CQC report explained · a nursing home
What the CQC found at St George's Nursing Home
Rated Good: inspectors found the home performing well and meeting their expectations.
What inspectors found, June 2023
St George's Nursing Home is rated Requires Improvement; inspectors found kind care and enough staff, but gaps in care planning, medicines checks and records continued.
This was an unannounced focused inspection on 22 March 2023. Inspectors checked whether earlier problems had been fixed. They observed care, spoke with the manager and six staff, contacted eight relatives, and reviewed care and medicines records.
People were supported by kind staff and there were enough staff to meet people's needs safely. Staff training, supervision, nutrition support, healthcare support and infection control were found to be effective. The effective rating improved from Requires Improvement to Good.
However, care plans did not give enough detail about some clinical needs, including catheter care. Medicines checks were not strong enough, and records did not always show what support staff had provided. The home remained in breach of regulations about safe care and treatment and good governance. Safe and well-led were both rated Requires Improvement.
Kind, respectful care
Inspectors saw staff treating people with kindness and respect. Relatives also described staff as caring and attentive.
“People were supported by staff who were kind and caring in their approach and understood people's individual needs well.” from the report
Enough staff
Inspectors found enough staff to meet people's needs safely. Call bells were answered promptly and staff supported people during the midday meal.
“With the recent recruitment drive, there were sufficient staff to meet the needs of people in the home.” from the report
Training and supervision
Staff received training and one-to-one supervision to help them carry out their roles effectively.
“Staff received good training and support to help them carry out their roles effectively.” from the report
Improved effectiveness
The effective rating improved from Requires Improvement to Good. Inspectors found support with eating, drinking, weight monitoring and access to healthcare.
“At this inspection the rating has changed to good.” from the report
Activities
Organised activities took place, and inspectors saw people engaging with and enjoying them.
“There were organised activities taking place and people appeared to be engaged and enjoying these.” from the report
Incomplete clinical care plans
seriousCare plans for three people with catheters did not clearly explain how staff should provide catheter care or reduce infection risks. This was a continued breach of Regulation 12.
“We checked care plans for 3 people with catheters in place and these lacked clear information about how the person's needs should be met.” from the report
Medicines checks
seriousMissed signatures had not been followed up, and an audit recorded that medicines were signed at the time even though staff were signing retrospectively. This was included in the Regulation 12 breach.
“Missed signatures on medicines administration records (MAR) had been identified but there was no evidence this had been followed up with the members of staff concerned.” from the report
Incomplete care records
seriousRecords did not always show what action staff had taken after weight loss or changes in a person's presentation. Welfare check records also had gaps, making wellbeing difficult to track.
“Records relating to people's care did not always fully document what action had been taken to support a person.” from the report
Previous problems not fully fixed
seriousThe provider's governance systems had not fully addressed breaches found at the previous inspection. This was a continued breach of Regulation 17.
“Breaches of regulation found at our last inspection had not been fully addressed, which meant there was a lack of effective and prompt response to concerns being identified.” from the report
Communication with relatives
needs fixingSome relatives said they were not always confident they would be told about changes in a person's health or behaviour. One relative also reported delays with heating and maintenance.
“Comments from some relatives indicated there were times when communication could be improved.” from the report
- 01What specific instructions are now in place for catheter care, including keeping the area clean and reducing infection risks?
- 02How are missed medicines signatures and retrospective signing now identified, investigated and followed up?
- 03How will you make sure records show all actions taken after weight loss, confusion or other changes in a person's wellbeing?
- 04How are gaps in welfare check records being prevented and reviewed?
- 05How will relatives be told promptly about changes in a person's health or behaviour and about maintenance problems?
This was a focused inspection checking earlier breaches, with infection prevention and control also reviewed; only Safe, Effective and Well-led were rated in this report. This explanation was written from the published report of 29 June 2023 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, December 2022
Requires Improvement; inspectors found kind care and good healthcare support, but care planning, incident monitoring and leadership systems were not reliable enough.
The inspection was unannounced and took place on 17 and 19 October 2022. Inspectors spoke with managers, staff and relatives, observed care, reviewed four people's care records and checked other documents.
The home was not always keeping people safe. Some care plans did not give staff enough detail about risks linked to catheters and stomas. Accident and fall records did not always show what follow-up had taken place. Medicines checks also needed improvement.
Relatives were generally positive about the care. People were treated kindly, received support with food and drink, and were helped to access healthcare. However, records about best-interest decisions were not always complete, and people were not always weighed regularly.
The overall rating changed from Good in March 2020 to Requires Improvement. There were breaches of Regulation 12 on safe care and treatment and Regulation 17 on good governance. The current managers had started an action plan, but CQC said it would monitor whether improvements were made.
Kind support
Inspectors saw staff supporting people kindly during a meal. Relatives also described staff as kind and said people received good care.
“We observed a meal time and saw that people received good, caring support from staff.” from the report
Healthcare support
Relatives said people received appropriate healthcare when needed. Staff worked with healthcare professionals and specialist nurses.
“Staff worked with healthcare professionals as necessary to meet people's needs.” from the report
Infection control
Inspectors were assured about infection prevention, the use of protective equipment and the home's response to infection risks.
“We were assured that the provider was using PPE effectively and safely.” from the report
Managers had started improvements
The manager and clinical manager had identified problems and created an action plan. They were open with inspectors about the areas needing attention.
“There was clear evidence that action was now being taken to improve the home.” from the report
Incomplete care plans
seriousCare plans did not always give staff clear instructions for managing risks. Inspectors found missing or insufficient information about catheter and stoma care.
“People were not always protected from the risks of unsafe care because care planning was not always adequate.” from the report
Inconsistent consent records
needs fixingRecords did not always show that people had consented to sensor mats or that capacity assessments had been completed properly.
“We saw some evidence of the MCA being put in to practice, however this was inconsistent and not always robust; improvements were required.” from the report
Weak oversight during management changes
seriousThe home had experienced changes of management over the previous year. Its monitoring systems did not identify important safety and quality problems.
“Governance systems had not been robust through changes of management.” from the report
- 01How have you improved care plans for people with catheters, stomas or other clinical risks?
- 02How do you now record and review falls, accidents and incidents, including the follow-up action taken?
- 03What new checks are in place for medicines, including stock checks?
- 04How do you record consent and mental capacity decisions for sensor mats and other safety measures?
- 05How will you tell families when a fall or other concern happens, and what progress has been made on the action plan?
This was an unannounced focused inspection of Safe, Effective and Well-led, including infection prevention and control; the report does not give new detailed findings for Caring or Responsive. This explanation was written from the published report of 1 December 2022 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of St George's Nursing Home
6 rated inspections over 8 years: the service has held its Requires improvement rating throughout.
- June 2023Requires improvementcurrent ratingstayed Requires improvementSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- December 2022Requires improvementdown from GoodSafe: Requires improvementEffective: Requires improvementWell-led: Requires improvement
- March 2020Goodup from Requires improvementSafe: GoodEffective: GoodWell-led: Good
- January 2019Requires improvementdown from GoodSafe: Requires improvementEffective: GoodCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- June 2016Goodup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- July 2015Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- September 2014
Report published without a new overall rating.
- October 2013
Report published without a new overall rating.
- June 2013
Report published without a new overall rating.
- December 2012
Report published without a new overall rating.
- June 2012
Registered with the Care Quality Commission on 11 June 2012.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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