Gilling Reane Care Home

Gilling Reane Care Home is a care home providing personal and nursing care and accommodation to older people. At the time of the inspection, 30 people were receiving regulated activities at the home. The service can support up to 33 people. The home is an adapted building with bedrooms based over 2 floors.

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

Some aspects of staff recruitment and employment discipline were not effective at ensuring staff members were always suitable to work with vulnerable people. Some essential safety checks and statutory process had not been made. There was inappropriate oversight of these processes by the provider. Further detail is in the 'safe' and 'well-led' sections of this report.

The registered provider was responsive to concerns noted during the inspection and took action to make improvements and promote safety of all staff who had been employed at the home. The service made appropriate notifications to CQC and other authorities of safety incidents to ensure these incidents received appropriate oversight.

People, their relatives and staff were confident in the management team at the home and praised how approachable they were. Staff said they were appropriately trained and supported. Records we observed supported this position.

Care and support risks to people were appropriately identified, assessed and managed in a timely way. Staff said the use of the service's digital care recording system assisted with this and helped communication around people's needs and any changes to their support requirements.

People received their medicines as prescribed by health care professionals. Staff were competent in this area and consulted external professionals when they came across issues.

Infection, prevention and control processes were appropriate and we were assured about the service's ability to mitigate the transmission of infections.

Staff were competent with safeguarding processes and knew how to protect people from abuse. Relatives said their loved ones felt safe in the home and were trusting of staff and management. The service's safeguarding processes were robust. We observed good practices and interactions between staff, management and people during the inspection.

Staff supported people to have access to healthcare professionals and specialist support and the service worked with external specialists. Professional's views on the service were positive.

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 20 August 2018).

Why we inspected

This inspection was prompted by a review of the information we held about this service. As a result, we carried out a focused inspection to review the key questions of safe 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 to requires improvement. 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 'Gilling Reane Care Home' on our website at www.cqc.org.uk.

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.

Following our inspection the provider completed an investigation into the employment and oversight issues. This identified the concerns in detail, the steps that were to be taken to resolve matters and how lessons had been learned.

Enforcement

We have identified breaches of regulations in relation to unsafe employment processes and the governance/oversight of the service at this inspection.

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 and other partner agencies to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect and will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

We found the following examples of good practice.

The home was supporting people who had tested positive for COVID-19 at the time of our inspection. The registered manager had contacted appropriate agencies for advice and support and had followed the guidance they gave.

Staff were trained in infection prevention and control and using Personal Protective Equipment, (PPE), safely.

The provider had ensured sufficient quantities of PPE were available.

The registered manager had arranged for agency staff to be deployed to ensure safe staffing levels were maintained. The agency staff worked with experienced staff employed in the home, who knew people well and could guide the agency staff on how to care for people.

The registered manager had followed government guidance about visiting.

The registered manager had followed best practice around safe admissions when people moved into the home. They had followed guidance regarding suspending any new admissions while the home was in outbreak.

The registered manager followed guidance around COVID-19 testing for staff and people who lived in the home. They had robust systems in place to ensure no one was deployed to work in the home unless they were fully vaccinated from COVID-19 or exempt.

The staff team kept the home clean and hygienic. Frequently touched surfaces were cleaned regularly throughout the day to reduce the risk of infection.

There was a well-established, experienced staff team working in the home. The staff had been responsive to the challenges caused by the outbreak of COVID-19 and worked additional hours and outside of their normal roles, where required, to maintain a safe service for people.

Our last comprehensive inspection of this service was in January 2017. At that inspection we assessed that the registered provider was meeting legal requirements. However, during our inspection we found some aspects of the safety of the service required improvement. We raised our concerns with the registered manager and they took immediate action to make the required improvements. We also found that the systems used to assess the safety of the service needed to be improved to ensure issues were identified and resolved promptly. We recommended that the registered provider took advice to improve the processes used to assess the quality of the service. We checked this at our inspection in June 2018 and found that the registered provider had made the required improvements.

Gilling Reane Care 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.

The home mainly provides support for older people and people who are living with dementia or who have mental health needs. The home is a large, period property which has been converted to be used as a care home. Accommodation is arranged over two floors and there is a passenger lift to assist people to access the accommodation on the upper floor.

There was a registered manager employed. 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 who could speak with us told us this was a good service and said they would recommend it.

Some people were not able to easily share their views. We saw people were relaxed and comfortable with the staff on duty. The staff knew people well and treated people with kindness and respect. People enjoyed talking and laughing with the staff and this supported their wellbeing.

People were safe and protected against abuse and harm. Risks to people’s safety had been identified and actions taken to manage hazards.

There were enough staff employed in the home to meet people’s needs and to spend time with people. Safe systems were used when new staff were recruited to ensure they were suitable to work in the home.

Medicines were handled safely. People could manage their own medicines and there were checks in place to support them to do so safely. People received their medicines as their doctors had prescribed.

The premises and equipment were checked to ensure they remained safe for people to use.

The staff were trained to give them the skills and knowledge to carry out their roles. The registered provider had systems to identify when training needed to be repeated to ensure the staff had up-to-date skills and knowledge.

People were provided with a choice of meals, drinks and snacks they enjoyed.

