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Care Home: Gillibrand Hall Nursing Home

  • Folly Wood Drive Chorley Lancashire PR7 2FW
  • Tel: 01257270586
  • Fax: 01257232989
  • Planned feature Advertise here!

  • Latitude: 53.645000457764
    Longitude: -2.6489999294281
  • Manager: Manager post vacant
  • Price p/w: ~
  • UK
  • Total Capacity: 50
  • Type: Care home with nursing
  • Provider: Century Healthcare Limited
  • Ownership: Private
  • Care Home ID: 6902
Residents Needs:
Old age, not falling within any other category, Dementia, Physical disability

Latest Inspection

This is the latest available inspection report for this service, carried out on 1st June 2010. CQC found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

For extracts, read the latest CQC inspection for Gillibrand Hall Nursing Home.

What the care home does well The routines of the home are flexible and aim to allow residents their freedom and independence by enabling them to retain as much control over their lives as possible, thus promoting equality and diversity. Visiting arrangements are in place to suit the needs of individual residents. The health care needs of people living at the home are well met meaning that residents have confidence that the staff team would arrange for medical assistance quickly if they were unwell. The home is well managed, with good training provided for staff. As well as qualified nursing staff, the home employs a substantial number of care staff. At this inspection it was established that over 50% of the care staff team are now qualified. This means that people are supported by staff who have had their work practice assessed and are deemed to be competent workers. There is a good system to introduce people to the home, with up to date written information provided and needs assessment done, so they know their needs can be met at the home. There is a good staff team in place and residents feel well supported. One person told us, "They look after me well, it`s like home from home". What has improved since the last inspection? Since the last key inspection, significant improvements have been. The way medication is managed is now better organised and all staff with responsibility for the administration and recording of medication have their competency regularly assessed. This helps to keep people safe and makes sure that staff remain competent to handle medication safely. All people living at the home now have a good, individual and detailed written plan of care that focuses on each area of identified need. This written information guides staff so that people are supported to do as much as possible for themselves while ensuring that all staff provide the right amount of support and assistance when required in a consistent way. Staff training is given high priority. An up to date staff training matrix was available. This showed that all staff have received a range of mandatory training that includes adult protection training and health and safety training including manual handling, fire safety, food hygiene, first aid and infection control. This again helps to keep people living at the home safe. The physical environment in the home has improved, especially in the dementia care unit. This unit is now arranged in a more domestic type of setting and provides a more stimulating and tactile environment for residents to enjoy. In both the upstairs unit and downstairs units, recent investment has ensured that residents live in comfortable and well maintained surroundings. What the care home could do better: Although there is a good system in place to make sure that the strengths and needs of each person are known prior to admission, there is a requirement that the outcome of the pre admission assessment is confirmed in writing to the prospective resident so that the prospective resident can be sure that their requirements could be met or alternatively not met, at the home. Up to now this has not been happening but we have been told that this will addressed as soon as possible. The management team are aware that the range of activities needs to be improved so that residents social care expectations are met. Several residents told us on Care Quality Commission surveys that activities were not always available that suited their needs. However, there is now a very recently appointed activities coordinator and it is anticipated that some priority will be given to developing and improving the range of social activities made available that are linked to individual social interests and hobbies. Although there has been continuing ongoing improvement to the physical environment at the home, the environmental improvement programme should continue until all areas of the home are of the same good standard. There are plans in place to sustain this area of development. It is important that the improvements noted at this inspection are maintained. The service now needs to build up a sustained track record of delivering good performance and managing improvement. Key inspection report Care homes for older people Name: Address: Gillibrand Hall Nursing Home Folly Wood Drive Chorley Lancashire PR7 2FW     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Denise Upton     Date: 0 1 0 6 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 34 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 34 Information about the care home Name of care home: Address: Gillibrand Hall Nursing Home Folly Wood Drive Chorley Lancashire PR7 2FW 01257270586 01257232989 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Century Healthcare Limited Name of registered manager (if applicable) Type of registration: Number of places registered: care home 50 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accommodated is: 50. The registered person may provide the following category of service only: Care home with nursing - Code N. To service users of the following gender: Either. Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP. Dementia - Code DE. Physical disability Code PD. Date of last inspection Brief description of the care home Gillibrand Hall is a listed building, set in its own grounds, within a residential area close to Chorley town centre. Public transport does serve the area nearby and the home is now accessible via the new Gillibrand north estate. The home provides care for up to Care Homes for Older People Page 4 of 34 Over 65 0 50 0 50 0 50 1 1 0 3 2 0 1 0 Brief description of the care home fifty residents of either sex that have nursing and/or personal care needs. At the time of the site visit, forty-two people were living at the home. Accommodation is set on two floors. Currently, the ground floor offers accommodation for residents who require nursing or personal care and the first floor for residents who suffer from dementia. The first floor is served by a passenger lift . A number of rooms are equipped with en-suite facilities and both floors have enough communal space. Residents have use of an enclosed courtyard, and garden areas to the front of the building, both of which are furnished with appropriate garden furniture. Information about the facilities and services provided can be found in the homes Statement of Purpose and Service User Guide, both of which have recently been updated. The current fees for residential accommodation at Gillibrand Hall range from £438:00 per week to £686:50 per week. However fees are individually assessed and determined by assessed needs. Further details about the fees and what is included in the fees can be obtained from the manager at the home. Care Homes for Older People Page 5 of 34 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This key inspection focused on outcomes for the people living at the home and involved gathering information about the service from a wide range of sources over a period of time. This unannounced key inspection site visit took place during the course of a mid week day and spanned a period of approximately ten hours. Twenty three of the thirty eight standards identified in the National Minimum Standards - Care Homes for Older People were assessed along with a reassessment of the requirements and recommendations made at the last key inspection. We spoke with the registered manager, the managing director of the company, the personnel manager, a qualified member of the nursing staff team, the cook and the activities organiser. In addition, two residents who were at home were also individually spoken with and brief discussion took place with several other residents in the lounge area of the home. Information was also gained from six residents and eight members of staff who completed and returned a Care Quality Commission (CQC) survey prior to the site visit Care Homes for Older People Page 6 of 34 taking place. This all helped to form an opinion as to whether Gillibrand Hall care home was meeting the needs and expectations of the people who live there. At the time of the site visit, forty two people were living at the home. Every year the manager is asked to provide us with written information about the quality of the service they provide. They are also asked to make an assessment of the quality of the service. This information, in part, has been used to focus our inspection activity and is included in this report. During the course of the site visit, a number of documents and records were examined and a tour of the building took place including communal areas of the home, toilets and bathrooms, some bedroom accommodation, the laundry and the kitchen area. There is a passenger lift in place to assist those residents who cannot manage the stairs. The last key inspection at Gillibrand Hall care home took place on 2nd June 2009. Random inspections also took place in January 2010 and March 2010. At a random inspection we do not look at all the minimum standards identified in the National Minimum Standards - Care Homes for Older People, instead we look at specific key areas . On the two occasions when the random inspections took place, we focused on the way medication is managed and quality of the individual plans of care. At the last key inspection there were shortfalls in these two areas of service provision. These are important issues that directly affect the quality of care delivered and whether positive and safe outcomes for residents has been achieved. At this inspection, much improvement was noted. Care Homes for Older People Page 7 of 34 What the care home does well: What has improved since the last inspection? What they could do better: Although there is a good system in place to make sure that the strengths and needs of each person are known prior to admission, there is a requirement that the outcome of Care Homes for Older People Page 8 of 34 the pre admission assessment is confirmed in writing to the prospective resident so that the prospective resident can be sure that their requirements could be met or alternatively not met, at the home. Up to now this has not been happening but we have been told that this will addressed as soon as possible. The management team are aware that the range of activities needs to be improved so that residents social care expectations are met. Several residents told us on Care Quality Commission surveys that activities were not always available that suited their needs. However, there is now a very recently appointed activities coordinator and it is anticipated that some priority will be given to developing and improving the range of social activities made available that are linked to individual social interests and hobbies. Although there has been continuing ongoing improvement to the physical environment at the home, the environmental improvement programme should continue until all areas of the home are of the same good standard. There are plans in place to sustain this area of development. It is important that the improvements noted at this inspection are maintained. The service now needs to build up a sustained track record of delivering good performance and managing improvement. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 34 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 34 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People thinking of moving into the home receive sufficient information to help them to make an informed decision and staff receive enough information to understand the persons needs. Evidence: Since the last inspection, the homes Statement of Purpose and Service User Guide have been reviewed and and updated, These two booklets, that tell residents, prospective residents and other interested people about the home and the services provided are now up to date and detailed. We were informed that the Statement of Purpose and Service User Guide can now be provided in alternative formats such as large print or on tape, to enable as may people as possible to access this important information. People are only admitted to Gillibrand Hall if their individually assessed needs could be met. The manager or the deputy manager carry out an assessment of people Care Homes for Older People Page 11 of 34 Evidence: