This inspection took place on 8 December 2015 and was unannounced. That means that St George's Residential Care Home (St George’s) did not know in advance that we were coming.

The previous inspection had been on 12 September 2014 when we had found the service was not meeting regulations in three areas: premises, staffing levels and aspects of quality monitoring. We requested the provider to submit an action plan, which they did on 5 December 2014. At this inspection we checked to see whether these regulations were now being met. We found that action had been taken in those three areas to meet the regulations. Our findings are set out in our full report.

St George's is situated in Gorton in north east Manchester. It is a former rectory converted to provide accommodation for up to 10 people. At the date of this inspection there were six people using the service, one of whom was temporarily in hospital.

There are six bedrooms on the first floor, with access via a staircase or lift. Each bedroom has a washbasin. There are bathroom and toilet facilities on both floors used by people living in the home. The ground floor has four more bedrooms, a lounge and separate dining room. A kitchen and laundry are also located on the ground floor.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 provider had taken over the service from the former provider in August 2015. Up to that point the former provider’s representative had carried out most of the management functions. The registered manager and other staff had remained in post when the current provider took over.

We found five breaches of regulations in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to staff recruitment and lack of staff supervision, medication management, deprivation of liberty safeguards, and assessing the quality of the service. There was also a breach of a regulation in the Care Quality Commission (Registration) Regulations 2009, relating to not reporting an allegation of abuse. You can see what action we have told the provider to take at the end of the full version of the report.

People told us they felt safe at St George’s.

We checked on the recruitment processes for staff. We found that one person had been working for six months without the proper checks having been done, which was a breach of the relevant regulation.

We spoke with staff who administered medication. The system for storing controlled drugs did not meet the requirements of legislation. This was a breach of the regulation relating to the safe and proper handling of medicines.

Fire prevention and detection systems were maintained. However, St George’s did not have individual evacuation plans, which created an additional risk. This was a breach of the regulation relating to reducing risks.

St George’s did not have a cook or a cleaner at the time of our inspection. Care staff prepared meals and did the cleaning. We found there were sufficient staff to meet the needs of residents.

The home was clean although some recommendations made in an infection control report still needed to be implemented.

Staff had received training during 2015 about health-related issues. However, the training in mandatory topics including safeguarding, food hygiene and medication was sporadic. Staff were uncertain whether supervisions had taken place, and we found no evidence of appraisals. This all meant that staff were not being fully supported in their role, which was a breach of the relevant regulation.

Staff had recently received training about the Deprivation of Liberty Safeguards (DoLS). Staff at St George’s had not yet applied for any authorisations under DoLS but were planning to do so. Mental capacity assessments had not been used, but were now needed at least for one person.

We saw people enjoying the food. People’s dietary needs were catered for. The provider was planning refurbishment of the building and as part of that we recommended that they should improve the environment for people living with dementia.

People told us they were well looked after, and the home was warm and comfortable. We observed that staff knew people well and were respectful, kind and attentive.

One person was in bed and the staff were turning them regularly to avoid pressure sores developing, although there was no chart in use to record this.

Staff had received training in end of life care and people were able where possible to stay in St George’s to the end of their lives.

We looked at care files which did not contain enough personal information about people. However, the small number of residents meant that staff were able to know each of them well and meet their personal needs.

Assessment procedures for potential new admissions had changed since the new provider took over.

A new system of recording daily notes on a grid sheet had been introduced. This might make it more difficult for medical professionals to keep track of people’s health.

We saw that care plan reviews were being done regularly.

There were no activities on the day of our visit. We found records showing that some activities did take place. We recommended that the provider should consider introducing a greater range of activities.

There had not been meetings for residents or their relatives, but people told us they could always discuss matters with the registered manager. There was a complaints policy. There had not been any formal complaints recorded since 2013, although we knew some verbal complaints had been made in the previous winter.

The registered manager was aware of the requirement to notify certain events to the CQC. We were informed about an allegation of abuse which had been made in October 2015 and had not been reported to the CQC. This was a breach of the relevant regulation regarding notification of events.

Residents and staff commented that the atmosphere at St George’s was calmer since the new provider had taken over. This had a positive impact on the care for residents. The new provider had promised refurbishment and development.

The provider was not involved in managing the quality of the care being delivered or other aspects of the management. The registered manager conducted some audits but there was scope for improving the range of audits. We found this was a breach of the regulation relating to assessing and improving the quality of the service.