The principles of the Mental Capacity Act 2005 were followed and people’s rights were respected. 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.

People were supported to maintain good health. Appropriate professionals were included in assessing people’s needs. The staff in the home contacted health care professionals appropriately and acted on advice given.

People’s dignity, privacy and independence were supported. People made choices about their lives and the decisions they made were respected.

Care was planned and delivered to meet people’s needs. The registered provider had introduced an electronic care planning and recording system. This could be updated quickly if a person’s needs changed and gave the staff up-to-date information about people’s care.

People were able to maintain relationships that were important to them. Visitors were made welcome in the home and people could see their friends and families as they wished.

People enjoyed following a range of activities in the home and local community.

The registered provider had a procedure for receiving and responding to complaints about the service. People who lived in the home knew how they could share any concerns about their support.

There were arrangements in place to ensure the effective management of the home. The registered manager was supported by a deputy manager and senior care staff. People knew the registered manager and were confident approaching her as they needed.

The registered manager and registered provider carried out checks on the service to ensure people received a good quality of service.

The registered manager had notified us of significant incidents that had occurred in the home. This meant we could check appropriate action had been taken.

Our last comprehensive inspection of this home was carried out 30 July and 1 August 2014. At that inspection we found breaches of legal requirements because there were not sufficient staff to assist people, people were not protected against the risk of infection and the processes used to assess the quality of the service were not effective. After the comprehensive inspection we received a concern that people had not been protected against hazards to their safety.

We carried out a focused inspection of the service on the 18 March 2015 to check the actions the provider had taken in response to the concerns we had identified at the comprehensive inspection. At the focused inspection we also looked at how the provider had assessed and managed hazards to people’s safety. We found that significant improvements had been made to the service and the breaches to requirements we found at our comprehensive inspection in 2014 had been met. However, we also found that risks to people’s safety had not been thoroughly assessed when they moved into the home. This was a new breach of legal requirements because people had not been protected against the risk of harm. During the focused inspection we saw additional risk assessments that the registered manager had completed to ensure hazards were identified and managed in the future.

At the comprehensive inspection in January 2017 we found the provider was meeting legal requirements. Although we found some areas where the service needed to be improved to ensure the consistency of the safety and quality of the service, we found significant improvements from our previous inspections. Everyone we spoke with told us this was a good service and said they would recommend it to other people. One person told us, “The care here is excellent I have no hesitation to recommend this home to others.”

Gilling Reane Care Home provides accommodation and personal care for up to 33 people. The home mainly provides support for older people and people who are living with dementia or who have mental health needs. The home is a large, period property which has been converted to be used as a care home. Accommodation is arranged over two floors and there is a passenger lift to assist people to access the accommodation on the upper floor. The home has 29 single bedrooms and two double rooms, which two people can choose to share. There were 31 people living at the home at the time of our inspection.

There was a registered manager employed in the home. 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 and associated Regulations about how the service is run.

Everyone we spoke with told us that they felt safe in the home. They told us that the staff were “friendly”, “caring” and “attentive” to people. The care staff knew people well and knew the things that were important to them in their lives. They used their knowledge of people to support them to maintain their independence and to comfort people if they felt anxious. One visitor told us, “This is such as caring place”. Another person said, “The support and the care of the staff has been very, very good”.

People told us they enjoyed the meals and activities provided in the home. Relatives we spoke with told us they could visit the home at any time they chose. People were provided with a range of activities they enjoyed and were able to maintain relationships that were important to them.

The staff working in the home supported people to see their doctors if they needed. People received their medicines safely and as their doctors had prescribed. This helped to ensure people maintained good health.

People who lived in the home were included in planning and agreeing to the care they received. People’s rights were protected because the principles of the Mental Capacity Act 2005 were followed where people were not able to make decisions about their care.

People told us they knew the registered manager and how they could speak to her if they needed. They said the home was well managed and that the registered manager and staff were committed to providing a good service to people. One person told us, “They [the registered manager] always sorts out anything and don’t make you feel like you are a nuisance”. Another person said, “The staff are easy to talk to. They do listen to you and sort things out if you are not happy.”

We saw that there were enough staff to provide people’s support in a timely way. The staff took time to chat and joke with people and we saw this supported people’s wellbeing.

The staff were trained in how to support people and had completed qualifications relevant to their roles.

We found that some aspects of the safety of the service needed to be improved. We discussed these with the registered manager at our visit to the home on 20 January 2017. When we returned to the home on 24 January 2017 we saw that the registered manager had addressed the issues we raised to ensure that people were safe in the home.

Although the registered manager and staff in the home had carried out checks on the service, these had not identified aspects of the service that required improvement. The processes used to monitor the quality and safety of the service needed to be more robust to ensure the consistency of the quality of the service provided.

We have made a recommendation about improving the processes to monitor the quality of the service.

People told us,

'We're very well looked after here',

'The staff are brilliant',

'The meals are very good'

and said, 'I can't think of anything they need to improve or do differently'.

A number of people who lived in the home could not easily express their views about the service or the care they received. We observed people in communal areas of the home to assess how they were supported by staff in the home. We saw that the staff on duty were knowledgeable about the care people needed and their preferences about how they wanted to be supported. People were treated with respect and given choices in a way they could understand. We saw the staff respected the decisions people made.