considering moving into the home. This is completed in order to determine if the level of care and support required could be provided at the home. Both the manager and deputy manager are experienced in undertaking pre admission assessments. The prospective resident is visited in their own home or in some cases, in hospital. This provides an opportunity for the prospective resident to find out more about the home and for the manager to undertake a formal assessment of current strengths and needs. This information, along with any other relevant assessments conducted by other agencys such as health assessments, are taken into account. This collated information, along with any further information provided by family or other advocates, provides the basis of the initial plan of care. Wherever possible, people are also actively encouraged to visit the home and meet staff and other residents as part of the assessment and introductory process. The files viewed showed that good pre assessment information is gathered and that relatives are involved in this process where possible. Information includes health and social care needs and highlights any areas of risk. This enables the registered manager to make an informed decision as to whether the individual needs and requirements of a prospective new resident could be met at Gillibrand Hall. Although the pre admission assessment process is thorough and the manager meets with the resident or their representative to discuss the outcome of the assessment, there is a requirement that once the assessment process is complete and the manager has made an informed decision as to whether the assessed need of the individual could be met at the home, the prospective resident must be provided with written information confirming the outcome of the pre admission assessment. Up to now this has not been happening. However we were told that this issue will be addressed as soon as possible. Gillibrand Hall care home does not provide intermediate care. Care Homes for Older People Page 12 of 34 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Gillibrand Hall are treated with dignity and respect. Promotion of health is taken seriously and people receive the care and support that they need in a way that meets their expectations. Evidence: Each person has a written plan of care covering the day time period and night time period and four of these were viewed. The detailed record and subsequent guidance to staff regarding the individual support required for each resident, and how this was to be achieved, has substantially improved in so much as all areas of assessed need now have an individual care plan that is detailed and informative. There was some evidence of good person centred care been promoted in the care plans seen that incorporated the likes or dislikes of a particular resident. For example, although all elements of the assessed need, aim of care and instruction sections of the care plan were completed in sufficient detail to ensure that staff had clear direction, one of the care plans evidenced included information for the activity coordinator to spend quality time with this particular resident and to ask her what she would like to do rather than making choices for her. For another people, the care plans were very detailed Care Homes for Older People Page 13 of 34 Evidence: regarding nursing interventions and nutritional needs and requirements. This sort of detail helps to ensure that a consistent service is provided and that the individual residents wants and expectations are met. One resident described the care and support provided as, Very good, I have no complaints, I am content and I never thought I would be living in a home. Care plans also included some social interests and religious needs and requirements and how these were to be maintained. This is good practice and shows that all needs and requirements are considered and strategies put into place to address each area of a residents chosen daily life style. Risk assessments are also in place and address potential risks. Specific individual risk assessments are determined by the requirements of each resident and can include, nutrition, mobility, falls, manual handling, sleep, leaving the building, bathing/showering, sleep, vision, and continence. Each risk assessment concludes with a plan and guidance for staff as to how to minimise the risk and this is regularly reviewed. For some residents a Deprivation of Liberty Screening tool is completed along with a Mental Capacity Act screening tool. This is good practice and helps to ensure that an individuals liberty and freedom of choice is not restricted unnecessarily. There was clear evidence that all individual care plans and risk assessments are reviewed and amended as required on a very regular basis. We were told that residents and where appropriate their relatives, are given opportunity to be involved in the care planning process, so that they could have some say into the care provided. This helps to ensure that the assessed needs and ways of addressing the assessed needs are known and agreed. This also means that staff always have clear, up to date information in order to provide a high quality, consistent service. A member of staff individually spoken with, confirmed that they felt sufficient written information was provided to ensure a good quality of care, that was supplemented by good verbal information sharing. Records are kept of each persons weight, with any significant changes being responded to. The health care needs of people living at the home are well met. Residents and staff are relaxed and get on well together. This comfortable relationship enables staff to get to know people well and any changes in health and well being are quickly noted and speedily addressed. There is a good relationship with health and social care professionals in order to maintain residents health and social well-being. An individual record is maintained of all health professional visits for each resident. This ensures that a good record is kept of health care visits and the frequency of need. Health care needs and requirements are addressed through detailed person centred care plans specific for each area of need including specialist nursing interventions. Care Homes for Older People Page 14 of 34 Evidence: Residents spoken with stated that their health care needs were being met. This was also confirmed by residents that completed a Care Quality Commission (CQC) survey. As part of the visit a pharmacist inspector looked at how medicines were