We carried out a review of the data available to us about Gilby House Nursing Home on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Gilby House Nursing Home, you can give feedback on this service.
Gilby House Nursing Home is a care home registered to provide accommodation, personal and nursing care for up to 22 people with mental health needs in one adapted building. At the time of our inspection, 21 people lived at the service.
People’s experience of using this service and what we found
A system was in place to monitor the quality and safety of the service, however these were not always effective in identifying and addressing issues.
We have made a recommendation in relation to capturing information to support service delivery.
Analysis of incidents were not always completed to identify any lessons learnt.
We have made a recommendation in relation to evidencing lessons learnt as a result of falls and incidents.
People were happy with the care they received, they felt safe and well looked after. Staff had been recruited safely. There were enough staff on duty who were provided with the appropriate training to enable them to
carry out their roles effectively.
People were supported to take their medicines safely as prescribed.
Staff received training in safeguarding and followed clear guidance which helped to protect people from abuse.
Care plans included risk assessments for known risks and staff followed support plans to help keep people safe. Care plans were up to date, risk assessments were in place and regularly reviewed.
The home was clean and tidy and additional cleaning ensured people were safe from the risk of infection.
People were regularly asked their views on the service provided and action had been taken when suggestions were made.
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 7 July 2021).
Why we inspected
This inspection was prompted by a review of the information we held about this service.
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.
This report only covers our findings in relation to the Key Questions safe, effective and well-led which contain those requirements. 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 remained good. This is based on the findings at this inspection.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Gilby House on our website at www.cqc.org.uk.
Follow up
We will continue to monitor information we receive about the service, which will help inform when we next inspect.
Gilby House Nursing Home is a care home registered to provide accommodation and personal and nursing care to 22 people with mental health needs. At the time of our inspection, 21 people lived at the service.
People’s experience of using this service and what we found
People were happy with the care they received, they felt safe and well looked after. Staff had been recruited safely. There were enough staff on duty who were provided with the appropriate training to enable them to carry out their roles effectively.
The home was clean and tidy; additional cleaning ensured people were safe from the risk of infection.
Care plans were up to date, risk assessments were in place and regularly reviewed.
People received their medicines on time and when they needed them. Staff had positive links with healthcare professionals which promoted people's wellbeing.
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 and staff spoke highly of the registered manager and their commitment to the service.
A system was in place which was used to monitor the quality and safety of the service. The registered manager carried out regular checks and analysis of incidents to ensure learning from events was shared with staff and actioned appropriately.
People were regularly asked their views on the service provided and action had been taken when suggestions were made.
For more details, please see the full report which is on the Care Quality Commission website at www.cqc.org.uk
Rating at last inspection (and update)
The last rating for this service was requires improvement (published 30 December 2020). There was a breach of regulation 17 (good governance) and regulation 12 (safe care and treatment). The provider completed an action plan after the inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulation 12 and regulation 17.
Why we inspected
We carried out an unannounced inspection of this service on 27 October 2020. A breach of legal requirements was found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment and good governance.
We undertook this focused inspection on 7 July 2021 to check the provider had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the key questions safe and well-led which contain those requirements.
The ratings from the previous inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from Requires Improvement to Good. This is based on the findings at this inspection.
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.
You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Gilby House Nursing Home on our website at www.cqc.org.uk.
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.
Gilby House Nursing Home is a care home registered to provide accommodation and personal and nursing care to 22 people with mental health needs. At the time of our inspection, 21 people lived at the service.
People’s experience of using this service and what we found
Areas of the service had not been properly maintained which meant people were not living in a well-cared for environment. Maintenance issues made it difficult to effectively clean the service. We found areas of the premises were dirty which placed people at risk of developing infections.
Not all risks to people’s safety and wellbeing had been identified and mitigated. Governance systems had failed to identify the shortfalls we found, which placed people at risk of harm and of receiving a poor-quality service.
People’s medicines were administered safely, and care plans contained appropriate guidance. Systems were in place to protect people from the risk of abuse. Safe recruitment checks were completed, and staff were allocated to people when they needed more support.
People’s needs were met by skilled and appropriately trained staff who worked closely with relevant professionals. People were supported with their own routines and care plans and their dietary needs were met.
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 were supported by caring staff who helped people to take part in activities they enjoyed. The management team supported and made time for people using the service and staff. People and staff were included in developing the service and were kept informed of changed to the service.
For more details, please see the full report which is on the Care Quality Commission (CQC) website at www.cqc.org.uk
Rating at last inspection and update
The last rating for this service was requires improvement (published 14 November 2019). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made and the provider was still in breach of regulations. The service remains rated requires improvement and has been rated requires improvement for the last two consecutive inspections.
