St Georges Court Care Centre provides accommodation and personal care for up to 76 older people, some of whom may live with dementia. There were 65 people living at the home at the time of our visit. The home is a purpose built care home and is located close to the centre of Cambridge.

At the last inspection, the service was rated Good. At this inspection we found the service remained Good.

There was a registered manager in post at the time of our visit. 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.

Staff knew how to respond to possible abuse and how to reduce risks to people. There were enough staff who had been recruited properly to make sure they were suitable to work with people. Medicines were stored and administered safely.

People were cared for by staff who had received the appropriate training and had the skills and support to carry out their roles. Staff members understood and complied with the principles of the Mental Capacity Act 2005. People were supported to have maximum choice and control of their lives. Staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. People received a choice of meals, which they liked, and staff supported them to eat and drink. They were referred to health care professionals as needed and staff followed the advice professionals gave them.

Staff were caring, kind and treated people with respect. People were listened to and were involved in their care and what they did on a day to day basis. People’s right to privacy was maintained by the actions and care given by staff members.

People’s personal and health care needs were met and care records guided staff in how to do this. There was a variety of activities for people to do and take part in during the day, and people had enough social stimulation. Complaints were investigated and responded to and people knew who to speak with if they had concerns.

Staff worked well together and felt supported by the management team. The monitoring process looked at systems throughout the home, identified issues and staff took the appropriate action to resolve these.

Further information is in the detailed findings below.

We carried out an unannounced comprehensive inspection of this service on 14 September 2015 and rated the service as good in all areas. After that inspection we received concerns in relation to people’s safety. As a result we undertook a focused inspection to look into those concerns. This report only covers our findings in relation to this topic. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for St George’s Court Care Centre on our website at www.cqc.org.uk”

This unannounced inspection took place on 9 December 2016.

Although appropriate action had been taken when any safeguarding concerns had been raised these had not always been reported to the Commission as required.

There was a staffing tool in place to calculate how many staff were needed to meet people’s needs. The staffing levels were sufficient to meet people’s basic needs. Extra staffing was sometimes required to support people when they displayed behaviour that challenged others. The registered manager had arranged for the extra staffing to be in place. The staff were not always aware of where people were and this could place them at risk.

Staff had access to personal protective equipment. This helped to decrease the risk of the spread of infection. People’s air mattress were regularly checked to ensure they were set at the appropriate levels to prevent them developing pressure sores.

St Georges Court Care Centre is registered to provide accommodation and nursing care for up to 76 people. There were 72 people living in the home at the time of the inspection. Accommodation is provided over three floors.

This unannounced inspection took place on 14 September 2015. The previous inspection was undertaken on 27 April 2015 and we found that that the provider had taken action to meet the legal requirements in relation to care and support that people needed. During a previous inspection in January 2015 we found that improvements were needed regarding how the provider assessed and monitored the service they were providing. We didn’t inspect this at the April inspection because we wanted to see if the improvements made could be sustained for a longer period. During this inspection we found that the provider had made the necessary improvements and that the legal requirements had been met.

At the time of the inspection there was not a registered manager in place. However the manager had applied to the Care Quality Commission to be registered. The application was being processed by the 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 2008 and associated Regulations about how the service is run.

People felt safe and staff knew what actions to take if they thought that anyone had been harmed in any way. There were procedures in place which were being followed by staff to ensure that people received their medication as prescribed. Risk assessments had been completed to identify and reduce risks to people where possible.

The requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) were being followed. This meant that where people were being restricted from leaving the home on their own to ensure their safety, this had been done in line with the legal requirements.

Staff had only been employed after a through recruitment procedure had been followed. There were enough staff available to meet people’s needs. Staff received the support and training they needed to carry out their roles effectively.

Staff were kind and compassionate when working with people. They knew people well and were aware of their life history, preferences, and their likes and dislikes. People’s privacy and dignity were upheld.

Staff monitored people’s health and welfare needs and acted on issues identified. People had been referred to healthcare professionals when needed.

People were provided with a choice of food and drink that they enjoyed.

There was a complaints procedure in place and people felt confident to raise any concerns either with the staff or the registered manager.

The manager obtained the views from people that lived in the home, their relatives and staff about the quality of the service and action taken if any improvements were needed.

We carried out an unannounced comprehensive inspection of this service on 12/13 January 2015 . Breaches of legal requirements were found and we served a warning notice. This was because people did not always receive the support with their health care needs that they required. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach.

We undertook this focused inspection to check that they had followed their plan and to confirm that 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 St Georges Court Care Centre on our website at www.cqc.org.uk

St George's Court Care Centre is a care home with nursing which provides a service for up to 76 people over three floors. At the time of our inspection there were 57 people living in the home.

A registered manager was not in post at the time of the 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 focused inspection on the 27 April 2015, we found that the provider had followed their plan which they had told us would be completed by the 11 March 2015 and legal requirements had been met.

People told us and we saw that they had received the support they required with their wound management, pressure area care and diabetes monitoring . The staff on duty knew the people they were supporting and demonstrated their knowledge about supporting people with changing their dressings and how often this should be completed. They were also aware of how people with diabetes needed to be monitored.

Staff had received additional training in relation to supporting people with pressure area care, wound management and diabetes.

St Georges Court Care Centre had three separate units in the home. One unit provided care and support specifically for people who were living with dementia. The other two units provided nursing care and support to mainly older people, some of whom were also living with dementia.

People who lived there told us they were happy and one person said, “I feel safe”.