being handled because we found some shortfalls on previous visits. Overall we found continued improvements that meant medicines were now being handled in a much safer way. Our checks of the medicines stocks and records showed they were usually given to people correctly. We found good improvements in the general stock control of medicines that meant they could be easily checked and accounted for. We found medicines could be easily accounted for because the records of medicines received, administered and disposed of were usually clear, accurate and complete. Any medicines that needed to be carried forward to a new monthly cycle were usually properly recorded and most medicines were dated on opening so they could be easily checked. Medicines were usually given to people at the right time in relation to mealtimes because they had been properly organised and people were generally given their medicines at a time that fitted into their normal daily routine. Giving medicines at the right time and dose is important because it helps make sure they work properly. We checked how controlled drugs, medicines that can be misused, were handled. The cupboard used for storage was secure and records were clear, accurate and properly witnessed. Secure storage and witnessed records of controlled drugs help prevent them being mishandled and misused. We checked a sample of care plans and supporting paperwork and found some good information about the use of when required medicines and detailed information about specific medicines and the health issues they were prescribed for. Medicines that were prescribed for pain had good information about how they were to be used and when they were given a clear record was made about when they had been administered. However, some of these plans had not been formally reviewed for several months so there was a risk they might not be up to date, we discussed this with the manager and gave some advice about how these could be improved. We looked at how external medicines such as creams were handled and found some improvements but we still found some records were not always up to date because a mixed system of recording was being used. We gave some advice about improving the paperwork so that only one record is used. We looked at how medicines were checked by the managers and saw efficient Care Homes for Older People Page 15 of 34 Evidence: recorded audits that found mistakes. When mistakes were found suitable action was usually taken to help prevent them happening again. All staff had received regular medicines training and this was repeated on a regular basis. Formal competency assessments were routinely carried out to help make sure staff were following the correct medicines handling procedures and these were repeated on a regular basis. Regular audits, good training and formal competency assessments help make sure staff have the necessary skills to handle medicines safely. A resident spoken with said that she felt that her privacy and dignity was respected and that staff were sensitive and mindful of residents feelings. This same resident described the staff team as Helpful and said that she was now used to carers helping with personal care tasks and that if she asked for a specific carer to assist with personal care tasks, she usually got the person that she had asked for. Of the four residents that completed a Care Quality Commission (CQC) survey prior to the site visit taking place, three people said that staff always listened and acted on what they said, the fourth person said usually. All care staff receive training in respect of maintaining privacy and dignity during induction training and National Vocational Qualification (NVQ) training, and supervision arrangements. Care Homes for Older People Page 16 of 34 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Currently residents are not always able to take part in activities that suit their lifestyles and interests. Meals are well managed and provide nutritious, daily variation for people living at the home. Evidence: People living at Gillibrand Hall care home are offered a choice of activities that are planned to address residents social care interests, wishes and lifestyle. Prior to admission and also following admission, staff try to obtain as much information as possible about the social, cultural and leisure needs of people living at the home. Peoples spiritual needs are also recorded so they can be given opportunity and any help they need to continue to follow their faith. However out of the six residents that completed a Care Quality Commission (CQC) survey, four of the six people said that only sometimes were activities arranged that they could take part in. The manager at the home is aware that this is an area that needs developing further so that peoples social needs and interests meet individual expectations. There is currently a range of activities offered that includes board games, pamper days, bingo, arts and crafts, baking, games, weekly music reminiscence therapy and sing-a-longs. There is also opportunity for some one to one time especially for people Care Homes for Older People Page 17 of 34 Evidence: that are bed bound in order to avoid isolation or for people living in the dementia care unit where some residents may find it difficult to engage in communal activity because of limited concentration. A Fathers day lunch is planned for anybody who has a male relative living at the home so that family members can enjoy a meal and spend time with their family member on this special day. There is a person who visits the home twice a week to engage residents in physical exercise and we were told that residents very much enjoy outings in the company mini bus. An activities board is provided so that residents and relatives can see what activities or events are taking place in that particular week and the dementia care unit is provided with a sensory room that is of great benefit for some people living at the home. We were told that care is now taken to make sure that the sensory room is used appropriately and only used by people that specifically benefit from this facility rather than anybody living in the dementia care unit. Religious care needs are given consideration. A priest and a member of the free domination church visit the home on a weekly basis to visit residents and to conduct a service for people that wish to participate and clergy also visit on request. No current resident has expressed a wish to attend a religious service at a local place of worship, however we were told that