We carried out this unannounced inspection on 21 and 22 June 2018.

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

Gilling Reane Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

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

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

People who could speak with us told us this was a good service and said they would recommend it.

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

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

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

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

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

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

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

The principles of the Mental Capacity Act 2005 were followed and people’s rights were respected. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

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

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

Care was planned and delivered to meet people’s needs. The registered provider had introduced an electronic care planning and recording system. This could be updated quickly

We carried out this comprehensive inspection on 20 and 24 January 2017, the inspection was unannounced.

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

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

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

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

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

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

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

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

People who lived in the home were included in p

We carried out an unannounced comprehensive inspection of this service on 30 July and 1 August 2014 at which breaches of legal requirements were found. This was because there were not sufficient staff to assist people, people were not protected against the risk of infection and the processes used to assess the quality of the service were not effective.

After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches.

Following the comprehensive inspection we received a concern that people had not been protected against hazards to their safety.

We undertook a focused inspection on the 18 March 2015 to check if the provider had followed their plan and taken action in response to concerns we identified at our comprehensive inspection. At this focused inspection we also looked at how the provider had assessed and managed hazards to people’s safety.

This report only covers our findings in relation to these topics. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Gilling Reane Care Home on our website at www.cqc.org.uk.

Gilling Reane Care Home provides accommodation for up to 33 people who require support with their personal care. The home mainly provides support for older people and people who have dementia. The home is a large, period property which has been converted to be used as a care home. Accommodation is arranged over two floors and there is a passenger lift to assist people to access the accommodation on the upper floor. The home has 29 single bedrooms and two double rooms, which two people can choose to share. There were 27 people living at the home at the time of our inspection.

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

At our focused inspection on the 18 March 2015 we found that people had been placed at risk of harm because a hazard to their safety had not been identified and managed.

People we spoke with told us that they felt safe living in the home. They said that there were sufficient staff to provide the support they needed. People told us that they knew the registered manager and said the home was well managed.

We found that when people moved to the home risks to their safety had not been thoroughly assessed. Risks to people from hot drinks had not been managed safely and people had been placed at risk. There had been one significant incident which had resulted in a person being harmed.

We found that the registered person had not ensured that risks to people’s safety were identified and managed. This was in breach of regulation 10 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, which corresponds to regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

At our focused inspection on the 18 March 2015, we found that the provider had followed their plan which they had told us would be completed by the 1 February 2015.

We saw that there were sufficient staff to provide people with the support they required. People told us that they received the support they needed in a timely way because there were enough staff employed in the home.

We found that the home was clean. Although we noted an odour in one area we saw that this was attended to promptly. People who lived in the home and their visitors told us that the home was usually clean. They said the staff took action if areas required cleaning and told us the accommodation provided was comfortable.

The processes used to monitor the quality of the service had improved. The registered manager and senior care staff carried out a range of checks to ensure people were provided with the support they required. We saw that action had been taken to address all the areas that we identified as requiring improvement at our comprehensive inspection.

Although we found that people had been placed at risk because a hazard to their safety had not been identified and managed, we saw that the registered manager had taken action to rectify this. Risk assessments had been completed to protect people from the risk from hot meals and drinks. We found that the staff on duty were aware of how to protect people from harm.

People we spoke with told us they were happy living at Gilling Reane Care Home and said the staff in the home provided a good standard of care. They told us they made choices about their lives and the decisions they made were respected. People made many positive comments about the staff employed in the home and the meals provided.

People told us,

“We’re very well looked after here”,

“The staff are brilliant”,

“The meals are very good”

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

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

Most of the people who lived in the home were not easily able to express their views about the service or the care they needed. We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

From our observations we saw that people received the care they needed in a way which respected their rights and protected their safety, dignity and independence.

People who lived in Gilling Reane Care Home told us they enjoyed the meals provided.

Visitors to the service told us people who lived in the home were well cared for and one person said the care provided was “brilliant”.

People living in Gilling Reane Care Home, (Gilling Reane), and their families told us the home provided a good standard of care.

People said they made decisions about their lives in the home and they knew who to speak to if they had any concerns about the services provided.

People told us:

“The staff are lovely”

“The staff do a really good job”.

And said,

“They are very good here, not that they’d tell you that themselves”.

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service.

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

This was an unannounced inspection, carried out over two days. During the inspection we spoke with 19 people who lived in the home, five visitors, eight staff and the registered manager of the home. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

We last inspected Gilling Reane Care Home in June 2013. At that inspection we found the service was meeting all the essential standards that we assessed.

We observed care and support in communal areas, spoke to people in private and looked at the care records for five people. We also looked at records that related to how the home was managed.

Although people told us that they felt safe in this home, we saw that there were times when there were not enough staff to meet people’s needs. This impacted on the support that people were provided with at meal times. We saw that one meal time was disorganised and people did not receive support at the time they needed it. We also found that a hoist and some parts of the accommodation were not maintained to a clean and hygienic standard and two areas of the home had an unpleasant odour. The systems used to assess the quality of the service had not identified the issues that we found during the inspection. This meant the quality monitoring processes were not effective as they had not ensured that people received safe care that met their needs.

People told us that they, and their families, had been included in planning and agreeing to the care provided. We saw that people had an individual plan, detailing the support they needed and how they wanted this to be provided. However, we found that some people’s support was not provided as detailed in their care plans and some people’s needs had not been thoroughly assessed. This meant people did not always receive support in the way they needed it.

The staff on duty knew the people they were supporting and the choices they had made about their care and their lives. People were supported to maintain their independence and control over their lives.

People were treated with kindness, compassion and respect. The staff in the home took time to speak with the people they were supporting. We saw many positive interactions and saw that people enjoyed talking to the staff in the home.

People had a choice of meals, snacks and drinks, which they told us they enjoyed. People had been included in planning menus and their feedback about the meals in the home had been listened to and acted on.

People were able to see their friends and families as they wanted. There were no restrictions on when people could visit the home. All the visitors we spoke with told us they were made welcome by the staff in the home. Some people had chosen to bring their pets into the home. They told us that it was very important to them that they were able to have their pet with them.

The home used safe systems when new staff were recruited. All new staff completed thorough training before working in the home. The staff were aware of their responsibility to protect people from harm or abuse. They knew the action to take if they were concerned about the safety or welfare of an individual. They told us they would be confident reporting any concerns to a senior person in the home.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 in relation to staffing, cleanliness and infection control and assessing and monitoring the quality of service provision. You can see what action we told the provider to take at the back of the full version of this report.