The inspection took place on 20 March 2018 and was unannounced.

St George’s Lodge Residential Care Home is registered to provide accommodation and care for up to 26 older people with a range of health needs, including people in the early stages of dementia. At the time of our inspection, 25 people were living at the home. Communal areas include a large lounge, dining room and gardens. A lift is available between the ground and first floor. The majority of rooms have en-suite facilities, such as a toilet and sink. St George’s Lodge Residential 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.

A registered manager was 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.

At the last inspection, the service was rated Requires Improvement under Effective and a requirement was made in relation to a breach of Regulation 11, need for consent. Consideration was not given in relation to people’s capacity to give their consent. Capacity assessments were not always recorded for people who appeared to lack capacity. At this inspection, we found that steps had been taken to address the issue and the rating under Effective has improved to Good. People were supported 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.

Medicines were not always managed safely. A staff member who administered medicines to people at lunchtime did not witness some people taking their medicines, but signed the Medication Administration Record to confirm they had taken them, which was inaccurate. Temperatures within the medicines storage area and in the refrigerator were consistently in excess of ideal temperatures which manufacturers recommend.

Care plans were not completed in a person-centred way and many lacked information about people’s personal histories, likes and dislikes. The provider had an accessible information policy in place, but account had not been taken of people’s impairments in order that adjustments could be made in line with the policy. Although some activities had been organised by care staff, these were not planned in line with people’s interests and hobbies.

Systems were not effective in monitoring the home and had not identified the issues we found at inspection.

Medicines were ordered and disposed of safely. Staff were trained in the administration of medicines. Some people were independent in taking their medicines and had been risk assessed accordingly. People felt safe living at the home and staff members had completed safeguarding training; they know what action to take if they suspected abuse. In addition to people’s risks being identified and assessed, premises had been assessed and were managed safely. Staffing levels were within safe limits. Safe recruitment practices were in place. The home was clean and smelled fresh. Staff understood their duties under the Duty of Candour and the need for honest, open communication when things went wrong.

Staff completed training in a range of areas considered relevant to their job role. They had regular supervision and annual appraisals with their managers. People had sufficient to eat and drink and we observed people having their lunchtime meal, which was a sociable occasion. People had access to a range of healthcare professionals and services. When people moved to the home they were encouraged to bring any personal items and furniture that w

The inspection took place on 18 November 2015 and was unannounced. St Georges Lodge is a care home without nursing that is registered to provide care and accommodation for 26 older people. At the time of our visit there were 26 people living at the home who had a variety of needs and some of them were living with dementia. The building is a large detached Victorian house and accommodation is provided on both the ground and first floor.

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.

Staff had received training in the Mental Capacity Act 2015 and Deprivation of Liberty Safeguards however, people’s consent was not always being sought in line with the Mental Capacity Act 2015. Consideration of someone’s capacity was not given in areas such as needing bed rails and capacity assessments and best interest decisions were not always recorded. This meant that peoples human rights were not always protected and decisions about their care was not always made in accordance with the law. This was identified as an area of practice that requires improvement.

People living at St Georges Lodge told us that they felt safe and there were policies and procedures in place to safeguard people, one person said “I’ve only got to press my bell and staff are here within seconds.” Risks were identified and assessed and staff understood and supported individuals to make choices. Incidents and accidents were recorded and monitored by managers.

Medicines were managed, stored and administered safely and staff were confident and knowledgeable in administration of medicines. There were sufficient numbers of suitable staff and safe recruitment processes were in place. Staff covered gaps in the rota between them and this provided good continuity for people who were supported by staff who knew them well.

People told us that staff were well trained and knowledgeable, one person said, “The staff are excellent.” We found that staff were well supported with training and supervision. People were supported to access health services and professionals including GPs, the specialist dementia care team, district nurses, and social workers. A visiting healthcare professional told us that “Staff are very thorough and aware of issues, they communicate really well with us and follow instructions.” The nutritional needs of people were identified and monitored effectively and the chef had good knowledge of individual needs and preferences. People told us that the food was good and that they had enough to eat and drink.

People, relatives and professionals spoke highly of the caring nature of staff. Staff knew the people they cared for well and had developed caring relationships with individuals. One member of staff said “It’s about putting the residents at the centre of what we do, if someone wants a pyjama day why shouldn’t they? ” People and their relatives were involved in planning their care and people told us they were happy with the care they received. People’s confidentiality, dignity and privacy were maintained. People considered staff to be respectful and said that they felt they were treated with dignity, one person said “My eyesight is poor, the staff always tell me what they are doing and the reason why.”

Peoples’ care plans were personalised and reflected their individual needs and preferences. Staff were knowledgeable about the individuals that they supported and respected their right to make choices about their care and support. The complaints process was accessible people told us that they would feel comfortable to raise any issues or complaints with the managers or Provider. The Provider took an active role in seeking feedback from people and their relatives and friends and spoke to people individually through the auditing process as well as on a daily basis. People had mixed views on activities and opportunities for social engagement and this was fedback to the provider. Everyone told us that they enjoyed the external entertainers that came in for musical events three or four times a month as well as organised trips out but some people felt that there were not many activities on offer on a daily basis.

There was a comprehensive quality assurance system in place and the owner was actively involved with oversight of the service. There was an open culture and staff and people told us that the managers and owners were visible and approachable

We found one breach of the Health and Social Care Act 2008(Regulated activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

The inspection took place on 18 November 2015 and was unannounced. St Georges Lodge is a care home without nursing that is registered to provide care and accommodation for 26 older people. At the time of our visit there were 26 people living at the home who had a variety of needs and some of them were living with dementia. The building is a large detached Victorian house and accommodation is provided on both the ground and first floor.