should this occur, the resident in question would be assisted to attend a place of worship of their choice. Very recently a new activities organiser has been appointed. Discussion with the activity coordinator confirmed that changes to the social care programme are to be made. At a planned relatives meeting that is soon to take place, a topic of discussion is to be social activities in the home and relatives and residents are to be given a questionnaire and asked what they think would be of benefit to the people living at the home. The activities organiser also told us that she was looking at what equipment needed to be purchased so that the activities programme could be strengthened. Each residents personal profile is to be updated and the home are looking at producing a data base of residents shared interests so that activities could be arranged for a specific group of residents. More trips out are to be planned and an external agency has been approached to visit the home and provide a range of further activities such a reminiscence day, a craft day and painting lessons. It is hoped that this pro active approach to addressing residents social care needs will provide residents with social stimulation that meets their expectations. People are encouraged to maintain contact with family, so that they can continue to be part of family life. Visiting arrangements are in place to suit the needs of individual residents. Visitors are made welcome at any time and residents can entertain their guests in a communal area of the home or in the privacy of their individual bedroom Care Homes for Older People Page 18 of 34 Evidence: accommodation. During the course of the site visit there were a number visitors, the relationship between the staff team and relatives appeared to be open, cordial and supportive. As far as possible, people are encouraged and supported to make decisions about their day-to day lives, such as when to go to bed, when to get up and how to spend their time. Advocacy information is available. Some people are able to manage their own financial affairs and for others a relative or other advocate takes on this responsibility. People are able to bring their own important possessions into the home and so personalise their individual bedrooms. People spoken with said they were happy with the meals provided. One person told us, The food is very good, I enjoy my meals and get plenty of it. Residents that completed a CQC resident survey all said that they always or usually enjoyed the meals served. There is a four week rotating menu that was evidenced that showed a wide range of food are offered. There is a choice of menu at each meal and residents are asked individually each day for their choice from the menu of the day. Alternatively a resident can choose a different meal of their choice. Some residents require or have chosen to have their meals in their bedroom and this is supported. A number of residents require their meal blended for ease of eating, this is done in such a way as to enable the resident to taste each element of the meal. As observed, staff assist residents at mealtimes discretely to maintain the dignity of the person. Specialist diets in respect of medical, religious or cultural requirements can be provided if required. Menus are periodically changed to reflect the seasons and residents can influence menu planning through regular relative and resident meetings agenda items. Each newly admitted resident or if appropriate their relative is spoken with individually to establish what foods they like or dont like, a number of the younger residents have suggested different foods and these have now been incorporated into the menus. Discussion with the cook confirmed that all foods are freshly made, fresh fruit and vegetables are served daily. The kitchen is also open at night to enable staff to prepare snack meals for residents such as cheese on toast should a resident request this. There appeared to be good systems in place in the kitchen and good relationships with dietitians when appropriate to make sure that residents were provided with a diet suited to their specific requirements. The cook also confirmed that a sufficient budget is made available to ensure a varied and nutritious diet is always provided. Care Homes for Older People Page 19 of 34 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are good procedures in place so that people who live at the home are able to express any concerns and be listened to, their rights are protected and they are safeguarded from abuse. Evidence: Gillibrand Hall Care Home has the corporate complaint policy and procedures in place, which includes details that any complaint would be responded to within a maximum of 28 days. From information contained in the Annual Quality Assurance Assessment (AQAA) completed by the manager prior to the site visit taking place, no complaints have been received by the home in the last twelve months and there have been no adult protection issues raised. The Care Quality Commission also received no complaint or concern about the home. We were told that a record of any complaint is kept that includes details of any action and investigation undertaken. The complaint procedure is incorporated in the homes Statement of Purpose and Service User Guide a copy of which is given to each newly admitted resident. The resident spoken with was very clear that if they did have any concerns they would speak with the manager or another member of staff. This same resident also told us that if they did have a complaint they felt that their concerns would be taken seriously and acted upon. This in the main, was supported by comments made on the CQC surveys completed by residents. However two people answered that although they felt that they could speak to somebody informally if they were unhappy about something, Care Homes for Older People Page 20 of 34 Evidence: they did not know how to make a formal complaint. Whilst it is appreciated that this information is incorporated in the Service User Guide, it may be useful to periodically verbally remind people, perhaps at a resident and relative meeting, how to make a formal complaint. During the visit, it was clear that people living at the home had formed good relationships with staff, meaning that any minor issues could be raised and dealt with informally as part of day to day life at the home. Information within the Annual Quality Assurance Assessment (AQAA) completed by the manager stated that the home works, In partnership with residents and relatives