Gillibrand Hall Nursing Care Home

Gillibrand Hall Nursing Care Home is a residential care home providing personal and nursing care to 47 people at the time of the inspection. The service can support up to 50 people.

Gillibrand Hall Nursing Care Home is a listed building and care is split over 2 floors. There are large, comfortable communal areas and a good amount of outdoor space.

People’s experience of using this service and what we found

People were at risk as systems to manage medicines were not always effective. The fire service identified actions required to make sure people were protected from the risk of fire, and this was ongoing. We have made a recommendation about fire safety. People were cared for by regular staff that knew them well, however the knowledge of agency staff was not as good. People and their relatives said they felt safe and well cared for and staff said they would recommend the home to others. The home was clean and tidy, and staff learned lessons if things went wrong.

People enjoyed living at the home and there were lots of opportunities for social contact. The home had its own transport to support people to go out and take part in local events regularly.

People were supported by staff that were caring and mindful of dignity, and people told us that staff treated them with respect. People were involved in their care and relatives spoke highly about staff.

Not all areas of governance were embedded, such as in relation to regulatory requirements and we have made a recommendation about this. There was a positive culture in the home and people living at the home and their relatives were positive about their care. The registered manager engaged with people and their relatives well and arranged regular team meetings.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 19 January 2021).

Why we inspected

We looked at infection prevention and control measures under the safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We received concerns relating to people’s dignity and respect. As a result, we undertook a focused inspection to review the key questions of safe, caring and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

Although we found no evidence during this inspection that people were at risk of harm from this concern, we have found evidence that the provider needs to make improvements. Please see the safe key question of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Gillibrand Hall Nursing Care Home on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified a breach in relation to the safe management of medicines at this inspection. The provider has taken steps to mitigate the risks, which we will review.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Gillibrand Hall is a care home providing personal care, nursing care and accommodation for up to 50 people. At the time of this inspection there were 47 people living in the home.

We found the following examples of good practice.

The home facilitated face to face visits, in line with government guidance. The registered manager told us this was essential to help support people's psychological and emotional well-being. Alternatives to in-person visitation, such as virtual visits, were also supported.

A ‘booking in’ procedure was in place for all types of visitors to the home including, a health questionnaire and evidence of a negative lateral flow test. This helped prevent visitors spreading infection on entering the premises.

People and staff were tested regularly for COVID-19. Staff employed at the home had been vaccinated, to help keep people safe from the risk of infection.

Infection control policies and audits were in place however they needed to be reviewed to ensure they home reflected best practice and current guidance.. We signposted the service to the local Infection Prevention and Control at the local authority for additional support and guidance.

The home was clean and well maintained. Cleaning schedules and audits were in place to help maintain cleanliness and minimise the spread of infection.

Staff were trained and competent in infection prevention and control best practices and how to put on and take off PPE. However, we noted there were no posters around the home to act as a visual reminder and prompt for staff and visitors on infection prevention and use of personal protective equipment (PPE). The home had adequate supplies of appropriate PPE.

The registered manager maintained links with external health professionals to enable people to receive the care and intervention they needed. Virtual consultations took place as and when necessary.

Gillibrand Hall is a care home providing personal care, nursing care and accommodation for up to 50 people. At the time of this inspection there were 45 people living in the home.

People's experience of using this service and what we found

People received safe care from suitably trained and qualified staff. People's relatives were confident they were safe in the home and praised the high quality of care staff provided.

People were supported to mobilise safely. Staff understood which equipment people needed to support them and followed the risk assessments in people's care records.

People had enough to eat, relatives praised the quality of the food. Snacks were available at all times. People's weight was closely monitored and referrals had been made to health professionals when required.

People were protected from the risk of infection and contamination. There were effective cleaning schedules in place, the home appeared very clean and hygienic. The provider maintained the building and managed environmental risks which included clinical waste and pest control.

The home was well managed and organised. Relatives praised the management of the home.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 6 March 2019) The overall rating for the service has remained the same. This is based on the findings at this inspection.

Why we inspected

We received concerns in relation to safe care and treatment, infection prevention and control and access to food. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection. We found no evidence during this inspection that people were at risk of harm from these concerns. Please see the safe and well-led sections of this full report.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Gillibrand Hall is a ‘care home.’ People in care homes receive accommodation and nursing or 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. Gillibrand Hall is a listed property set in its own grounds. It is located in a residential area, close to the town of Chorley. The home provides residential and nursing care for up to 50 people and at the time of inspection 50 people were living there. Accommodation is set on two floors. This includes accommodation for people with nursing needs and the first floor provides care specifically for people who live with dementia. There are a range of aids and adaptations in place to meet the needs of people using the service.

