This was an unannounced comprehensive inspection which took place on 6 and 7 December 2018.

Gillibrand Hall is a ‘care home.’ People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided and both were looked at during this inspection. Gillibrand Hall is a listed property set in its own grounds. It is located in a residential area, close to the town of Chorley. The home provides residential and nursing care for up to 50 people and at the time of inspection 50 people were living there. Accommodation is set on two floors. This includes accommodation for people with nursing needs and the first floor provides care specifically for people who live with dementia. There are a range of aids and adaptations in place to meet the needs of people using the service.

The service had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered provider, they are 'registered persons.' Registered managers have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.” The registered manager was supported in the day to day running of the service by a deputy manager.

At our previous inspection on 2 June 2016, the service was rated as ‘good.’ At the last inspection the overall rating had remained good, but some improvements to ensure that the service remained consistently safe.

We looked at how the service managed recruitment and found that this was not always safe. We noticed that staff had only been requested to provide a ten-year history of employment. This meant that not all checks had been carried out in line with the current regulations. We raised this with the provider who amended all application forms to capture a full employment history.

Medicines were not always safely handled. Although we found areas of good practice during inspection we had concerns about the safe temperature storage of medication. We found the daily maximum and minimum temperatures were out of range on one fridge and there were issues around this being reset. This was dealt with swiftly on inspection and a new fridge was delivered.

During a tour of the building, we found sliding bolts on the outside of some bedroom doors. We raised this as a concern and requested that they be taken off the doors immediately as this was unacceptable. This was actioned immediately.

Assessments of environmental risks and equipment had been undertaken to ensure people’s safety and well-being. However, although work was currently being completed regarding re-wiring the service, we found that the electrical safety certificate for the service was out of date. We raised this with the provider who promptly arranged for the electrical safety check to be carried out. The provider told us that extensive work was being carried out and this was the reason for the delay.

All of the people we spoke with at the home, told us they felt safe. Staff knew how to keep people safe. Training in safeguarding adults had been undertaken and staff were clear about their responsibilities to report any concerns. The service also had a safeguarding champion, who staff could access for additional support.

The home was exceptionally clean and all staff had received training in infection control and were aware of their responsibilities in relation to this.

Specific risk assessments regarding individuals had been thoroughly undertaken and risk was managed well. The service had protocols in place in the event of vulnerable people going missing from the service.

Assessments of need were comprehensive and people’s needs were considered before they came to live at Gillibrand Hall. We saw evidence of person centred care plans developed to meet their needs.

Staff had time to care. The service encou

This inspection was unannounced and took place on 2 June 2016. The service was last inspected in September 2014 and was found to be meeting all the regulations we reviewed.

Gillibrand Hall is a listed property set in its own grounds. It is in a residential area close to the town of Chorley. The home provides residential and nursing care for up to fifty people. Accommodation is set on two floors. This includes accommodation for people with nursing needs and the first floor provides care specifically for people who live with dementia. There are a range of aids and adaptations in place to meet the needs of people using the service.

The service had a registered manager in place. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

All of the people we spoke with who lived at the home told us that they felt safe.

We spoke with staff about the home’s safeguarding procedures. They were all aware of the provider’s safeguarding policy and how to report any potential allegations of abuse or concerns raised and were aware of the procedures to follow.

We looked at recruitment processes and found the service had recruitment policies and procedures in place to help ensure safety in the recruitment of staff.

People we spoke with told us they felt there were always enough staff on duty, as did all the relatives we spoke with. We observed staffing levels to be sufficient on the day of our inspection and reviewed staffing rotas for the previous two week period to our inspection. We found staffing levels to be sufficient to meet the needs of the people in the home.

The home had a medicines management policy in place, which included procedures for the administration, disposal, refusal and storage of medicines. We observed two members of staff administering medicines and found they did so in line with best practice guidance. Both members of staff told us that they were regularly tested for competence for administering medicines and we found evidence of this when reviewing training records.

Relatives we spoke with told us they thought staff were well trained, competent and cared about the people living at the home.

We observed staff to be patient with people and understanding of their needs and how people’s behaviour was affected due to them living with dementia. It was obvious that staff knew the people they cared for well and knew how to calm people if they became agitated.

We checked whether the service was working within the principles of the Mental Capacity Act 2005 (MCA), and whether any conditions on authorisations to deprive a person of their liberty were being met. We found the provider was working in line with the key principles of the MCA.

We saw that staff attended regular training via the staff training matrix and found staff to be knowledgeable about their role. We found evidence within staff files of training undertaken.

People told us that staff respected their privacy and treated them with dignity. We observed staff interactions with people during our inspection and found them to be warm and compassionate. Staff were friendly, patient and were discreet when providing personal care interventions.

Relatives we spoke with said they could visit the home whenever they wished to without restriction. They told us that staff called people by their first name and knew the people they were caring for well.

People we spoke with and their relatives told us they knew how to raise issues or make complaints. They also told us they felt confident that any issues raised would be listened to and addressed.

We examined the care files of six people who lived at the home. We found documentary evidence to show that people had their care needs assessed

In this report there is no named registered manager. There was a manager in post at the time of our inspection who had applied to become the registered manager which our records reflected.

We considered our inspection findings to answer questions we always ask;

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well-led?

This is a summary of what we found -

Is the service safe?

We looked at staff rotas and discussed staffing levels with the manager at the home. We found that there were systems in place to ensure that staffing levels were sufficient to meet the needs of the people living at Gillibrand Hall. Observations throughout the day showed that staff were able to meet the needs of the people living at the home on the day of our inspection.

Is the service effective?

We found evidence of the involvement of, and referral to, other professionals such as the speech and language therapy service, incontinence service, GP's and opticians.