having realised expectations of the home, by this practice to reduce any concerns or complaints. A member of staff spoken with was clear about what action she should take if a complaint was made to her so that the complaint could be quickly investigated and addressed. Gillibrand Hall care home continues to have a variety of policies and procedures in place for the protection of residents. This includes the corporate adult protection policy and a whistle blowing policy to help protect people living at the home from abuse or discrimination. All staff have received training regarding protection and abuse. Care staff also receive guidance in respect of adult protection as part of their National Vocational Qualification training (NVQ). Opportunity is also provided for this topic to be discussion during one to one supervision and at team meetings. This helps to remind staff of the importance of protecting residents and the responsibility of the staff group in this matter. Care Homes for Older People Page 21 of 34 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A clean, pleasant and comfortable environment is provided that is now meeting the needs of all residents. Evidence: Gillibrand Hall care home is an older listed building set in its own extensive grounds. Resident accommodation is arranged over two floors and is now designed to accommodate people with a variety of needs and requirements including dementia. The home is welcoming, comfortable, well maintained and provides accommodation that suits the needs and requirements of the people living there. Bedroom accommodation is provided on both the ground and first floor of the building, the majority of which have been refurbished. A number of bedrooms are provided with an en-suite facility and are personalised to reflect the needs and wishes of the occupant. Pictures and ornaments give a homely touch and there are photographs displayed of residents and staff enjoying social events. The dementia care unit is situated on the upper floor and communal areas are light and airy. Since the last key inspection, significant improvement has been made to the dementia care unit to ensure that it provides an appropriate physical environment for people with dementia to live. The communal space has been redesigned to provide a more specious dining area with individual seating areas along side the dining tables. There is also now a specific, more cosy lounge area at one end of this combined room. Care Homes for Older People Page 22 of 34 Evidence: This has also created areas where residents can engage in conversation and activity without being part of the larger group. A smaller comfortable lounge area has been created in what appeared to be an under used room next to the main communal combined lounge and dining room. This provides residents with some choice of where they choose to spend their time and enables activities to take place in one area whilst providing a quiet place for those who choose not to participate. The dementia unit is also provided with a sensory room that is of great benefit to a number of residents. As previously stated in this report, we were told that the sensory room is now been used more appropriately, in that only people that actually benefit from the facility are encouraged to use it rather than as previously, anybody that was accommodated in the unit. There is now good, appropriate signage in place throughout the unit that includes resident bedrooms showing a picture of the occupant and the previously bland walls have been given some attention. Pictures and art work have been provided in communal areas including corridors and very tactile and stimulating wooden squares were seen that are about to be placed in communal areas that include, a variety of locks, musical instruments, bolts, light fittings and a range of different cloths and materials. This will provide a more stimulating environment and interesting activity for residents to engage with. Some of the individual bedroom furniture, carpets and soft furnishing in this unit have also been replaced and bedrooms refurbished as part of the on-going refurbishment programme. This has made a very positive difference to the physical environment and provided a much more attractive and pleasant environment for people to live. There is a hotel style digital television system in all rooms and communal area of the home. Other areas of the home have also received attention. Some flooring has been replaced in bathrooms, a wet room has been provided and another bathroom is about to be converted to a wet room, corridors have been re carpeted, all windows have been replaced in the court yard area, further windows in communal areas and private accommodation have been updated, the laundry has been refurbished to good effect, some carpets and furniture have been replaced and attention has been given to part of the roof. In addition, the downstairs dining room has been refurbished, some additional profiling beds have been provided, some light fittings replaced and nearly half of the rooms have been redecorated in the last twelve months. One member of staff spoken with stated, The environment in the home is much improved. We were told that further planned improvements include, providing lights in the parking area, part of the extensive garden areas is to be developed for the benefit of Care Homes for Older People Page 23 of 34 Evidence: residents and a new nurse call system is to be provided in July 2010. What is important now is to ensure that the current programme of refurbishment continues as planned until all resident accommodation is of the same good standard. The resident spoken with was pleased with their bedroom accommodation and the communal space provided and residents that completed a CQC survey said that the home was always or usually fresh and clean. There are a variety of policies and procedures in place for the control of infection and safe handling of waste products. Laundry facilities are located in a designated area, separate from the main house, and do not intrude on residents. The laundry is well equipped to meet the needs of the home. All laundry is washed at an appropriate temperature. The AQAA confirmed that all staff have received infection control training meaning that they know how to reduce the risk of infection within the home. The laundry was clean, tidy and well managed. The laundry person stated that there was a good, safe system in place to ensure that foul, dirty clean and clean washing was washed separately and that residents received