Relatives we spoke with or who left us comments cards complimented the care and support staff gave people. One person said, "I haven’t seen my (relative) smile so much in all the years I have known them. The staff are so kind”.

However, one person was concerned about the number of staff and told us they had seen people who had to wait over an hour to get help to go to the toilet.

The care delivered to people did not always meet the needs of people who were living with dementia. We also observed that when staff communicated with people, the level of their interactions varied. This was because some staff spoke with people in a very limited way while others were able to engage people with the activity or task and initiate conversations.

Staff made an effort to get to know people they cared for and treated them with sensitivity and understanding. However, this level of knowledge was not consistent on all units of the home and did not demonstrate a clear understanding of best practice guidelines in dementia care.

Evidence that we checked demonstrated that the provider worked well with other health and social care professionals to ensure people received ongoing support.

There were systems in place to monitor the quality of care that people received and make improvements as a result of learning from feedback.

During our inspection, on 24 October 2013, we found that improvements had been made to ensure that people were protected from the risk of infection because appropriate audits had been put in place and action had been taken where issues had arisen. We found that the home was clean and hygienic throughout.

Staffing levels had been increased to ensure people’s care and support needs were being met in a timely way.

We observed staff working with people and looked at the records and found that people were receiving the care and treatment that they needed. One person who lived in the home told us "Staff are nice and friendly". We spoke to one relative who said that he found the staff helpful and that they did the best they could do. He said “he did not have any cause to complain”.

We found that although there were systems in place to prevent people being exposed to the risk of infection improvements were needed to ensure that appropriate standards of cleanliness were maintained.

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Since the previous inspection the manager had recruited staff to ensure that that any staff absence could be covered. However we found that staffing levels on the afternoon shift on the ground floor sometimes meant that people had to wait up to half an hour for assistance with personal care.

There were systems in place to ensure that staff received the training and support they needed so that they could safely provide care and treatment to people using the service.

The home had a variety of ways that they monitored the quality of the service being provided. People who lived in the home and their relatives were encouraged to give their views about the home and had been involved in decisions about their care.

During our inspection of St Georges Court on 10 October 2012 and 26 October 2012 we used a number of different methods to help us understand the experience of people using the service. This was because some of the people using the service had complex needs which meant that they were not able to tell us about their experiences.

People we spoke with told us they were happy at this home. They said staff treated them with respect and their privacy and dignity were maintained. One person said, “I’m looked after very well. I’m very well treated and respected”. A family member said, “I’m so pleased with the care my [relative] is getting”.

People told us they were able to make choices in most areas of their daily lives, including about the care they received, the food they ate and what they did during the day. However, people who needed staff to support them did tell us they sometimes had to wait for assistance when staff were busy.

A member of staff said, “The management are really good, they provide everything for the residents who are looked after really well”. Another member of staff told us, “I’m very happy here. It’s really lovely. It’s about the people; they [the company] genuinely care”.

People said they felt safe, they received the care they needed in the way they preferred, and they knew how to make a complaint.

People liked the staff. However there were not always enough staff to meet all their needs in a timely way.

St Georges Court Care Centre is a care home with nursing which provides a service for up to 76 people over three floors. At the time of our inspection there were 66 people living in the home.

This unannounced inspection took place on 12 and 13 January 2015. The previous inspection was undertaken on 25 and 26 June 2014. During the inspection of 25 and 26 June 2014 we found that three regulations were not being met. We received an action plan that stated the required improvements would be completed by 31 August 2014. We required the provider to make improvements to ensure that people’s legal rights were upheld regarding making decisions about their care and welfare. We found that this action had been completed. We also required that improvements were made to ensure that each person had their individual needs assessed and planned for and that care was delivered in a way that met people’s needs. We found that the necessary improvements had not been made in all areas of people’s care. We also required that improvements were made regarding keeping accurate records. We found that this improvement had not been made in all areas of people’s care.

At the time of this inspection there was no registered manager in place. However, the current manager was in the process of applying to become 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.

Although people’s healthcare needs were monitored the issues weren’t always consistently acted upon in a timely manner. For example, although staff were aware that some people needed to have their dressings changed this wasn’t always completed when it should have been. This meant that people were at risk of receiving care or support that could put their health and welfare at risk. Care plans and records did not always contain all of the information that staff required so that they knew how to meet people’s needs in a consistent manner. We also found that staff did not always follow care plans so that people received care in the manner that they preferred. For example, the care plan for one person stated that staff should assist them with nail care daily. However we found during the inspection that this had not be carried out.

The provider had quality assurance processes and procedures in place to improve, if needed, the quality and safety of people’s support and care. However, the provider had not identified the issues we found during our inspection and this placed people at risk of receiving inappropriate care.

People felt safe living at the home and staff were aware of the procedures to follow if they suspected anyone was at risk of harm. There were a sufficient number of staff employed at the home. However, there were sometimes delays of people receiving the care they needed. People received their correct medication on time by trained staff.

Staff were only employed after a thorough recruitment process had been undertaken. Staff received an induction which included training and shadowing experienced members of staff. Staff felt supported and could discuss any concerns they may have had with a member of the management team.

People were provided with adequate amounts of food and drink to meet their individual likes and nutritional and hydration needs.

The CQC is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) Deprivation of Liberty Safeguards (DoLS) and to report on what we find. Action had been taken to ensure that if people did not have the capacity to make decisions then these were made in their best interests and in line with the legislation.

People’s privacy and dignity were respected and care was mainly provided in a caring and compassionate way.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of the report.