Gilby House provides accommodation for up to 19 adults with care needs relating to their mental health. The home is situated in the centre of town close to local amenities.

This unannounced inspection took place on 3 February 2017. The last comprehensive inspection of the service took place in May 2016. At that time the service was in breach of three regulations pertaining to delivering safe care and treatment, obtaining consent and working in line with the principles of the Mental Capacity Act and the operation of good governance systems. The overall rating was ‘Requires Improvement’. We completed a focused inspection in August 2016 to check that improvements had been made and that the service had achieved compliance with the regulations. We found evidence to confirm satisfactory improvements had been made and the service was fully complaint. We did not change the overall rating for the service because to do this required evidence of sustained improvements over time.

The service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Records showed that staff had undertaken a range of training to ensure they could carry out their roles effectively. However, we saw training deemed as service specific by the registered provider had not always been completed. Staff told us they were supported in their roles but we saw that they had not received supervision in line with the registered provider’s internal policies. Staff had not received an annual appraisal in 2016. The registered provider was aware of these shortfalls and action had been taken to rectify them. This included, the registered manager and clinical lead being booked onto a ‘delivering effective supervision and appraisal’ training [which was completed shortly after the inspection concluded], staff being booked onto service specific training and a supervision planner being created to ensure they received supervisions and appraisals in accordance with the registered provider’s policies.

We saw that the service had achieved very high rates of compliance through the registered provider’s audits completed by the registered manager. The registered manager and regional director informed us that the audits required development to ensure they were fit for purpose and could be used to drive improvements within the service.

People who used the service were protected from abuse and avoidable harm by staff who had been trained to recognise the signs of potential abuse and knew what action to take if they suspected abuse had occurred. People were supported to take positive risks in their lives and action had been taken to promote their safety.

People were supported by suitable numbers of staff to meet their assessed needs. Throughout the inspection we saw people received care and support in a timely way. Staff had been recruited safely. We saw evidence to confirm before prospective staff were offered a role within the service suitable references and a DBS check were obtained.

People who used the service received their medicines as prescribed. Safe arrangements were in place for the ordering, storing, administering and destruction of medicines.

Staff gained people’s consent before care and support was delivered. Staff we spoke with understood the principles of the Mental Capacity Act 2005 which were adhered to. The registered manger had made Deprivation of Liberty Safeguards applications which helped to ensure people were not restricted unlawfully and the support they received was the least restrictive option.

People ate a balanced diet of their choosing. Options were available at each meal and we saw that people could request drinks and snacks and help themsel

Gilby House Nursing Home provides accommodation for up to 19 adults with care needs relating to their mental health. The home is situated in the centre of Winterton, close to local amenities and bus routes.

We carried out this unannounced focused inspection of the service on 22 August 2016. The inspection was carried out to check that the registered provider had made the required improvements and had achieved compliance with the regulations we identified as being in breach at the comprehensive inspection undertaken in May 2016.

At the comprehensive inspection carried out in May 2016 a tour of the service was undertaken and concerns with infection prevention and control practices were identified. A legionella risk assessment had been completed in November 2015 which identified that immediate actions were required; we saw these had not been actioned. Hot water was not available in one of the downstairs toilets and a bedroom.

During this focused inspection we found that a programme of refurbishment had been completed and all permeable surfaces had been replaced or removed. The immediate actions identified in the legionella risk assessment had been appropriately actioned.

At the comprehensive inspection carried out in May 2016 we reviewed the medicines management within the service and found medicines were not always stored safely and PRN (as required) medicine protocols lacked relevant information to ensure they were administered consistently by the nursing staff.

During this focused inspection we found improvements had been made to the medicine storage facilities and that PRN protocols had been updated in line with the National Institute for Health and Care Excellence guidelines.

At the time of our comprehensive inspection carried out in May 2016 a number of people who used the service were subject to a Deprivation of Liberty Safeguards (DoLS) because the care and support they required amounted to 24 hour supervision and control. We found evidence that the service had failed to support the person in line with the requirements and conditions of their authorised DoLS.

During this focused inspection we found improvements had been made to ensure people were supported in accordance with their DoLS authorisation and in their best interests and the least restrictive way to meet their needs.