their freshly laundered clothes in a timely manner. Hand washing facilities and gels are available in the laundry area and are also sited throughout the home. Care Homes for Older People Page 24 of 34 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing arrangements and recruitment and training ensure that people are cared for and supported safely. Evidence: Staffing levels at Gillibrand Hall are determined by the assessed needs of residents accommodated. In additional to qualified nursing staff, additional care staff are on duty during busy periods of the day and all night staff have waking watch responsibility. Along with the activity co-coordinator, handyman and administrative staff, there are sufficient ancillary staff employed to ensure standards in respect of domestic tasks and catering are maintained. The resident spoken with said that she was satisfied with the level of care and support provided and had no complaints regarding staff or staff not being available when assistance was required. This was also confirmed by residents that completed a CQC survey who told us that staff were either always or usually available when they needed them. One person wrote that The staff are kind and another person told us that staff were Helpful. However there was a more mixed response from members of staff that completed a CQC staff survey. Of the eight members of staff that completed a survey, only two of them told us that there was always sufficient staff on duty to meet the assessed needs of residents accommodated, the majority of staff said that only sometimes were there enough staff on duty, with several people saying that the home could be improved by Care Homes for Older People Page 25 of 34 Evidence: having more staff on duty. One member of staff commented in answer to the question, What could the home do better, replied, Needs more staff to meet needs better of the residents. It is important that care staffing levels are kept under constant review so that holistic assessed needs can all be consistently met. This is especially important if dependency needs of existing residents increase or if people are admitted to the home who required a substantial amount of staff time. Staff training and development is given high priority. National Vocational Qualification (NVQ) training is promoted, with more than 50 of the care staff team having achieved Level 2 of this award. An additional, five members of the care staff team have achieved a more advanced Level 3 of this award. Currently a further two members of staff are undertaking the level 2 qualification and a further four members of the care staff team are working towards achieving a Level 3 qualification. In addition two of the domestic staff team and two cooks have successfully completed an NVQ qualification in relevant subjects. NVQ training is a nationally recognised qualification for care staff and shows that the majority of care staff working at the home have had their skills, knowledge and understanding assessed in order to provide a good standard of care. This means that residents can be confident that they are supported by a skilled staff team. In addition to care staff, qualified nurses are also employed. All the registered general nurses are encouraged to attend all mandatory courses as well as specific courses in order to ensure that they maintain their registration requirements. From information provided in the Annual Quality Assurance Assessment (AQAA) that the manager was asked to complete prior to the site visit taking place, it is understood that any newly appointed members of the care staff team are routinely provided with nationally recognised Skills for Care induction training. This makes sure that newly appointed care staff have the basic skills and understanding to ensure that they are competent to provided an appropriate level of care and support. This was also confirmed by people that had completed a CQC staff survey with most people saying that their induction covered everything that they needed to know to do the job, Very well. Good additional training is also provided that is valued by staff that includes mandatory health and safety training. Further training in specialised areas is provided specific to the individual needs of the people living at the home and to develop the skills and knowledge of the individual member of staff. This helps to ensure that a good, individualised service is promoted by a well trained staff team. Additional mandatory training includes safeguarding, challenging behaviour training, and dealing with aggression training is also mandatory for all categories staff that work in the Care Homes for Older People Page 26 of 34 Evidence: dementia care unit or come into contact with the dementia care unit. Since the last key inspection, a staff training data base has been set up that will prompt when each individual member of staff is due refresher training. This will help to make sure that all staff received regular updated training so as to ensure that best practice is consistently maintained for the benefit of residents accommodated. Gillibrand Hall care home has the structured corporate recruitment policy and procedure in place for the employment of new staff. The staff files of three members of staff were viewed, two of which were of staff that had been recently appointed. Records included an application form, two references including one from the previous employer, a criminal records bureau disclosure and a check against the nationally held list of people that have been deemed unsuitable to work with vulnerable people. This robust system helps to ensure that only suitable people are employed that have the personal qualities to work with vulnerable people. The management team recognises the importance of recruiting staff that have the qualities that people like such as being friendly, good communicators and caring. Comments from staff that completed a CQC survey were in the main, positive. One person in answer to the question What does the home do well said, It meets the needs of the care required to all our residents at all times. We always ask residents what they wish to do such as meals, activities. I love my job. Another person told us in answer to the same question, By having good staff and management, everyone is easy going and friendly. A third member of staff said, The home does well with looking and caring for the elderly with or without special needs. Care Homes for Older People Page 27 of 34 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service is well