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.

Staff had received training in the Mental Capacity Act 2015 and Deprivation of Liberty Safeguards however, people’s consent was not always being sought in line with the Mental Capacity Act 2015. Consideration of someone’s capacity was not given in areas such as needing bed rails and capacity assessments and best interest decisions were not always recorded. This meant that peoples human rights were not always protected and decisions about their care was not always made in accordance with the law. This was identified as an area of practice that requires improvement.

People living at St Georges Lodge told us that they felt safe and there were policies and procedures in place to safeguard people, one person said “I’ve only got to press my bell and staff are here within seconds.” Risks were identified and assessed and staff understood and supported individuals to make choices. Incidents and accidents were recorded and monitored by managers.

Medicines were managed, stored and administered safely and staff were confident and knowledgeable in administration of medicines. There were sufficient numbers of suitable staff and safe recruitment processes were in place. Staff covered gaps in the rota between them and this provided good continuity for people who were supported by staff who knew them well.

People told us that staff were well trained and knowledgeable, one person said,“The staff are excellent.” We found that staff were well supported with training and supervision. People were supported to access health services and professionals including GPs ,the specialist dementia care team, district nurses, and social workers. A visiting healthcare professional told us that “Staff are very thorough and aware of issues, they communicate really well with us and follow instructions.” The nutritional needs of people were identified and monitored effectively and the chef had good knowledge of individual needs and preferences. People told us that the food was good and that they had enough to eat and drink.

People, relatives and professionals spoke highly of the caring nature of staff. Staff knew the people they cared for well and had developed caring relationships with individuals. One member of staff said “It’s about putting the residents at the centre of what we do, if someone wants a pyjama day why shouldn’t they? ” People and their relatives were involved in planning their care and people told us they were happy with the care they received. People’s confidentiality, dignity and privacy were maintained. People considered staff to be respectful and said that they felt they were treated with dignity, one person said “My eyesight is poor, the staff always tell me what they are doing and the reason why.”

Peoples’ care plans were personalised and reflected their individual needs and preferences. Staff were knowledgeable about the individuals that they supported and respected their right to make choices about their care and support. The complaints process was accessible people told us that they would feel comfortable to raise any issues or complaints with the managers or Provider. The Provider took an active role in seeking feedback from people and their relatives and friends and spoke to people individually through the auditing process as well as on a daily basis. People had mixed views on activities and opportunities for social engagement and this was fed back to the provider. Everyone told us that they enjoyed the external entertainers that came in for musical events three or four times a month as well as organised trips out but some people felt that there were not many activities on offer on a daily basis.

There was a comprehensive quality assurance system in place and the owner was actively involved with oversight of the service. There was an open culture and staff and people told us that the managers and owners were visible and approachable.

We found one breach of the Health and Social Care Act 2008(Regulated activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

At our last inspection on 7 July 2013 we found that the provider was non-compliant with care and welfare of people. This was because some of the care records we looked had not been updated to reflect people's current needs. This meant that care and treatment was not always assessed and planned in a way that ensured people's safety and welfare. We asked the provider to send us an action plan which identified how they would achieve compliance in this area. This was returned on 8th August 2013 and showed how the provider had updated the care plans of people who were at high risk of falls and that a new form to record the number of falls was now included in the care plans.

During this inspection we looked at the care records of three people who lived at the home. We also spoke with the manager. We saw evidence that risk assessments and care plans were updated regularly to reflect peoples current needs. This meant that arrangements were now in place to ensure people experienced safe and appropriate care.

We spoke with five people who lived at the home. They all said that they liked living there. They were all very happy with the care they received. One person said, "I'm delighted to be here." Another said, "They really look after me here."

We looked at the care records of five people. We saw evidence that people's consent had been obtained for their care and treatment. However, some of the records we looked at showed that care plans had not always been updated to reflect people's current needs.

We spoke with three members of staff. They all said that they were happy working in the home. They all said they received sufficient training and were encouraged to acquire further skills and qualifications. They all said they felt well supported in their roles.

We saw that the home had systems in place to monitor the quality of service provision. Feedback from the people who lived there was actively encouraged and there was evidence that concerns raised were acted upon.

People told us what it was like to live at this home and described how they were treated by staff and their involvement in making choices about their care. They also told us about the quality and choice of food and drink available. This was because this inspection was part of a themed inspection programme to assess whether older people living in care homes were treated with dignity and respect and whether their nutritional needs were met.

The inspection team was led by a CQC inspector joined by an Expert by Experience (people who have experience of using services and who can provide that perspective). We spoke with six people who lived in the home, two relatives visiting the home, and observed the care and support provided to others who were unable to communicate verbally. We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

People told us they liked the staff and the quality of care they provided. One person said, “the staff are professional . . . they treat me like a human being.” One family member said, “I’ve seen a few care homes in my time but this is superb!” One person told us, “even if I won the lottery I would not move from here.”

People told us they felt safe and comfortable in the home. They found staff to be approachable and responsive to any concerns. All of the people we spoke with said they had no reservations about raising concerns with staff “but can’t imagine ever needing to.”

People told us that they enjoyed the food prepared by the home’s chef and felt they always had enough. People told us that meals were nutritious and balanced. They felt they had a great deal of choice in their daily activities and in their meals.