Gittisham Hill House

Updated 12 December 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This comprehensive inspection was carried out on the 17 and 24 August 2018. The first day of the inspection was unannounced; the inspection team consisted of one adult social care inspector. The second day of the inspection was announced completed by two adult social care inspectors and an expert by experience. An expert by experience is a person who has experience of using, or caring for someone using, this type of service.

We reviewed all information the Care Quality Commission (CQC) held about the service before the inspection. This included all contacts about the home, previous inspection reports and notifications sent to us. A notification is information about important events which the service is required to tell us about by law. We reviewed the Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make.

We used different methods to help us understand people’s experiences. People who lived at the service had varying levels of communication. We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

During the inspection we spoke with 15 people who used the service and 14 visitors. We received written feedback from two relatives following the inspection. We also spoke with the 12 staff, including the registered manager, clinical lead nurse and deputy manager; nursing and care staff; two activities co-ordinators, the chef, the maintenance person and the administrator. We received feedback from eight professionals who work closely with the people who lived at the service. This included a GP; four specialist nurses, social workers and Devon County safeguarding team.

We looked at records relating to the management of the service including six people’s care plans and associated records including medicines administration records. We looked at three staff personnel files including staff training and recruitment records. We reviewed a selection of compliments and the complaints log as well as the accident/incident records. Documentation relating to the maintenance and safety of the premises was also inspected.

Updated 12 December 2018

We carried out a comprehensive inspection on 17 and 24 August 2018. The first day of inspection was unannounced; we arranged the second day of inspection before we visited.

Gittisham Hill House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Gittisham Hill House is registered to provide accommodation for a maximum of 39 people who require nursing and personal care. The home is situated near Honiton, Devon. The service specialises in the care of older people, most of whom are living with dementia. When we visited 36 people lived at the service, five of whom were receiving nursing care.

This was the first inspection of the service since being registered by the providers, RV Care Homes Limited.

There was 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. Since the site visit we have been informed that the registered manager had been promoted within the organisation and is no long in day to day charge of the service. A new manager has been appointed and will be registered with the Care Quality Commission.

The service had an extremely positive culture that was person-centred, open, inclusive and empowering. People’s needs were supported by sensitive, compassionate and caring staff. Staff understood individual’s diverse needs and preferences and supported them to enjoy as much independence as possible. Staff respected people’s right to privacy and supported people to maintain their dignity. Comments included, “Carers are marvellous…will do anything for you…I would certainly recommend it” and “Staff try incredibly hard. They have got to know Mum, they are supportive and understanding. They make her feel relaxed…”

The provider was keen to improve the experience of people living with dementia. They had introduced an innovative approach to dementia care which was reflective of best practice guidelines. The new approach focused on wellbeing and comfort, learning and development, and the environment. Feedback and observations during the inspection showed the approach was having a positive effect on people’s well-being.

The registered manager provided strong leadership and support. People using the service, their relatives, staff and professionals acknowledged the improvements achieved since the registered manager’s appointment. The registered manager was developing a learning culture. Lessons were learnt when things went wrong and actions were taken to reduce the risks. Emphasis was placed on continuous improvement of the service and best practice. Working with a range of professionals meant staff’s practice was influenced by current best practice and research. People using the service were involved in decisions about the service. For example, taking part in staff recruitment interviews. The registered manager used effective quality assurance processes to improve the service.

People were protected against abuse and avoidable harm. People involved in accidents and incidents were supported to stay safe and action was taken to prevent further injury or harm. There sufficient numbers of staff available to meet any needs or requests quickly. Staff were recruited safely to ensure they were suitable to work at the service. People’s medicines were safely managed. The service was clean throughout and good infection prevention measures were in place.

The staff team were well trained and supported to have the skills to achieve good outcomes for people. People were supported to maintain their health and prompt action was taken to refer people to healthcare professionals when they became unwell or their health needs changed. People enjoyed a healthy and varied diet, which met their needs and preferences. People were supported to have maximum choice and control of their daily lives and staff supported them in the least restrictive way possible. This ensured people’s rights were protected. The premises had been designed with people’s needs and comfort in mind.

Arrangements for social activities met people’s individual needs; there was an emphasis on people enjoying life as much as possible. There was an extensive range of group and individual activities. People and their relatives said there were plenty of opportunities to participate in meaningful activities. The registered manager was working to implement an ‘inter-generational project’, which would welcome local school children to the service to support people with activities such as creative writing and basic IT skills.

The registered manager used concerns and complaints to improve people’s experience. They fostered a ‘no blame’, learning culture and viewed feedback as an opportunity for improvement. People were confident any concerns would be dealt with.