Why we inspected
We carried out an unannounced comprehensive inspection of this service on 4 and 6 September 2019. A breach of legal requirements was found. The provider completed an action plan after the last inspection to show what they would do and by when to improve good governance.
We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the key questions Safe, Effective and Well-led which contain those requirements.
We reviewed the information we held about the service. No areas of concern were identified in the other key questions. The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service remains requires improvement. This is based on the findings at this inspection.
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 coronavirus and other infection outbreaks effectively.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Gilby House Nursing 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.
We have identified breaches in relation to ensuring the safety of the premises, infection control and quality assurance. Please see the action we have told the provider to take at the end of this report.
Follow up
We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
Gilby House Nursing Home is a care home registered to provide accommodation and personal and nursing care to 22 people with mental health needs. At the time of our inspection, 20 people lived at the service.
People’s experience of using this service and what we found
Risk’s relating to people’s mental health needs had not been appropriately assessed and management strategies were not clearly recorded. Quality assurance systems had failed to identify this. Staff completed cleaning tasks and felt this reduced the quality time they could spend with people. People told us there could be more activities.
People were happy with the service and the support provided by staff. One person said, “It's one of the best [care homes] I've been in.” People’s independence was promoted, and people achieved good outcomes. Staff respected people’s privacy and dignity and were professional when providing support.
People received their medicine as prescribed and were supported to access healthcare services when needed. People were positive about the food and their dietary needs were met. People could spend their time as they wished and could have visitors at any time.
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 and staff were included in the development of the service and kept informed of any changes to be made. Complaints were investigated in line with the provider’s procedure and senior managers were kept informed of important information. Staff were invested in, completed a wide variety of training and could develop their careers.
For more details, please see the full report which is on the Care Quality Commission website at www.cqc.org.uk
Rating at last inspection
The last rating for this service was good (published 22 March 2017).
Why we inspected
The inspection was prompted in part by notification of a specific incident. Following which a person using the service died. This incident is subject to a criminal investigation. As a result, this inspection did not examine the circumstances of the incident.
The information CQC received about the incident indicated concerns about the management of ligature risks. This inspection examined those risks.
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.
The provider was working to address areas of risk in the environment. Some changes had been made to manage the risk of ligature points and an action plan was in place to support with addressing this.
Enforcement
We have identified a breach in relation to identifying, assessing and managing risks at this inspection. Please see the action we have told the provider to take at the end of this report.
Follow up
We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
This unannounced inspection took place on 3 February 2017. The last comprehensive inspection of the service took place in May 2016. At that time the service was in breach of three regulations pertaining to delivering safe care and treatment, obtaining consent and working in line with the principles of the Mental Capacity Act and the operation of good governance systems. The overall rating was ‘Requires Improvement’. We completed a focused inspection in August 2016 to check that improvements had been made and that the service had achieved compliance with the regulations. We found evidence to confirm satisfactory improvements had been made and the service was fully complaint. We did not change the overall rating for the service because to do this required evidence of sustained improvements over time.
The service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.
Records showed that staff had undertaken a range of training to ensure they could carry out their roles effectively. However, we saw training deemed as service specific by the registered provider had not always been completed. Staff told us they were supported in their roles but we saw that they had not received supervision in line with the registered provider’s internal policies. Staff had not received an annual appraisal in 2016. The registered provider was aware of these shortfalls and action had been taken to rectify them. This included, the registered manager and clinical lead being booked onto a ‘delivering effective supervision and appraisal’ training [which was completed shortly after the inspection concluded], staff being booked onto service specific training and a supervision planner being created to ensure they received supervisions and appraisals in accordance with the registered provider’s policies.
We saw that the service had achieved very high rates of compliance through the registered provider’s audits completed by the registered manager. The registered manager and regional director informed us that the audits required development to ensure they were fit for purpose and could be used to drive improvements within the service.
People who used the service were protected from abuse and avoidable harm by staff who had been trained to recognise the signs of potential abuse and knew what action to take if they suspected abuse had occurred. People were supported to take positive risks in their lives and action had been taken to promote their safety.
People were supported by suitable numbers of staff to meet their assessed needs. Throughout the inspection we saw people received care and support in a timely way. Staff had been recruited safely. We saw evidence to confirm before prospective staff were offered a role within the service suitable references and a DBS check were obtained.
People who used the service received their medicines as prescribed. Safe arrangements were in place for the ordering, storing, administering and destruction of medicines.
Staff gained people’s consent before care and support was delivered. Staff we spoke with understood the principles of the Mental Capacity Act 2005 which were adhered to. The registered manger had made Deprivation of Liberty Safeguards applications which helped to ensure people were not restricted unlawfully and the support they received was the least restrictive option.
People ate a balanced diet of their choosing. Options were available at each meal and we saw that people could request drinks and snacks and help themselves to cold beverages at any time. People’s individual dietary requirements were known and catered for. When concerns with people’s dietary intake or general health were identified relevant professionals were contacted without delay.