Is the service caring?

We spoke with three people who lived at the home and two visiting relatives. All the people we spoke with were positive about their, or their loved ones, experience of living at the home. Some of the comments we received were as follows;

"Staff are all very helpful and very nice. If I want any help I just have to ask."

"It's more than alright here, I get well looked after."

"As far as the care is concerned (name) is doing great. I'm a frequent writer and I'm impressed."

"Staff don't get flustered. they have plenty of sympathy and concern for the people living here."

Is the service responsive?

The home had a 'key-worker' system in place which meant that people had named staff members to bring up issues with and staff were able to get to know people and their needs in detail. Staff we talked with were able to name and talk about the people they were a key-worker for.

Is the service well-led?

We were shown a copy of the audit tool used by the manager and discussed its use with them. The audit tool covered a wide range of issues such as care plan contents, risk assessments, Deprivation of Liberty (DOLs) screening, activities and communication with relatives and carers. In addition to this tool weekly medication audits were carried out and the area operations manager carried out a bi-monthly audit of the home.

People who lived at Gillibrand Hall were positive about their experiences and the comments received reflected this, one person living at the home stated, "The carers here are great, they really look after you. They always knock on the door before they come in and always explain what they are doing for me”.

Care plans showed that people's care was delivered in a person centred way and that their likes and dislikes were noted and recognised by staff. From speaking to staff, looking at their personnel files and staff training files it was apparent that staff felt supported and had the opportunity to develop.

The provider had an effective system in place to identify, assess and manage risks to the health and safety of people using the service and others.

Staffing levels were found to be sufficent to ensure the safety of residents at all times throughout the day and night. A suitable system was in place to ensure that residents needs were catered for with extra staff being introduced if needed.

On the day of the inspection there had been an outbreak of ‘winter virus’ on the dementia unit. This meant infection control measures had been put in place and limited the time we spent in the dementia unit.

We spoke with a range of people including the manager, staff, residents and visitors. We did this to gain the views of people who used the service.

People we spoke with told us they liked living there, comments included, "Oh yes everybody is very helpful,” and, “It’s a busy home there’s always something going on.” Also, “A lot of things have been planned for Christmas.”

People who used the service told us staff treated them with dignity and respect. They told us they had time to spend with residents and help them with personal tasks. One person told us, “I am happy here, everyone is very helpful.”

We spoke with eight staff members to gain their views about how they provided care and support. They told us they liked working at the home and said they worked well as a team. Comments included, “Worked here for a long time, it is a really nice place to work.” Also, “We get a lot of satisfaction working with the residents, they are all very different.” Another staff member told us, “There are enough of us to do the work. We also have time to spend with individual residents. They like the time we have with them.” In general staff told us they worked in sufficient numbers to meet the needs of people who lived there.

People we spoke with told us that they had their medicines at about the same times every day. They confirmed that the times were ‘about right’ not too early, or late. One person who had chosen to self-administer some of their own medicines confirmed that they had everything they needed and that they had enough information about what their medicines were for. Another person explained that because they had been poorly, they were happy for staff to look after their medicines for them.

People who use the service told us staff treat them with dignity and respect. They told us they have time to spend with them and help them with personal tasks. One person told us, “they can’t do enough for us, they are very patient”.

People told us they are kept informed about appointments which are made for them, and about any treatment they are to receive.

Staff caring for people with specific dementia conditions demonstrated they knew what their individual needs were and how to meet them.

People told us they liked the choice of activities and that the activity co-ordinator was "very good at her job".

We spoke to the cook who has many years experience, they told us they have many years experience in preparing meals for people in residential care and has a good understanding of the nutritional needs of people.

Staff we spoke to told us they have received training in safeguarding people. "I have been here a long time and have had a few courses on safeguarding people, they up date it every now and then"

People we spoke to told us they thought the home was clean and did not have any offensive odours. "They are always tidying up", "I like to keep my room as I like it and they let me do that", "I like to flick a duster around when I want to".

Staff we spoke to told us they have specific duties to carry out in respect of maintaining the homes cleanliness. " I have had training in infection control and we have the policies and procedures to follow".

One lady looked after some of her own medication and she told us she liked this because she felt it gave her Independence. "I am quite capable of managing my own tablets and the staff let me do this". Another lady told us that she always got her medicines when she needed them and she had never been left in pain. We watched nurses give some people their medication and they did this in a kind and unhurried manner.

Staff we spoke to said they find it a nice environment in which to work.

"We work between the units; they are both different in their own ways”

“Even though it’s big it is still homely", "the maintenance work keeps us busy".

Staff we spoke to told us they receive training in the use of various pieces of equipment as part of the induction programme, so that they can use them safely.

People we spoke to said the staff couldn’t do enough for them and were always around when you needed them.

"On the whole they do a good job", "Some of them have been here for a long time".

People we spoke to told us "there are always staff around when you need them". They told us they liked the fact there are not many changes to the staff team so that they can get to know them.

Staff we spoke to said they felt there is a good staff team. They said each shift has a good skills mix, and that the communication between them is good. "we are always told is there are any special duties we need to do when we come on shift".

People told us they thought the staff team knew what they were doing. They told us they had confidence in the staff, and felt they had the skills to carry out their roles.

The staff told us they informally get the views of people just by talking to them. “Some people will tell you what they think and if they want us to change something"

“People with dementia can't just tell you what they think, but their actions can sometimes give you a clue, it's just about watching their body language and behaviour".

People we spoke to told us they felt confident they could raise an issue of concern or complaint to the manager if they felt they needed to. "I have complained about things in the past and it usually gets sorted out"

People we spoke to were aware they had care plans and written information about them.