Gibraltar Road Nursing Home

About the service

Gibraltar Road Nursing Home is a nursing care home providing personal and nursing care to 8 people at the time of the inspection. The service can support up to 10 people.

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

Right Support: 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. The provider acknowledged they were undertaking a thorough review of the service. The provider had a plan to improve the service’s systems and processes. The provider was working closely with local authority partners in the development of their service improvement plan.

Right Care: People received person-centred care. Staff respected people's rights and treated them with privacy and dignity. People had care plans and risk assessments in place, however, these were not always up to date. This meant people were at increased risk of not always receiving safe care and treatment. The registered manager was open and transparent about work being done to update care plans and risk assessments. The registered manager had a plan to ensure care plans and risk assessments were routinely reviewed and kept up to date.

Right Culture: The culture of the service supported people and staff in an inclusive way; enabling people to live their day-to-day lives as they chose to. Staff told us that the culture of the service had greatly improved as a new team had been formed. However, quality assurance systems to assess and monitor the service were not always being routinely used and CQC was not always being sent notifications as required. Notifications are communications informing CQC about events the provider needs to tell us about. This meant the provider did not have enough of an oversight of the service to ensure it was being managed safely and quality maintained. Therefore, we could not be assured people always receive high quality care. The registered manager had a plan to ensure the necessary quality assurance systems were in place.

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 10 September 2019).

Why we inspected

We received concerns in relation to governance, care planning, risk management, health action plans, mental capacity assessments and best interest decisions, staffing and medicines management. A decision was made for us to inspect and examine those risks. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

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.

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.

We have found evidence that the provider needs to make improvements. Please see the safe and well led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

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

Enforcement

We have identified breaches in relation to good governance at this inspection.

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.

We found the following examples of good practice.

The premises looked clean. Hand sanitisers and PPE stations were situated throughout the building.

Staff were observed wearing appropriate PPE. There was prominent signage and instructions to explain what staff should do to ensure safety.

Alternative forms of maintaining social contact were used for friends and relatives; for example: keeping in touch using video calls.

The service had laundry processes in place so clothes were not mixed and washed together.

Further information is in the detailed findings below.

Gibraltar Road accommodates up to eight people in one adapted building. Another two people are accommodated in an attached but self-contained annex. At the time of our inspection there were eight people living in the main house and two in the annex.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

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

People said they were happy living at Gibraltar Road. Staff were able to recognise and knew how to report safeguarding concerns. Risks were managed based on people’s specific needs and staffing levels ensured people were safe.

The service had achieved the platinum award for the Gold Standards Framework which ensures end of life care is the best it possibly can be for people.

Medication and infection control practices were safe and followed necessary guidelines. People accessed external health and social care services when needed. Best practice guidance was followed and adhered to by the service. Staff had sufficient supervision and regular training to ensure their knowledge was current.

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.

People received appropriate support with eating and drinking, and the registered manager and staff ensured communication flowed well. The home was in the midst of planning an extensive refurbishment programme.

Care documentation reflected people’s needs and was pictorial and easy read when referring to people’s outcomes. Many people had enjoyed recent holidays.

Staff interacted with people well and were kind and sensitive in their approach. The atmosphere was calm and relaxed, and there was a good deal of laughter and enjoyment. The registered manager understood the needs of people well and encouraged the staff team to develop.

Robust quality assurance systems ensured quality was constantly being reviewed and any improvements were actioned promptly.

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

Rating at last inspection – Requires improvement (9 August 2018)

Why we inspected

This was a planned inspection based on the previous rating.

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.

The last inspection of this service took place in May 2016. We did not identify any breaches of regulation at that time and rated the service as Good.

Gibraltar Road Nursing Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Gibraltar Road Nursing Home is run by the Mayfield Trust which is a registered charity.

Gibraltar Road accommodates up to eight people in one adapted building. Another two people are accommodated in an attached but self-contained annex. At the time of our inspection there were eight people living in the main house and two in the annex.

Gibraltar Road aims to work in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

There was a registered manager in post. This person had been registered as the manager for the service since 2010. 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.

People felt safe at Gibraltar Road Nursing Home and staff knew what to do if they though anybody was at risk. People received their medicines appropriately but some improvements were needed in the management of medicines. Risks to people were assessed and managed. Staffing levels met people’s needs. Environmental risks were not always recognised or managed well.

