St Georges Residential Care Home provides accommodation and personal care for up to three adults with learning disabilities. At the time of our inspection there were three people using the service. The manager of the service was also the owner and sole provider so did not need to have a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service.

This inspection took place on 16 and 22 August 2017. Our first visit was unannounced. At the previous inspection in November 2016 the service was not meeting all the regulations we inspected.

At our inspection in November 2016, we found that medicines management was not always safe as we could not always confirm people were receiving their medicines as prescribed. This was a breach of the regulation relating to safe care and treatment and we issued a warning notice to the registered provider following our inspection.

At this inspection we found that improvements had been made and medicines were now being managed safely. Medicines were being supplied in sealed blister packs by the pharmacist and records showed that people were receiving their medicines as prescribed.

At our last inspection we observed that staff sometimes did not refer to people in an age-appropriate manner, use their preferred names or keep them informed about what they were doing. During this inspection we saw that staff knew people using the service well, were aware of their likes and dislikes and treated them respectfully.

The service understood and complied with the requirements of the Mental Capacity Act (MCA) 2005. One person using the service had a Deprivation of Liberty Safeguards (DoLS) authorisation in place for their safety. The provider had applied for authorisations for two other people and these were awaiting assessment from the local authority.

The provider and staff were aware of safeguarding procedures. Any risks associated with people’s care, daily routines and activities were identified with action taken to minimise these. Care plans addressed the support people required with personal care, maintaining their health and their activities of daily living. There were enough staff on duty to support people safely.

The provider understood their role and responsibilities. There were systems in place to help ensure the safety and quality of the service provided.

This inspection took place on 24 and 29 November 2016 and was unannounced. At our last comprehensive inspection on 23 October 2015 we found the provider was in breach of the legal requirement about safe care and treatment in relation to medicines management. We carried out a follow up inspection on 3 March 2016 and found that although the provider had taken action to address the shortfalls they had not made sufficient improvements to meet the requirements of this regulation.

St Georges Residential Care Home provides accommodation and personal care for up to three adults with learning disabilities. At the time of our inspection there were three people using the service. The manager of the service was also the owner and sole provider and so did not need to have a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service.

Medicines were still not managed safely. People did not always receive their medicines in line with instructions from the doctor or pharmacist. Medicines were not always signed for at the time when they were administered, increasing the risk of errors. There were not clear records to show how much medicine should be in stock and staff were unable to account for some missing tablets. Some unsafe practices were being followed, such as splitting tablets in half with a kitchen knife and storing them in unsealed packaging. The provider’s audits and quality monitoring systems were not sufficiently robust to identify or rectify these problems and medicines audits had not been completed for the last two months. The provider was in breach of the regulations relating to safe care and treatment, notification of incidents and good governance. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

Staff sometimes did not refer to people in an age-appropriate manner, use their preferred names or keep them informed about what they were doing. However, at other times staff treated people with respect, were sensitive to their emotional needs and knew how to communicate with them effectively so they had the information they needed to make choices about their care. Staff promoted people’s independence by giving them opportunities to do as much for themselves as possible.

The home environment was safe because the provider had measures in place to store chemicals safely, maintain fire safety and otherwise ensure the safety of the environment. People had individual risk assessments and risk management plans that were tailored to their needs. There were arrangements in place to safeguard people from harm and abuse. There were enough staff to keep people safe.

People were able to choose from a variety of nutritious, high quality home-cooked food that met their nutritional and cultural needs. People enjoyed the food supplied by the service and staff provided the support people needed to eat their meals and drink enough fluids. Staff monitored people’s weight and food intake to ensure they maintained a healthy body weight. People received the support they needed to maintain their health and attend healthcare appointments.

The manager and staff understood their requirements under the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS). DoLS provides a process to make sure that people are only deprived of their liberty when this is necessary to keep them safe and in a way that ensures their rights are upheld. The provider ensured the relevant processes were in place and appropriate people were involved in any decisions about people’s care that were made when they did not have the mental capacity to make the decisions for themselves.

Staff were provided with enough training and support to enable them to carry out their roles effectively. The provider was able to access guidance on good practice to inform their work at the s

This inspection took place on 3 March 2016 and was unannounced. At the last inspection on 23 October 2015 we found the service was breaching the regulation relating to medicines management. This was because when we checked medicines stocks we were unable to confirm people always received their medicines as indicated on the Medicines Administration Record (MAR). After the inspection the manager wrote to us with their action plan setting out how they would improve medicines management.

The service provides personal care and support to people within a small care home setting. It specialises in providing care to people who have a learning disability and a range of communication needs. There were three people using the service at the time of our inspection.

There was no registered manager in post because the service was owned by an individual who was also the manager of the service 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.

During this inspection we found that the manager had not sufficiently improved medicines management. This was because the service was repackaging people’s medicines in pill dispensing boxes which is classed as ‘double dispensing’. Double dispensing introduces a risk as only specific professionals such as pharmacists and chemists are able to dispense medicines as they have been specially trained to do so. Other staff administering the medicines cannot also be sure people are receiving the right dose of medicine at the right time, as prescribed, because they do not have the medicines original packaging with pharmacy label to double check as they administer to people.

