yellow paint and blue soft furnishings. One man said that he did not like the colours but ‘you get what you get’.

People we spoke with in the lounge said that they would like to get out more. The home is within very close walking distance of the town centre and the activities organiser said that she takes people out into town but can only take one person at a time.

Over recent months a number of allegations of poor care practice have been made by members of staff and former members of staff at the home. These have been investigated by Wirral Council and Wirral PCT and were not upheld, however they found that there were ‘discrepancies in paperwork, which was not always updated, signed off and at times difficult to find’.

Health and social care staff from Wirral Council and Wirral PCT identified areas that need to be addressed to improve the standards and quality of care at St George’s. They told us that the maintenance person in the home was adjusting pressure mattresses and in all instances this should be done on the advice of a nurse. The manager told us that the maintenance person was adjusting bed rails (where required) in order to accommodate pressure mattresses and the nurses were responsible for setting the correct pressure of mattress for the individual.

They identified that more staff training is needed, particularly in lifting and moving of people and the manager told us that they are currently ‘taking action to ensure compliance with the use of slings and training for key staff in relation to the manual handling of residents using hoists’.

They considered that there is room for improved communication skills between staff residents and relatives, and the manager is introducing new systems to enable residents and their relatives to contribute more to care planning and care reviews.

People we spoke with told us that:

‘the nurses here are great, nothing is too much trouble’

‘I can't fault the nurses they are great, all the staff are lovely’

‘if I need to see a doctor they make sure I do and he usually comes quickly’

‘I go to hospital appointments when I need to’

The staff from Wirral Council who visited the home reported that: ‘Quality and choice of food was very poor, often food was cold’.

We sat with three people at lunchtime and they all knew what they were having for lunch, although there was no information regarding menu choices readily available. They had asked for steak and chips, the alternative was omelette and chips. Three other people, seated behind us, were not aware of what was for lunch. There was a list that recorded choices people had made.

All of the meals were presented identically with vegetables and gravy. People had not been asked whether they wanted to have vegetables and gravy and one person was observed scraping the vegetables off her plate and into her drinking glass. Drinks were available on the table. A kitchen assistant served hot drinks and was able to give everyone their preferred choice without asking, and it was clear that he knew exactly what everyone's preferred drinks were.

Soft diets were liquidized separately and served in a bowl. The cook said that they were in a bowl because "we have always done it this way". Staff then mixed it all together despite the cook taking the time to keep items separate. All of the soft diets were identical. Staff said that people who require a soft diet are not offered a choice as ‘they have dementia and can't say’. Staff said that there are no records to show what foods people like or dislike and the cook confirmed that there was no choice for people who have a soft diet.

The meal time was generally relaxed. Staff did not rush people. The tables were laid and gentle background music was playing. People in special seating were not taken into the dining room to eat, but ate in the lounge. Staff were unable to offer an explanation as to why these people were not moved into the dining room. When people were given their food, staff gave no reminder or prompt. They put the food down and said "here is your dinner". We observed one carer assisting a gentleman with his meal. There was no conversation or interaction. The only words that the carer said were "we’ve nearly finished".

People we spoke with at lunchtime made the following comments:

the food is tasty

I really like the food

It's very nice, great food

Nobody had a negative comment about the food. Some people said that they would like more choice. We saw that some people had items that were not on the menu, but this was not generally communicated to people.

We spoke with people who live at the home and visiting relatives. The majority told us that people were safe and their needs were met by the staff. Information about raising concerns was available at the main entrance of the home. We observed that care staff moved an individual (who was not able to mobilise) appropriately and following the necessary guidance to maintain the person’s safety. Throughout the day we saw that care staff treated people with respect.

One person we spoke with said ‘Its always lovely and clean, it never smells’.

People we spoke with confirmed that they have their prescribed medication and one person told us "I am asked if I want the cream and staff do use it where I want it".

People living at the home told us:

"I have a lovely little room"

" I like my room it’s my space"

"it’s a lovely decorated home, especially since it was redone"

"I wish I did not have to smoke outside"

A relative spoken with said "I choose the room as I knew my mum would like it, its bright and cheery".

The people we spoke with all said that the care staff were ‘nice’ and ‘kind’.

People said:

‘the nurses here are great, nothing is too much trouble’

‘I can't fault the nurses they are great, all the staff are lovely’

Before our visit, a family member had expressed his concerns to Wirral Council regarding the ratio of staff to residents. He considered that this has resulted in his father’s continence difficulties not being managed adequately, however he said that his father was very happy there.

Social workers from Wirral Council reported tension amongst the staff group which has made it a difficult environment for staff to work in.

During our visit we saw that the staff were not rushed. They attended to people in a calm manner when they requested support.

People we spoke with considered that the care staff were skilled in their jobs and they were complimentary about the care provided and the caring nature of the staff.

People we spoke with said that the staff are very supportive and if they had any concerns they were confident that these would be addressed.