This unannounced inspection took place on 21 November 2016. We last inspected St Georges Residential Care Home in March 2015. At the inspection in March 2015 we found the service was not meeting all the regulations that we assessed and we asked the provider to take action to make improvements. This was in relation to medicine management, providing consistently appropriate and person centred treatment, restrictions on a person’s liberty and effectively monitoring the quality of service provision.

We issued four requirement notices and asked the registered provider to tell us how they were going to make the improvements required. At this inspection on 21 November 2016, we found that the registered provider and registered manager had made the changes and improvements needed to meet the requirement notices from the previous inspection

St George's Residential Home provides accommodation and personal care for up to 41 older people. The home is in an older property, close to local amenities in the town of Millom and has been adapted and extended for its current use. The bedrooms in the home vary in size and layout. There is a garden to the rear of the home for people living there and this is private and has accessible outdoor seating. There is parking available at the front of the home for staff and visitors. There were 28 people living at the home at the time of our inspection.

The service had 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 and associated Regulations about how the service was run. We noted that there was a clear structure and lines of responsibility being promoted by the registered manager and deputy. A member of care staff told us, “It’s a very open and friendly place to work”.

People living in the home told us that they felt safe living there and relatives we spoke with told us they were satisfied and “more than happy” with the care being provided. Some people who were living with dementia could not tell us their views but those people who could told us they felt “safe” and “secure” living there. We were told by one person who lived there, “I am happy here”.

People confirmed they had a choice of meals and drinks and they told us the food was “good” and that they enjoyed their meals. People were involved in discussions and feedback about food at their ‘residents’ meetings.

We saw that the people who lived there were being well cared for and were relaxed and comfortable in the home and with the staff that were supporting them. The atmosphere was informal and inclusive and people told us that they would be comfortable raising any complaints or concerns with the registered manager. Everyone we spoke with praised the staff that supported them and the friendliness of the staff and management.

People told us that care staff were available to help them when they needed assistance and that staff respected their privacy. People living at St Georges told us they were able to see their friends and families as they wanted and go out into the community with support. There were no restrictions on when people could visit them in their home. People were able to follow their own interests, practice their religious beliefs and see their friends and families as they wanted. People commented positively on the range of activities available to them in the home and the social events arranged for them.

The registered manager had a system to calculate dependency and staffing needs which they reviewed at three monthly intervals. We could see that the home was being adequately staffed to meet people’s needs during the day. We have made a recommendation that the registered manager reviewed their dependency tool to consider the layout of the home and sought guidance on curr

This unannounced inspection took place on 23th March 2015. We last inspected St. George’s Residential Care Home in January 2014. At that inspection we found the service was meeting all the regulations that we assessed.

St George's Residential Home provides accommodation and personal care for up to 41 older people and is situated in the conservation area of Millom. The home was originally a vicarage to which a substantial purpose built extension was added, which provides the majority of bedrooms with ensuite facilities and private telephone systems. Capital expenditure in recent years has seen the provision of additional car parking and ambulance facilities and creation of a dementia friendly sensory garden to help provide stimulation in a safe environment for people living in the home.

There were 26 people living at the home at the time of our inspection.

The service had 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 and associated Regulations about how the service is run.

People living at St George’s told us that they felt safe and were happy living in this home.

Staff demonstrated sufficient knowledge of people’s needs in regard to medicines. We found one medication record that indicated that there had been a prescribing error with a controlled medicine [a medicine liable to misuse] made by the GP. This error had not been picked up by staff on checking the medicines into the home or noticed the error on their stock checks. Staff had administered the correct dose despite the incorrect prescription but had not raised the error with the GP.

We found that the service did not have information in place to ensure that people received ‘as required’ medicines in a consistently person centred way.

We saw that the accident reporting systems in place did not always operate effectively. We saw that an accident had occurred involving a person living there but action had not been taken promptly to make sure they received appropriate care and treatment following an injury.

We found that the service had not always given thorough consideration to some of the equipment in place to support people’s safety. We saw this, for example, where door alarms and movement sensors were being used to monitor people’s movements on a best interest’s basis. Applications had not always been made to a supervisory authority where there was doubt about a person’s liberty being restricted in some way.

There were systems to assess the quality of the service provided in the home but we found that some quality checks or ‘audits ‘had not been effective, such as with medicines. Areas of improvement identified at audit had not always been followed up to make sure they had been addressed promptly and reviewed.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 that corresponds to the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to medicine management, providing consistently appropriate and person centred treatment, restrictions on a person’s liberty and effectively monitoring the quality of service provision.