The service had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered provider, they are 'registered persons.' Registered managers 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 registered manager was supported in the day to day running of the service by a deputy manager.

At our previous inspection on 2 June 2016, the service was rated as ‘good.’ At the last inspection the overall rating had remained good, but some improvements to ensure that the service remained consistently safe.

We looked at how the service managed recruitment and found that this was not always safe. We noticed that staff had only been requested to provide a ten-year history of employment. This meant that not all checks had been carried out in line with the current regulations. We raised this with the provider who amended all application forms to capture a full employment history.

Medicines were not always safely handled. Although we found areas of good practice during inspection we had concerns about the safe temperature storage of medication. We found the daily maximum and minimum temperatures were out of range on one fridge and there were issues around this being reset. This was dealt with swiftly on inspection and a new fridge was delivered.

During a tour of the building, we found sliding bolts on the outside of some bedroom doors. We raised this as a concern and requested that they be taken off the doors immediately as this was unacceptable. This was actioned immediately.

Assessments of environmental risks and equipment had been undertaken to ensure people’s safety and well-being. However, although work was currently being completed regarding re-wiring the service, we found that the electrical safety certificate for the service was out of date. We raised this with the provider who promptly arranged for the electrical safety check to be carried out. The provider told us that extensive work was being carried out and this was the reason for the delay.

All of the people we spoke with at the home, told us they felt safe. Staff knew how to keep people safe. Training in safeguarding adults had been undertaken and staff were clear about their responsibilities to report any concerns. The service also had a safeguarding champion, who staff could access for additional support.

The home was exceptionally clean and all staff had received training in infection control and were aware of their responsibilities in relation to this.

Specific risk assessments regarding individuals had been thoroughly undertaken and risk was managed well. The service had protocols in place in the event of vulnerable people going missing from the service.

Assessments of need were comprehensive and people’s needs were considered before they came to live at Gillibrand Hall. We saw evidence of person centred care plans developed to meet their needs.

Staff had time to care. The service encouraged staff to spend protected time getting to know people and their likes and preferences. People we spoke with and their relatives told us there was always enough staff on duty. We reviewed the staffing rotas and found the staffing levels to be sufficient to meet the individual needs of the people being cared for in the home.

People received care from staff who were compassionate, kind and caring and people were treated with dignity and respect. Staff understood people’s preferences and knew what mattered to the people they cared for. People were encouraged to be as independent as possible with support from staff. There was a welcoming and homely atmosphere at the service.

People were supported by well trained, competent staff, who received regular support and supervision.

People were supported to have maximum choice and control in their lives and staff supported them in the least restrictive way possible; the policies and the systems in the service supported this practice. The principles of the Mental Capacity Act (MCA) were followed.

Changes in people’s health were identified and appropriate referrals to health professionals were made. People had sufficient amounts to eat and drink and their nutritional and hydration needs were well met.

People had opportunities for social engagement and activities, regardless of the level of disability. People told us that they were stimulated at the home and we observed people with profound needs benefiting from sensory experiences in the Namaste suite.

People were complimentary about the management team and the staff felt valued and well supported.

Systems were in place to support people to raise any concerns or make any complaints and we saw that the service learned from mistakes. We saw that a wide range of auditing and monitoring was carried out by the registered manager and staff at head office on a monthly basis.

Gillibrand Hall is a listed property set in its own grounds. It is in a residential area close to the town of Chorley. The home provides residential and nursing care for up to fifty people. Accommodation is set on two floors. This includes accommodation for people with nursing needs and the first floor provides care specifically for people who live with dementia. There are a range of aids and adaptations in place to meet the needs of people using the service.

The service had a registered manager in place. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

All of the people we spoke with who lived at the home told us that they felt safe.

We spoke with staff about the home’s safeguarding procedures. They were all aware of the provider’s safeguarding policy and how to report any potential allegations of abuse or concerns raised and were aware of the procedures to follow.

We looked at recruitment processes and found the service had recruitment policies and procedures in place to help ensure safety in the recruitment of staff.

People we spoke with told us they felt there were always enough staff on duty, as did all the relatives we spoke with. We observed staffing levels to be sufficient on the day of our inspection and reviewed staffing rotas for the previous two week period to our inspection. We found staffing levels to be sufficient to meet the needs of the people in the home.

The home had a medicines management policy in place, which included procedures for the administration, disposal, refusal and storage of medicines. We observed two members of staff administering medicines and found they did so in line with best practice guidance. Both members of staff told us that they were regularly tested for competence for administering medicines and we found evidence of this when reviewing training records.

Relatives we spoke with told us they thought staff were well trained, competent and cared about the people living at the home.