It was clear staff had developed supporting relationships with the people who used the service and knew their preferences for how care and support was to be delivered. People were treated with dignity and respect by staff and were encouraged to express their views. Staff supported people to enhance their levels of independence.
We saw that people’s needs were assessed before they moved into the service. People or their appointed representative was involved in the initial and on-going planning of their care. Care plans had been developed to guide staff how to deliver effective care and support in a consistent and safe way. The care plans we saw re-enforced the need for staff to encourage people to be as independent as possible and to treat them with dignity and respect.
People were encouraged to take part in activities within the service and supported to follow their personal interests outside of the service.
The registered provider had a complaints policy that was available in an easy read format to ensure it was accessible to the people who used the service. People who used the service told us they knew how to make complaints or raise concerns about their care.
The registered manager was aware of their responsibilities to report notifiable incidents to the Care Quality Commission. We checked the records held within the service against the information we held and found the registered manager had fulfilled their obligations and had reported specific events as required. The registered provider was aware of and took responsibility for the day to day management of the service.
The service did not have a registered manager in post. There had not been a registered manager at the service for over eight months. The service had been managed during this time by a number of managers and at the time of our inspection a registered manager form another of the registered provider’s services was managing the service.
The last inspection was completed in June 2014 and the service was found to be compliant with the regulations inspected at that time. This unannounced inspection took place on 6 and 9 May 2016.
The quality assurance systems utilised within the service were not effective. We found shortfalls in care and support that had not been detected by the internal audits and when areas for improvement were highlighted action was not taken in a timely way.
During a tour of the service we found concerns with infection prevention and control practices. There was no hot water available in a downstairs toilet and a first floor bathroom had numerous permeable surfaces which meant it could no longer be cleaned effectively. A legionella risk assessment had been completed in November 2015 and we saw there were immediate actions that had not been completed.
Medicines were not always stored safely. We found that temperatures in the medicines room had exceeded the manufacturers recommended guidelines. Failing to store medicines at appropriate temperatures could have an adverse effect on their potency. We found that the PRN (as required) medicine protocols lacked relevant information to ensure they were administered consistently by the nursing staff.
Some people who used the service were under a Deprivation of Liberty Safeguards (DoLS) because the care and support they required amounted to 24 hour supervision and control and was a deprivation of their liberty. We found evidence that the service had failed to support the person in line with the requirements and conditions of their authorised DoLS.
Staff knew the people they were supporting including the preferences for how care and support should be delivered. Staff described how they would tailor their approach to providing care to each person who used the service to meet their individual needs. People were treated with dignity and respect by staff during their interactions.
Care plans had been developed to meet the assessed needs of the people who used the service. However, some of the care plans we saw lacked depth and insight into how the person needed to be supported. We also found that when professionals directed staff to monitor people’s conditions appropriate action was not taken.
We have made a recommendation regarding the development of behavioural support strategies.
Staff had completed training in relation to the safeguarding of vulnerable adults. During discussions it was apparent that they were aware of their responsibility to report any abuse and poor care they became aware of. Staff were recruited safely and deployed in suitable numbers to meet the assessed needs of the people who used the service.
During discussions with staff they told us they felt supported in their role. The training matrix showed that staff had recently completed relevant training to ensure they had the skills and knowledge to carry out their roles effectively.
People who used the service received a balanced diet of their choosing and facilities were provided to enable them to help themselves to hot and cold drinks as well as breakfast cereals and snacks.
The registered provider had a complaints policy in place which was available in an easy read format to ensure it was accessible to the people who used the service.
The service had informed the Care Quality Commission of accidents and incidents as well as other notifiable events as required.
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. You can see what action we told the provider to take at the back of the full version of the report.
We carried out this unannounced focused inspection of the service on 22 August 2016. The inspection was carried out to check that the registered provider had made the required improvements and had achieved compliance with the regulations we identified as being in breach at the comprehensive inspection undertaken in May 2016.
At the comprehensive inspection carried out in May 2016 a tour of the service was undertaken and concerns with infection prevention and control practices were identified. A legionella risk assessment had been completed in November 2015 which identified that immediate actions were required; we saw these had not been actioned. Hot water was not available in one of the downstairs toilets and a bedroom.
During this focused inspection we found that a programme of refurbishment had been completed and all permeable surfaces had been replaced or removed. The immediate actions identified in the legionella risk assessment had been appropriately actioned.
At the comprehensive inspection carried out in May 2016 we reviewed the medicines management within the service and found medicines were not always stored safely and PRN (as required) medicine protocols lacked relevant information to ensure they were administered consistently by the nursing staff.