At the comprehensive inspection carried out in May 2016 the quality assurance systems utilised within the service were not effective. We found shortfalls in care and support that had not been detected by the internal audits and when areas requiring improvement were highlighted action was not taken in a timely way. There was inadequate leadership within the service as there was no registered manager.

During this focused inspection we found improvements had been made to ensure the effectiveness of the quality assurance systems and the manager of the service had successfully registered with the CQC to become the registered manager.

Gilby House Nursing Home provides accommodation for up to 22 adults with care needs relating to their mental health. The home is situated in the centre of town close to local amenities and bus routes.

The service did not have a registered manager in post. There had not been a registered manager at the service for over eight months. The service had been managed during this time by a number of managers and at the time of our inspection a registered manager form another of the registered provider’s services was managing the service.

The last inspection was completed in June 2014 and the service was found to be compliant with the regulations inspected at that time. This unannounced inspection took place on 6 and 9 May 2016.

The quality assurance systems utilised within the service were not effective. We found shortfalls in care and support that had not been detected by the internal audits and when areas for improvement were highlighted action was not taken in a timely way.

During a tour of the service we found concerns with infection prevention and control practices. There was no hot water available in a downstairs toilet and a first floor bathroom had numerous permeable surfaces which meant it could no longer be cleaned effectively. A legionella risk assessment had been completed in November 2015 and we saw there were immediate actions that had not been completed.

Medicines were not always stored safely. We found that temperatures in the medicines room had exceeded the manufacturers recommended guidelines. Failing to store medicines at appropriate temperatures could have an adverse effect on their potency. We found that the PRN (as required) medicine protocols lacked relevant information to ensure they were administered consistently by the nursing staff.

Some people who used the service were under a Deprivation of Liberty Safeguards (DoLS) because the care and support they required amounted to 24 hour supervision and control and was a deprivation of their liberty. We found evidence that the service had failed to support the person in line with the requirements and conditions of their authorised DoLS.

Staff knew the people they were supporting including the preferences for how care and support should be delivered. Staff described how they would tailor their approach to providing care to each person who used the service to meet their individual needs. People were treated with dignity and respect by staff during their interactions.

Care plans had been developed to meet the assessed needs of the people who used the service. However, some of the care plans we saw lacked depth and insight into how the person needed to be supported. We also found that when professionals directed staff to monitor people’s conditions appropriate action was not taken.

We have made a recommendation regarding the development of behavioural support strategies.

Staff had completed training in relation to the safeguarding of vulnerable adults. During discussions it was apparent that they were aware of their responsibility to report any abuse and poor care they became aware of. Staff were recruited safely and deployed in suitable numbers to meet the assessed needs of the people who used the service.

During discussions with staff they told us they felt supported in their role. The training matrix showed that staff had recently completed relevant training to ensure they had the skills and knowledge to carry out their roles effectively.

People who used the service received a balanced diet of their choosing and facilities were provided to enable them to help themselves to hot and cold drinks as well as breakfast cereals and snacks.

The registered provider had a complaints policy in place which was available in an easy read format to ensure it was accessible to the people who used the service.

The service had informed the Care Quality Commission of accidents and incidents as well as other notifiable events as required.

Full information about CQC

People’s needs were assessed and care and treatment was planned and delivered in line with their individual care plan. People we spoke with told us they were satisfied with the care they received. Comments included, “It’s the best care home I have been in.”

People were provided with a choice of nutritious food and drink. People told us they enjoyed the meals. However, people may not always be provided with a suitable diet which had put one person's health and welfare at risk.

We found that staff were not following the provider's procedures in relation to reporting allegations of abuse. This meant that some incidents of alleged abuse had not been reported or investigated and there may be a risk of further abuse occurring if appropriate action has not been taken.

People we spoke with told us that medicines were administered appropriately. Comments included, “They (Staff) know when I need my tablets.”

People who used the service told us that they liked the home. However, we found the home had not been adequately maintained and people who used the service had been put at risk.

People had their comments and complaints listened to and acted on. People told us, "I have no complaints but the staff are open enough for you to be able to mention things to."