run with a high level of consultation with people meant that people using the service could contribute to its development. Evidence: Since the last key inspection, a new manager has been appointed. The new manager is a registered nurse and well qualified and experienced in managing a care home for older people. The homes manager continues to attend a variety of courses to make sure that her knowledge is up to date, in order to advise and guide staff appropriately. Staff and residents spoke highly of the manager. One resident told us, The new matron is lovely and kind and listens to us and asks us if we are happy. A member of staff said, There has been much improvement since ????? came into post, the manager is very supportive, good manager, a lot of empathy, very approachable, like a breath of fresh air. And, the Matron is, Very focused on our residents and wants what is best for them at all times. It is understood that an application to register this person as the registered manager at Gillibrand Hall, is soon to be submitted to the Care Quality Commission. In order for the manager to be registered with the Care Homes for Older People Page 28 of 34 Evidence: Commission, this person with have to demonstrate that they have the qualifications, experience and personal qualities to run the care home in the best interest of the people that live there. Ways to gain information regarding quality assurance about the home and whether the support offered is meeting residents needs, is considered important. Various quality assurance systems are in place including, questionnaires for residents, their family and other stakeholders. Planned resident and relative meetings are held regularly, as are staff meetings. There is also a Tuesday evening surgery where residents, relatives or other interested people can go and talk with the manager about anything that is appropriate. We were told that good minutes are kept of all the meetings held. The customer satisfaction surveys are provided bi-annually. Outcomes are tabulated, the home informed of the outcome, and any action required has to be completed within a specified time scale. This information is provided to residents and relatives by way of the notice board, resident and relative meetings and individual discussion. Recently a Gillibrand Hall newsletter has been introduced. This also provides information for residents and relatives along with a variety of other topics that are of interest to people either living or visiting the home. Gillibrand Hall has also successfully maintained the Investors in People award (an external quality assurance monitoring organisation) demonstrating that there is a commitment to have the quality of care provided, assessed both internally and externally. Care plans are in place and are reviewed on a regular basis. This gives a natural opportunity to gain feedback about the service from the resident, their family, or any other interested party involved in the review. Residents also enjoy frequent daily dialogue with members of staff. This helps residents to say what they think about any aspect of their life at the home, at a time of their choice without waiting, so that any matters could be immediately addressed. People living at the home are encouraged to remain financially independent or are assisted in this task by a relative or other advocate. However where the home do retain monies for some people, a robust system is in place to protect the interests of residents. This includes clear and accurate records of any financial transactions undertaken, secure facilities to hold monies and regular financial audits undertaken by company managers external to the home. Records relating to health and safety were seen. Records showed that equipment such as manual handling equipment and fire equipment are regularly serviced and that electrical installation and electrical equipment are also checked. The staff training Care Homes for Older People Page 29 of 34 Evidence: matrix also confirmed that staff receive mandatory health and safety training including, fire safety training, first aid training, moving and handling training and infection control training. Since the last inspection further health and safety training has been provided to make sure that staff are aware of the importance of maintaining the health and safety of residents and their responsibility in this matter. We were told that although food hygiene training is not mandatory, all care staff that have obtained an NVQ level 2 qualification, undertake this training as part of their course. It is recommended that all staff that prepare, cook and assist in serving meals or assist a resident to eat a meal, be provided with this important training. This is especially important with regard to care staff that are reluctant to undertake NVQ training or care staff that have not yet had opportunity to undertake this training, so that they are aware of good food hygiene principles and practices. Refresher training is also provided on a planned basis to ensure that staff have regular up to date information to act on. All these checks, along side the training that staff receive, help to protect people living at the home, staff and visitors. Care Homes for Older People Page 30 of 34 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 31 of 34 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 3 14 People considering moving into the home must be advised in writing of the outcome of the pre admission assessment. This would confirm to the prospective resident that their current needs and requirements could be met or alternatively not met. 31/07/2010 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 12 The social activities programme should be strengthened so that the social care needs and expectation of all people living at the home are well met. It is important that the current programme of refurbishment and renewal continues until all resident accommodation is of the same good standard. Staffing levels should be kept under consistent review to ensure that assessed needs can be consistently met. 2 19 3 27 Care Homes for Older People Page 32 of 34 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 4 38 All staff that prepare, cook, or serve food or assist residents with eating should be provided with mandatory food hygiene training. Care Homes for Older People Page 33 of 34 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Older People Page 34 of 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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