This inspection took place on 1 February 2018 and was unannounced. This meant the staff and provider did not know we would be visiting.

At our last inspection in November 2016 the service received an overall rating of good. The domain responsive was rated as requires improvement. At this inspection we found improvements had been consistently maintained with regard to record keeping and the rating for the responsive domain has now improved to good. We found the evidence continued to support an overall rating of good.

St Georges is a ‘care home’. People in care homes receive accommodation and 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.

St Georges accommodates a maximum of 38 older people, including people who live with dementia or a dementia related condition, in one adapted building. At the time of inspection 36 people were using the service.

A manager was in post. They had applied but were not yet registered with the Care Quality Commission. 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.

There was no evidence or information from our inspection and on-going monitoring that demonstrated serious risks or concerns.

This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

People said they felt safe and they could speak to staff as they were approachable. We considered however that staff deployment needed to be kept under review. We have made a recommendation about ensuring staff are appropriately deployed to meet people’s needs. We observed activities were not always available to keep some people engaged and stimulated in some areas of the home where staff were not always available.

Staff knew about safeguarding vulnerable adults procedures. Staff were subject to robust recruitment checks. Risk assessments were in place and they accurately identified current risks to the person as well as ways for staff to minimise or appropriately manage those risks. A system was not in place to look at trends and patterns where several incidents such as falls occurred.

People had access to health care professionals to make sure they received appropriate care and treatment. Staff followed advice given by professionals to make sure people received the care they needed. People received a varied and balanced diet to meet their nutritional needs. Systems were in place for people to receive their medicines. However, we have made a recommendation about the management of medicines.

Appropriate training was provided and staff were supervised and supported. Staff had a good understanding of the Mental Capacity Act 2005 and best interest decision making, when people were unable to make decisions themselves. 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.

Detailed records reflected the care provided by staff. Care was provided with kindness and people’s privacy and dignity were respected. Communication was effective to ensure staff and relatives were kept up to date about any changes in people’s care and support needs and the running of the service.

A complaints procedure was available. People told us they would feel confident to speak to staff about any concerns if they needed to. The provider undertook a range of audits to check on the quality of care provided.

People had the opportunity to give their views about the service. There was regular consultation with people and family members and their vie

We last inspected St Georges Nursing Home on 12 and 14 January 2016 and found the provider had breached a regulation we inspected against. Specifically the provider had breach Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 - person centred care. Care plans in respect of people using the service were not always complete or updated so there was a risk they may receive inconsistent or inappropriate care. This focused inspection took place on 28 November 2016 and was done to check that improvements had been made. The inspection was unannounced.

St Georges Nursing Home is a care home without nursing and provides accommodation and support for up to 38 people. Of the 38 single bedrooms, 24 had en-suite facilities and there were several accessible toilets and bathrooms on each of the two floors. At the time of the inspection there were 32 people using the service, some of whom were living with dementia.

The manager was not registered with the Care Quality Commission at the time of the inspection. The current manager had come into post on 31 October 2016 and had begun the application process to be registered with the Commission.

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.

We found the quality and detail in care plans had improved. Detailed records of monthly evaluations of care plans were completed which evidenced the appropriateness and relevance of care plans. The manager was very clear that care plans should be re-written in response to any change in need.

This inspection took place on 12 and 14 January 2016 and was unannounced. We last inspected St Georges Nursing Home on 22 January 2014 and found it was meeting all legal requirements we inspected against.

St Georges Nursing Home is a care home without nursing and provides accommodation and support for up to 38 people. Since the last inspection the service is no longer providing nursing care but it retains the name St Georges Nursing Home. Of the 38 single bedrooms, 24 had en-suite facilities and there were several accessible toilets and bathrooms on each of the two floors. At the time of the inspection there were 31 people using the service, some of whom were living with dementia.

The service had a registered manager who had been in post since September 2015 and who has been registered with the Commission since December 2015.

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.

Care plans were in place and evaluated on a monthly basis. Changes in people’s needs which had been identified in the evaluations were not always updated in care plans so people may not have been receiving care that met their needs. Care plans did not always contain specific guidance for staff to follow, such as how to use the hoist when supporting a person with mobility needs. Detailed guidance on how to support people who were disoriented, distressed or confused was not always evident.

The registered manager was aware that care plans needed to be improved and this had been recognised in an action plan but there was no timeframe for completion. This meant there was an ongoing risk that people may receive inconsistent or inappropriate care.

Staff knew how to safeguard people from harm and abuse and how to report any concerns. They were confident that the registered manager would take action as required.

Accidents and incidents were recorded and action taken to minimise risks. Risk assessments were completed on a monthly basis and identified control measures to manage situations.

Risk assessments and contingency plans were in place in relation to the premises. Health and safety checks were completed and service contracts and maintenance plans were in place.

The registered manager had recently recruited a deputy manager and was waiting for pre-employment checks to be completed. These included references and a Disclosure and Barring Service check so they could be confident the person was suitable for the post. There were enough staff to meet people’s needs but recruitment was ongoing for additional care staff.

Medicines were stored, administered and managed in a safe way. The staff who were responsible for administering medicines were trained and completed a competency check on a six monthly basis.