We found a number of incidents that had not been reported to us by the provider within an acceptable time frame, as is required by regulation.

We carried out an inspection to see if the provider had improved levels of cleanliness since our previous visit in September 2012. We saw that the issues had been addressed, although some communal areas were in need of redecoration. There had been an infection control audit and items had been addressed.

People we spoke with were happy with the care they received and two people showed us their personal rooms that were in good decorative order and kept clean.

In this report the name of registered managers Sarah Kelly and Thomas Magorokosho appears. However they were not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time.

People we spoke with were very positive about the care and support they received. They told us they liked living at the home. Comments included “It’s just like being on a super holiday that is never ending” and “It’s a very nice home, we are lucky to get it.”

People confirmed they had been involved in planning their care. They told us they were well cared for. Comments included “I have access to my care plan” and “We are well looked after.”

People we spoke with told us that they felt safe living in the home. Comments included ”Yes, I feel safe here” and ”I feel safe with the staff, I have not had any problems with other people living here but staff do enough to protect us.”

People we spoke with were very positive about the staff who worked in the home. Comments included “They are all nice”, “They are good” and “The majority are very good, they are caring and understanding.”

People said that they thought there was sufficient staff to meet their needs.

People told us they were consulted about the way the service was delivered. They told us “We have residents meetings; they are a good forum for discussion. They listen to us, for example people requested that the bingo sessions were extended and they were”, “We have residents meetings quite often” and “We had a meeting last Friday, we discussed bingo and changes to the days out.”

During this review we spoke with people who lived in the home. They told us their needs were met and they were well cared for. Comments included “Staff help me with a shower,” “Staff help me with my wheelchair and getting out” and “I think I am spoilt here, I am very happy.”

People we spoke with understood that records about the care they required were held in the home. They told us they had had the opportunity to be involved in the development of these records. Comments included “They came to see me at my previous home, they asked questions about my care and wrote a care plan and then we discussed this,” “I have a care plan and staff write in this” and “I have seen my care plan.”

People told us they receive the care and support they need from the nurses who work in the home and other health care professionals as required. One person told us “I didn’t feel too clever today and they took me to the doctors.”

People living in the home were satisfied with the activities provided. They told us “There are plenty of activities and I enjoy the singers,” “We go out in the car to Cleethorpes or for a ride around” and “I do some crayoning and I go out with the staff shopping.”

People told us they are treated with respect, and are involved in the decisions about their care and support. Comments from people included; "I go to bed when I want and you have a choice of meals", "I have my room as I like it", "I can choose what to do" and " I have a bath or shower when I want".

People we spoke with were satisfied with the care they received. One person spoken with said "No problems with the care here, the staff are pretty good" and another person said "staff help me, do anything for me, always ask me how I like things, they know me well".

They told us that staff supported their independence but some people felt there weren’t enough activities arranged. Comments included "Very little to do, I sit and watch TV mostly", "We used to have Bingo, I spend more time in my room now, I have a TV and a computer" and "Sometimes play dominoes and go to a car boot sale".

Staff were described as being kind and friendly. People spoken with commented "I get on with all the staff", "Staff help me, do anything for me, always ask me how I like things, they know me well", "They are ok" and "The staff are nice".

People also said that they felt their views were listened to and knew who to talk to if they had any worries or concerns.

At our last inspection on 24 October 2013 we issued a compliance action as we found people were not always provided with a suitable diet which had put one person’s health and welfare at risk. At this inspection we found the service had put measures in place to protect people by ensuring their diet was of the correct texture to aid their swallowing difficulties.

Our previous inspection had identified a number of concerns relating to the fire safety of the building. We reported these to the fire service who carried out a fire safety audit. We have received confirmation from the fire service that all these issues have been addressed to its satisfaction.

In October 2013 we also found that staff were not always provided with the correct information about how to report any allegations of abuse or neglect. At this inspection we saw information was displayed clearly throughout the home and included the correct and up-to-dare information.

Our inspection on 24 October 2013 identified a number of incidents, including one person's death, that had not been notified to the local authority's safeguarding team and to CQC, as required under law. At this inspection we found the manager had out in place a series of auditing tools to ensure this would not happen again.