There was information in care plans that showed the staff had discussed with people if they wished to be resuscitated should their health conditions change. The service had policies in place in relation to the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). However in practice these safeguards were not always being consistently applied.

We looked at staff training and development records and found that there were lapses in the provision of some training. We saw that training had been scheduled to take place to bring staff training up to date in these areas.

People we spoke with who lived in the home told us that they made decisions about their daily lives. We saw that people who needed support to eat and drink received this in a supportive and discreet manner.

We found that people living at the home were able to see their friends and families as they wanted. There were no restrictions on when people could visit them. We could see that people were able to follow their own faiths and beliefs and take part in activities in the home if they wanted to.

The registered provider had systems in place to make sure people living there were protected from abuse. They also had safe systems for recruitment to make sure the staff being employed were suited to working with the people living there.

The environment of the home was welcoming and the communal areas were decorated and arranged to make them homely and relaxing. Records indicated that the mobility equipment in use had been serviced and maintained under contract agreements and that people had been assessed for its safe use.

People knew how they could complain about the service they received and told us they were confident that action would be taken in response to any concerns they raised. All the visitors we spoke with told us that staff made them welcome when they came to visit or when they wanted to speak with them.

You can see what action we told the provider to take at the back of the full version of this report.

We have made a recommendation about staff appraisals being carried out in line with the service’s policy for providing annual appraisals of its employees.

People told us they were satisfied with the care they received. We found that staff knew the people who lived there well and were familiar with their conditions and needs. People living there appeared confident and comfortable with the staff helping them.

From our observations and conversations with people living there we found they had received the support they needed and were being given choices about their care and their social activities. We observed that staff encouraged people to maintain their independence. We were told by people living there, "I find the staff are very good" and “They (staff) will do anything for you, nothing is too much trouble”.

We did not receive any negative comments about the standard of care received, the food served and the cleanliness of the home. People said the food was "good" and “excellent” and people told us that they were always given a choice. On our walk around the building we saw that the home was being maintained and was clean and tidy. People had been able to personalise their rooms with their own things.

The service had robust recruitment processes to help make sure the people employed were suited to the role. There was a clear training programme in place to help make sure staff had the right skills and knowledge to give the right care and support.

People we spoke with told us they knew who they could speak to if they had a concern or complaint and said they would be confident raising concerns with the manager

The people living at St George's Residential Care Home we spoke with during our visit told us that they liked living there and were happy with the support they received. One person told us that, "I am happy here and content" and another told us "I feel safe here." People told us the food was "good" and "excellent" and that they were always asked what they liked and wanted.

People also told us that they could decide how they spent their time and one person said, "There is always something going on if you want to join in". Several people told us about the organised social activities and the ones they had particularly enjoyed like trips out and visiting musicians. People also told us that they felt they did not have to join in any activity or outing if they did not want to. People we spoke with told us that they had not felt the need to complain about care and they expressed confidence in the staff and the manager to deal with anything that worried them.

We spent a lot of time talking to people living there and watching what was going on and received only positive comments about the "lovely" and "kind" staff and the individual attention people felt they got from them. People told us that they felt their home was clean and comfortable and, we could see as we walked around, that this was the case. People also told us how much they liked their gardens and spending time out there when the weather was good.

People living at St George's Residential Care Home who talked with us during our visit told us that they liked living there and were happy with the services they received. We spent much of our visit talking to people living there and observing daily life in the home. We did not receive any negative comments at all about the standard of personal care and individual attention they received or the food on offer to them. It was the same for views on the cleanliness of the home and the staff approaches and support.

One person told us, "It’s a lovely place to be if you are poorly” and said that “Staff are polite and can't do enough”. People also told us that they felt staff knew them well and that staff were "experienced and professional.”

We were also told how clean and well kept they felt their home was and we could see as we walked around that was the case. People also talked enthusiastically about the gardens and how "lovely" they had been in the summer and talked about the ducks and chickens that had an enclosed run in the garden. Several people told us they spent time out there in the better weather.

People we talked with told us that they had not felt the need to complain about care during their time there. Alll the people we talked with expressed confidence in the staff and manager to listen and take action if they were unhappy about something.

People talked positively about the food being provided for them and their choices in this. Some told us that the food was “excellent”and that staff knew what they liked and could have. People also told us that they could chose where they took meals and how they spent their days and told us about the different individual and group activities and outings available to them. They also told us that they got up when they wanted to and went to bed when it suited them. Some people told us that they had made friends whilst living there and that they felt “safe” living there.