During this focused inspection we found improvements had been made to the medicine storage facilities and that PRN protocols had been updated in line with the National Institute for Health and Care Excellence guidelines.
At the time of our comprehensive inspection carried out in May 2016 a number of people who used the service were subject to a Deprivation of Liberty Safeguards (DoLS) because the care and support they required amounted to 24 hour supervision and control. We found evidence that the service had failed to support the person in line with the requirements and conditions of their authorised DoLS.
During this focused inspection we found improvements had been made to ensure people were supported in accordance with their DoLS authorisation and in their best interests and the least restrictive way to meet their needs.
At the comprehensive inspection carried out in May 2016 the quality assurance systems utilised within the service were not effective. We found shortfalls in care and support that had not been detected by the internal audits and when areas requiring improvement were highlighted action was not taken in a timely way. There was inadequate leadership within the service as there was no registered manager.
During this focused inspection we found improvements had been made to ensure the effectiveness of the quality assurance systems and the manager of the service had successfully registered with the CQC to become the registered manager.
Our previous inspection had identified a number of concerns relating to the fire safety of the building. We reported these to the fire service who carried out a fire safety audit. We have received confirmation from the fire service that all these issues have been addressed to its satisfaction.
In October 2013 we also found that staff were not always provided with the correct information about how to report any allegations of abuse or neglect. At this inspection we saw information was displayed clearly throughout the home and included the correct and up-to-dare information.
Our inspection on 24 October 2013 identified a number of incidents, including one person's death, that had not been notified to the local authority's safeguarding team and to CQC, as required under law. At this inspection we found the manager had out in place a series of auditing tools to ensure this would not happen again.
People were provided with a choice of nutritious food and drink. People told us they enjoyed the meals. However, people may not always be provided with a suitable diet which had put one person's health and welfare at risk.
We found that staff were not following the provider's procedures in relation to reporting allegations of abuse. This meant that some incidents of alleged abuse had not been reported or investigated and there may be a risk of further abuse occurring if appropriate action has not been taken.
People we spoke with told us that medicines were administered appropriately. Comments included, 'They (Staff) know when I need my tablets.'
People who used the service told us that they liked the home. However, we found the home had not been adequately maintained and people who used the service had been put at risk.
People had their comments and complaints listened to and acted on. People told us, "I have no complaints but the staff are open enough for you to be able to mention things to."
We found a number of incidents that had not been reported to us by the provider within an acceptable time frame, as is required by regulation.
People we spoke with were happy with the care they received and two people showed us their personal rooms that were in good decorative order and kept clean.
In this report the name of registered managers Sarah Kelly and Thomas Magorokosho appears. However they were not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time.
People confirmed they had been involved in planning their care. They told us they were well cared for. Comments included 'I have access to my care plan' and 'We are well looked after.'
People we spoke with told us that they felt safe living in the home. Comments included 'Yes, I feel safe here' and 'I feel safe with the staff, I have not had any problems with other people living here but staff do enough to protect us.'
People we spoke with were very positive about the staff who worked in the home. Comments included 'They are all nice', 'They are good' and 'The majority are very good, they are caring and understanding.'
People said that they thought there was sufficient staff to meet their needs.
People told us they were consulted about the way the service was delivered. They told us 'We have residents meetings; they are a good forum for discussion. They listen to us, for example people requested that the bingo sessions were extended and they were', 'We have residents meetings quite often' and 'We had a meeting last Friday, we discussed bingo and changes to the days out.'
People we spoke with understood that records about the care they required were held in the home. They told us they had had the opportunity to be involved in the development of these records. Comments included 'They came to see me at my previous home, they asked questions about my care and wrote a care plan and then we discussed this,' 'I have a care plan and staff write in this' and 'I have seen my care plan.'
People told us they receive the care and support they need from the nurses who work in the home and other health care professionals as required. One person told us 'I didn't feel too clever today and they took me to the doctors.'
People living in the home were satisfied with the activities provided. They told us 'There are plenty of activities and I enjoy the singers,' 'We go out in the car to Cleethorpes or for a ride around' and 'I do some crayoning and I go out with the staff shopping.'
People we spoke with were satisfied with the care they received. One person spoken with said "No problems with the care here, the staff are pretty good" and another person said "staff help me, do anything for me, always ask me how I like things, they know me well".
They told us that staff supported their independence but some people felt there weren't enough activities arranged. Comments included "Very little to do, I sit and watch TV mostly", "We used to have Bingo, I spend more time in my room now, I have a TV and a computer" and "Sometimes play dominoes and go to a car boot sale".
Staff were described as being kind and friendly. People spoken with commented "I get on with all the staff", "Staff help me, do anything for me, always ask me how I like things, they know me well", "They are ok" and "The staff are nice".
People also said that they felt their views were listened to and knew who to talk to if they had any worries or concerns.