The inspection took place on 15 and 19 December 2016 and was unannounced.

There was 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.

The service had a strong visible person centred culture with staff regularly going the extra mile to ensure people's wishes and goals were achieved. Relatives and healthcare professionals consistently told us staff provided outstanding care and were always compassionate during interactions with people.

Staff received a thorough induction before they started work.

People were supported by staff that had the skills and knowledge to meet their assessed needs.

The provider had employed skilled staff and took steps to make sure care was based on local and national best practice. Information regarding diagnosed conditions was documented in people’s files.

Recruitment practices were safe and relevant checks had been completed before staff commenced work. Staff worked within good practice guidelines to ensure people’s care, treatment and support promoted good quality of life.

The provider had appropriate arrangements in place to assess people’s capacity to make decisions about their care and treatment. Staff were knowledgeable about the requirements of the Mental Capacity Act 2005.

People who required assistance to eat and drink were supported effectively. Appropriate assessments had been conducted for anyone who had difficulty in swallowing their food. Interactions between staff and people during meal times were respectful and dignified.

Multi-disciplinary teams including mental health workers and occupational health were involved in reviewing and updating people’s risk management plans.

Medicines were managed safely. Any changes to people’s medicines were prescribed by the service’s GP and psychiatrist. People were involved before any intervention or changes to their care and treatment were carried out.

People had access to activities that were important and relevant to them. Records showed people’s hobbies and interests were documented and staff accurately described people’s preferred routines. There was a range of activities available within the home.

The provider actively sought, encouraged and supported people’s involvement in the improvement of the service. People’s care and welfare was monitored regularly to make sure their needs were met within a safe environment. The provider had systems in place to regularly assess and monitor the quality of the service provided.

People told us the staff were friendly and management were always visible and approachable. Staff were encouraged to contribute to the improvement of the service. Staff told us they would report any concerns to their manager and said the management and leadership of the service was good and very supportive.

During our visit we spoke with eight people who lived at the home and two relatives. Following our visit we also spoke with six people and two relatives of people who received care in their own homes. They told us that they were involved in how their care was provided. One person living at St Georges said: "I know I have a care plan, and I can discuss anything with my carer" Another person told us: "They did ask me about my care needs before I came in here, and they look after me extremely well".

During our visit we observed a lunch time sitting within the dining area. We observed people being treated in a dignified and respectful way. One person told us, "The food is really good here and if I don't like what's on the menu I can always ask for something else." People told us they enjoyed their meal. The mealtime was calm and people were treated politely and supportively.

The registered manager confirmed that all members of staff received training in safeguarding adults on commencement at the service and received refresher training annually. Care workers we spoke to were able to describe the main types of abuse and the actions they would take if abuse was suspected.

Appropriate checks were undertaken before care workers began work. The registered manager explained the recruitment process to us and gave us examples of what they had done when they had concerns, for example they requested more than two references.

There was a customer satisfaction survey that was carried out yearly and we noted that this was planned for December this year. The survey included relatives and other health and social care professionals. The last survey showed that people were positive about the care that they were receiving.

Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. The manager told us that consent for care and support was obtained by people using the service or their representatives during discussion about the care and support the person needed. We saw signatures confirming their agreement within the care plans.

We looked at six care plans of people who lived at St George's and six care plans for people who received home care. The care plans contained an assessment of capability and need for all aspects of life such as personal care, sleeping, mobility, nutrition, pain and tissue viability. The care plans were very clear and reflected the needs of that person.

All medication administration records included a photograph of the person for whom the medication related to together with their room number. Records were kept when medicine was refused by people or not required, for example, when people said they didn't need pain relief.

The complaints procedure was on the information board at the entrance to the home and a copy of this was in the welcome pack given to people on admission to the home or before the home care service started. We saw a record of complaints and they had been responded to in a timely manner by the registered manager.

St. George's Nursing Home and Home Care is registered to offer accommodation for people who may require nursing and or personal care and personal care to people in their own home. We looked at records for both these activities and spoke with staff offering care and support to people in the care home and in people’s own home.

During our visit we spoke with six people who live at the home, three relatives, four staff and the provider about their thoughts and experiences of St George’s.

They told us that they liked living at the home and that the staff were helpful with nothing being too much trouble and that the senior staff were easy to talk to.

We observed lunch being served and we saw that people had the choice of having lunch in their room or going to the dining room. We saw how staff interacted with people offering them choice and the patient manner in how they communicated. One person told us there were always activties which they could join in and a relative told us about the homemade Christmas gifts they had received.

Staff told us that they had received regular training, were supported by the management of the service and that they could speak with senior staff about any concerns they had about the running of the service.

Relatives we spoke with told us that the home was ‘homely’ and spoke about the provider with high regard; although they said they could also speak freely with all staff. “The staff conduct themselves in a caring and professional manner”.