Other training included mental capacity, safeguarding, dignity, dementia and person centred care. Staff champions were being identified so they could receive additional training and act as a point of contact for any queries. Training was discussed in each staff member’s supervision and in the team meetings. Staff said they felt well supported and well trained.

Authorised Deprivation of Liberty Safeguards were in place, and the registered manager and staff understood mental capacity principles. Staff included people in decision making at every opportunity.

People had access to health care services, with one relative saying, “They are very responsive to people’s health needs.” Where required people had been referred to the falls team and speech and language therapist, as well as having regular appointments for medicines reviews and sight check-ups.

People told us, “The food is lovely.” Staff were knowledgeable about people’s dietary requirements and ensured people were we

We carried out an unannounced visit following concerns made known to the Care Quality Commission.

We spoke with a number of people throughout the day and they told us of St Georges “A1,” “No complaints at all,” “Lovely food.”

We saw on the day of our visit, there were sufficient qualified, skilled and experienced staff to meet people's needs.

Care records had enough information so staff would be able to know how to support each person in the right way.

Some people were not able to tell us directly what they thought about the service. However, during our visit we spent time observing how care staff supported people and this was positive and respectful.

Care plans were written in a clear and easy to understand way and people's personal preferences were clearly recorded. There were sufficient staff on duty to support people for their care needs.

We looked at how the service recruited staff by checking five staff files. These showed that the appropriate checks and procedures were being followed.

Comments from people who live at St George's Nursing home included "The food is lovely." and "The staff are always there for me."

Comments from relatives included "My ... is happy so I am happy". "Staff are always at hand for a chat".

We found people who used the service understood the care and treatment choices available to them. People's needs were assessed, and the planning and delivery of care and treatment met their needs and protected their rights.

The provider had an effective system to regularly assess and monitor the quality of service that people received. They also had an effective system in place to identify, assess and manage risks to the health, safety and welfare of people who used the service.

We spent time with people who lived at the home and visitors to get their views of the service at St Georges Nursing Home. All of the people we spoke with had positive comments about the care and support they had experienced.

Some people were up and about and quite independent and we saw that they were

able to do as they wished. A visitor we spoke with confirmed they were satisfied with the care their relative received and had no concerns.

People told us they felt “safe” at the home. A relative told us, “We have no concerns about the service. The staff are always lovely no matter what time we come.”

One person said, “Everything is fine. The staff are lovely.” Another person said, “I make my own decisions, I decide my own time for getting up and going to bed. I prefer to stay in my room."

Another person said, “You do have choices at mealtimes and it is written on the menu sheet. Sometimes there is too much, I can’t eat it all.”

This visit focused on checking whether shortfalls identified at our last review had been addressed to ensure that people using the service had their dignity maintained by sufficient numbers of staff.

People were very positive about living at the service and told us they experienced comfortable relationships with the staff. Their comments included, “I can do what I want and the staff are kind and friendly”; “staff know what to do when I get unwell”; “The food is okay and we have a choice”; “yes I feel cared for and respected”; “I am able to go where I please and get up when I want to”; “They have made a change at breakfast time and everyone comes downstairs – it works ok and I can go for breakfast when I want”; “There seems to be enough staff and they come when I call”; “They are always busy but there if I need them”.

We talked to eleven people who use the service, and also observed the care of some. Comments received included, “I’m happy here. I tell them what I think ”; “They provide “total care. They are my angels”. A service user told us that staff attended immediately when she pressed her buzzer for help.

We also spoke to five sets of visitors who were related to five service users living in the home. Some were very complimentary about the care but several sets of visitors were concerned that whilst their relatives’ health care needs were well looked after, they frequently observed that there were no staff around in the lounges when they visited; that service users could be heard calling for help to go to the toilet and were either ignored or told to wait.

Several visitors said that their relatives were frequently wearing other people’s clothes or other people had their relatives’ clothes on. One visitor said they had often found that their relative was not wearing underwear and had had to prompt staff about this. Another said they found their relative wearing clothing with dried drinks spill on. Another said their relative often needed a shave.

We were also told, “Some carers complain to us about service users ringing the buzzer (for help) which I don’t think is very professional but another of the carers is spot on with everything”. Another visitor said, “It’s overall good care and I would not consider anywhere else. It is consistently good”.

Visitors told us that their relatives were receiving good care in terms of their health and wellbeing, including the support they needed with nutrition, skin care, moving and transferring and medication. They told us service users see doctors and other specialist medical staff when needed and receive routine check ups from opticians, dentists, etc. One visitor said she finds the care of her relative very good with very good attention to her fluid and food intake, care of her skin and general wellbeing. Another described their relative’s complex needs and said they needed a lot of support from staff which they received and his skin and nutrition was looked after well. One visitor commented that she had chosen this home to care for her relative because it had been rated as excellent (in 2008) and did not disagree with this and found the care “consistently good”.

Other service users and visitors were also happy with the care and treatment provided although one set of visitors said they thought the care provided had deteriorated and said that they had not always been kept informed of hospital appointments, which meant they had not been able to support their relative with this.

People who live here and their visitors were asked what they would do if they had a concern or complaint. All were clear that they would raise any concerns with the manager. Some said they had done this and received a satisfactory resolution to the issues they raised; others said they had not received any outcome to the concerns they raised although they knew that their concerns had been logged. A comment was received that the manager “says the right things but does not always carry through”.