This summary is based on our observations during the inspection, speaking with two people who used the service, two visiting professions, one relative, the registered individual and one member of staff. Some people using the service had complex needs which meant that they were not able, or not fully able, to verbally communicate their views. We looked at people’s care plans, staffing records and other records relevant to the management of the service.

If you want to see the evidence supporting our summary please read the full report.

We considered our inspection findings to answer five questions we always ask:

• Is the service safe?

• Is the service caring?

• Is the service responsive?

• Is the service effective?

• Is the service well led?

Is the service safe?

The manager and staff had received training in the Deprivation of Liberty Safeguards (DoLs) and understood when an application should be made.

We saw that the home was well maintained with various health and safety checks carried out regularly. People had safe access to a well-kept garden. Procedures in relation to fire safety were in place.

There were enough suitably competent staff employed to meet the needs of the people who lived at the home. Staff recruitment procedures were robust to ensure that only suitable people were employed. People’s personal records, and other records relevant to the management of the service, were accurate and fit for purpose.

Is the service caring?

We saw that people working at the home were caring. Also the feedback we received from people who used the service, their relatives and visiting professionals was positive about the standards of care and support provided at the home.

Is the service responsive?

We saw that the home regularly sought the views of people using the service, staff and relatives. We found that the home had responded positively to suggestions that had been made.

The way in which care should be provided was set out clearly in care plans. We saw that care was delivered in line with this.

Is the service effective?

People were protected from the risks of inadequate nutrition and hydration. Also, people told us that they liked the food they were provided with and we saw that it met their cultural needs.

People’s needs were regularly assessed. Care plans were “person-centred” focusing on people’s individual needs. We found that care was delivered in line with these care plans.

Is the service well-led?

The provider had regard to the views of people using the service and relatives. Systems were in place to effectively assess and manage risks in relation to people’s health, safety and welfare.

We used a number of different methods to help us understand the experiences of people using the service because these people were not able to tell us how their care was delivered. We spoke with one relative who told us “I have no complaints, I feel X is happy there.” Another relative told us “They provide excellent care.” The staff we met demonstrated a very good understanding of the needs of the people who used the service.

We saw that people and their family were involved in making decisions about their care and treatment. Their needs were assessed and care was delivered in line with their individual care plan.

We found the provider worked in co-operation with other professionals to support people with their health and welfare needs. Medicines were prescribed and given to people appropriately.

We saw that people’s personal records were accurate and fit for purpose and were kept securely.

We found that staf had received training in relation to safeguarding vulnerable adults and knew what to look out for and how to report such matters should they arise.

People who used the service and their families were supported to raise any concerns. We saw that concerns were dealt with effectively and in a timely way.

We used a number of different methods to help us understand the experiences of people using the service, because the people using the service had complex needs which meant they were not able to tell us their experiences. We spoke to the relatives of two people, who told us they were happy with the care provided. One person told us ‘The service is very good’. They told us staff looked after their relative well. Another person told us they had no complaints about the service. They told us they liked that staff respected the cultural and religious needs of their relative and delivered care and support that matched these needs. They said ‘It’s almost like a family home. We’re always welcome to visit’. We also spoke with a social worker from the local authority who told us staff had responded well to delivering appropriate care and support to people who use the service.

This inspection took place on 23 October 2015 and was unannounced. At the previous inspection on 20 June 2014 we found the service to be meeting all the regulations we inspected.

The service provides personal care and support to people within a small care home setting. It specialises in providing care to people who have a learning disability and a range of communication needs. There were three people using the service at the time of our inspection.

There was no registered manager in post because the service was owned by an individual who was also the manager of the service 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.

Medicines management was not always safe as we could not always confirm people received their medicines as prescribed. This was a breach of the regulation relating to safe care and treatment. You can see the action we told the provider to take at the back of the full version of the report.

Staff understood how to recognise abuse and how to report any concerns they had relating to this. People had appropriate risk assessments in place with risk management plans to manage the risks. The premises and equipment were maintained safely.

There were enough staff to meet people’s needs and the manager followed a robust recruitment process so that only suitable staff worked with people at the service.

The manager and staff understood their requirements under the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS). DoLS provides a process to make sure that people are only deprived of their liberty in a safe and correct way, when it is in their best interests and there is no other way to look after them. The manager had assessed which people required DoLS and made the necessary applications as part of keeping them safe.

People received the necessary support to receive appropriate food and drink and people’s preferences, cultural and religious needs relating to food and drink were met. Staff supported people with their health needs and people had access to the health services they needed.

Staff received the right training to carry out their roles and understood people’s needs. They were well supported by the manager through a programme of supervision.

The manager and staff understood people’s needs and backgrounds and this information was recorded in care plans for staff to refer to. Staff supported people to be as independent as they wanted to be and to take part in activities they were interested in. People were involved in their care plans. Care plans contained accurate information and were regularly reviewed. People, their relatives and staff were involved in the running of the care home.

There was a suitable complaints system and relatives had confidence the manager would resolve any issues they rose with them. The manager and staff had a good understanding of their roles and responsibilities and they were meeting the requirements of their registration with CQC in submitting statutory notifications.