We observed staff to be patient with people and understanding of their needs and how people’s behaviour was affected due to them living with dementia. It was obvious that staff knew the people they cared for well and knew how to calm people if they became agitated.

We checked whether the service was working within the principles of the Mental Capacity Act 2005 (MCA), and whether any conditions on authorisations to deprive a person of their liberty were being met. We found the provider was working in line with the key principles of the MCA.

We saw that staff attended regular training via the staff training matrix and found staff to be knowledgeable about their role. We found evidence within staff files of training undertaken.

People told us that staff respected their privacy and treated them with dignity. We observed staff interactions with people during our inspection and found them to be warm and compassionate. Staff were friendly, patient and were discreet when providing personal care interventions.

Relatives we spoke with said they could visit the home whenever they wished to without restriction. They told us that staff called people by their first name and knew the people they were caring for well.

People we spoke with and their relatives told us they knew how to raise issues or make complaints. They also told us they felt confident that any issues raised would be listened to and addressed.

We examined the care files of six people who lived at the home. We found documentary evidence to show that people had their care needs assessed by the home and by external healthcare professionals prior to moving to the home. We found people’s plans of care to be person centred, which outlined clear aims, objectives and actions to be taken.

People told us that activities were provided, which people got involved with. There was evidence of recent activities taking place, both within and outside the home, on display.

We spoke with people who lived at Gillibrand Hall about the management and culture within the home. The responses we received were positive.

We spoke with senior managers of Century Healthcare during our inspection including the organisation’s Managing Director (MD). They told us that they were very happy with the staff team and the current staffing and management structure.

We saw that a wide range of audits were carried out at the home. All auditing and monitoring was sent to the organisation’s head office on a monthly basis and this information was analysed and any actions identified were sent back to the home manager.

A wide range of updated policies and procedures were in place at the home, which provided the staff team with current legislation and good practice guidelines.

We considered our inspection findings to answer questions we always ask;

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well-led?

This is a summary of what we found -

Is the service safe?

We looked at staff rotas and discussed staffing levels with the manager at the home. We found that there were systems in place to ensure that staffing levels were sufficient to meet the needs of the people living at Gillibrand Hall. Observations throughout the day showed that staff were able to meet the needs of the people living at the home on the day of our inspection.

Is the service effective?

We found evidence of the involvement of, and referral to, other professionals such as the speech and language therapy service, incontinence service, GP's and opticians.

Is the service caring?

We spoke with three people who lived at the home and two visiting relatives. All the people we spoke with were positive about their, or their loved ones, experience of living at the home. Some of the comments we received were as follows;

"Staff are all very helpful and very nice. If I want any help I just have to ask."

"It's more than alright here, I get well looked after."

"As far as the care is concerned (name) is doing great. I'm a frequent writer and I'm impressed."

"Staff don't get flustered. they have plenty of sympathy and concern for the people living here."

Is the service responsive?

The home had a 'key-worker' system in place which meant that people had named staff members to bring up issues with and staff were able to get to know people and their needs in detail. Staff we talked with were able to name and talk about the people they were a key-worker for.

Is the service well-led?

We were shown a copy of the audit tool used by the manager and discussed its use with them. The audit tool covered a wide range of issues such as care plan contents, risk assessments, Deprivation of Liberty (DOLs) screening, activities and communication with relatives and carers. In addition to this tool weekly medication audits were carried out and the area operations manager carried out a bi-monthly audit of the home.

Care plans showed that people's care was delivered in a person centred way and that their likes and dislikes were noted and recognised by staff. From speaking to staff, looking at their personnel files and staff training files it was apparent that staff felt supported and had the opportunity to develop.

The provider had an effective system in place to identify, assess and manage risks to the health and safety of people using the service and others.

Staffing levels were found to be sufficent to ensure the safety of residents at all times throughout the day and night. A suitable system was in place to ensure that residents needs were catered for with extra staff being introduced if needed.

We spoke with a range of people including the manager, staff, residents and visitors. We did this to gain the views of people who used the service.

People we spoke with told us they liked living there, comments included, "Oh yes everybody is very helpful,' and, 'It's a busy home there's always something going on.' Also, 'A lot of things have been planned for Christmas.'

People who used the service told us staff treated them with dignity and respect. They told us they had time to spend with residents and help them with personal tasks. One person told us, 'I am happy here, everyone is very helpful.'

We spoke with eight staff members to gain their views about how they provided care and support. They told us they liked working at the home and said they worked well as a team. Comments included, 'Worked here for a long time, it is a really nice place to work.' Also, 'We get a lot of satisfaction working with the residents, they are all very different.' Another staff member told us, 'There are enough of us to do the work. We also have time to spend with individual residents. They like the time we have with them.' In general staff told us they worked in sufficient numbers to meet the needs of people who lived there.