Staff received good levels of training and said they were well supported by the registered manager. People received a diet suitable to their needs and preferences although the mealtime experience varied in quality. People's rights were upheld through adherence to the Mental Capacity Act and associated legislation although we noted relevant people were not always involved in best interests meetings.

People told us they felt well cared for and we observed a kind, caring and friendly approach from staff. Staff knew people well. Care records in relation to people’s communication needs were variable in quality. Appropriate action had not been taken to support a person in meeting their spiritual needs.

Care was planned with a person centred approach and where possible people were involved in this. People were supported to engage in activities within and outside of the home including an annual holiday. However individual activity planners lacked detail and evidence of weekly review and people had not always been supported effectively in meeting their goals. The service had not received any complaints but compliments received were shared with staff. The user friendly complaints procedure would have benefitted from additional pictorial information.

People, staff and relatives had confidence in the registered manager and we saw they had systems in place to review the quality and safety of the service. Issues and changes of personnel at a higher management level and the need for the registered manager to support other of the provider’s services, had affected the overall governance of the service. We were assured of and saw evidence that these issues were being addressed.

Gibraltar Road Nursing Home is a converted property which provides accommodation and nursing care for up to nine people with a learning disability. There are seven bedrooms in the main house and two in the bungalow. All of the bedrooms are single occupancy. The main house has two lounges and a dining room and the bungalow has its own communal space and kitchen.

At the time of our visit there were nine people using the service.

There is a registered manager in post. 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.

People told us they felt safe in the home. Staff had a good understanding of how to control risks to people’s health, safety and welfare.

Staff were recruited safely and there were enough staff on duty to provide people with the care and support they needed. Staff received appropriate training, supervision and support.

We saw staff knew people well and there was a warm and relaxed atmosphere in the home. People were supported to follow their interests in the community and a wide range of activities. Staff supported people to be as independent as possible and we saw people helping clear the tables after lunch.

Care and support plans were individualised and focused on what each person wanted to achieve and what support they required from staff.

We found people had access to healthcare services and these were accessed in a timely way to make sure people’s health care needs were met. The medication system was well managed and people received their medicines at the right times.

People told us meals were good and we saw the menus provided both choice and variety.

Gibraltar Road Nursing Home was well maintained and homely. People’s bedrooms were personalised and we found everywhere was clean and tidy.

We found the service was meeting the legal requirements relating to Deprivation of Liberty Safeguards (DoLS).

We saw there were systems in place to monitor the quality of the service. When areas for improvement were identified action was taken to address any shortfalls. People using the service were asked for their views and staff responded to their requests.

Is the service caring?

Is the service responsive?

Is the service safe?

Is the service effective?

Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people who used the service, their relatives, staff supporting them and from looking at records.

Is the service safe?

Systems were in place to make sure that managers and staff learnt from events such as accidents and incidents and concerns. This reduced the risks to people and helped the service to continually improve.

The medication system was well managed and people received their medication at the right times.

The registered manager sets the staff rotas, they take people's care needs into account when making decisions about the numbers, qualifications, skills and experience required. This helps to ensure that people's needs are always met.

Is the service effective?

People's health and care needs were assessed with them or their relatives, and they were involved in writing their plans of care.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people.

A relative told us; 'My relative couldn't be in a better place. The staff are so caring and interested in their life. Everyone is always welcoming and I am kept up to date about their health.'

People's preferences and interests had been recorded and care and support had been provided in accordance with people's wishes.

Is the service responsive?

People completed a range of activities in and outside the service regularly, which helped to keep people involved with their local community.

Is the service well-led?

One relative said; 'The manager has people's best interest at heart.' The three members of staff we spoke with said they were confident in the manager's abilities. They all said the manager listened to them and worked in a very 'hands on' way.

The service has a quality assurance system, records seen by us showed that identified shortfalls were addressed promptly. As a result the quality of the service was continuingly improving.

People who were able told us that they enjoyed living at Gibraltar Road, liked the staff and going out.

We used a number of different methods to help us understand the experience of people using the service, because some people using the service had complex needs which meant that they were not able to tell us their experiences. For example we observed that the atmosphere within the home was relaxed and friendly and people appeared happy and well looked after.

People who were able told us that they enjoyed living at Gibraltar Road , liked the staff and their bedroom.

One person said 'I like going out and staff take me shopping. I am looking forward to my holiday in Filey. I like everyone here.'

We also looked at recent surveys that people living in the home had completed, these were some of the comments:

'I am quite happy here with the way staff treat me.'

'My life is alright, I make all the choices I want. I like my bedroom a lot.'