The inspection took place on 20 December 2018 and 08 January 2019 was unannounced.

Gills Top is a residential ‘care home’ which provides accommodation and personal care for up to 27 older people, including people living with dementia. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. At the time of the inspection there were 24 people living at the home.

Rooms were located over two floors and there was an accessible lift available to use. There was a lounge area/dining room located on the ground floor as well as lounge upstairs for people to access. All rooms were single occupancy and had en-suite facilities.

At the last inspection, which took place in June 2016 the service was rated ‘Good’. At this inspection we found the service remained ‘Good’ and continued to meet all the essential standards that we assessed.

There was a registered manager at the time of the inspection. A registered manager is person who has registered with the 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.

The manager was aware of their regulatory responsibilities and notified CQC of all events and incidents which occurred at the service. This enabled CQC to monitor the safety and welfare of people living at the home.

People who lived at Gills Top told us they felt safe. We checked care plans and risk assessments and found that they contained up-to-date, relevant and consistent information.

Medication systems and processes were safely in place. Staff received appropriate medication training and regularly had their competency assessed. The storage area for medicines was not always appropriate. We made a recommendation about this in the report.

The home employed an adequate number of staff to provide the support people required. We received positive feedback about the staffing levels from people, relatives and healthcare professionals during the inspection.

Recruitment was safely managed. Pre-employment checks were carried out; candidates were appropriately vetted before commencing employment.

Safeguarding and whistleblowing procedures were in place. Staff explained their understanding of what ‘safeguarding’ and 'whistleblowing' meant and the actions they would take to safeguard people in their care.

The environment was clean, odour-free and well-maintained. Dedicated domestic staff ensured that health, safety and infection control procedures were followed.

The home complied with the principles of the Mental Capacity Act 2005. People’s level of capacity was appropriately assessed and reviewed.

Staff received regular supervision and were supported with training, learning and development opportunities.

People’s nutrition and hydration support needs were assessed and supported from the outset. We saw the appropriate support measures in place to ensure people’s nutrition and hydration needs were regularly monitored and reviewed.

People received an effective level of support from the staff team and external healthcare professionals. Appropriate referrals were made to district nurses, community matrons, speech and language therapists (SALT) and falls prevention teams.

We observed staff providing warm, kind and compassionate care. People told us they were treated with dignity and respect and felt safe and cared for.

People were encouraged to engage in a variety of different activities. There was an activities co-ordinator in post who arranged activities around different likes and preferences of people who lived at Gills Top.

There was a formal complaints policy in place. People and relatives were provided with the complaint p

We carried out this unannounced inspection on 15 June 2016. At the previous inspection, which took place on 30 September 2014, the provider met all of the regulations that we assessed.

Gills Top is registered to provide care for up to 27 older people, some who are living with dementia. The service is owned and managed by Anchor Trust. The property is detached and purpose built and is within a short walking distance of Grassington village. Accommodation is provided over two floors and there is a passenger lift. There is a small car park to the front of the property.

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.

At this inspection we found the service was being managed and operated in line with their legal responsibilities.

Staff told us the manager and other senior staff, employed by the service, were supportive and approachable. They also confirmed to us that the on call arrangements were well organised, and that they could seek advice and help out of hours if necessary. This meant there was good oversight of the service, and staff were confident about the management structures.

Staff had a good understanding of the Mental Capacity Act and we saw consent was sought routinely. People had been supported to make their own decisions wherever possible, and staff had taken steps to support people to do this. Where people were unable to make a decision there was a best interest decision recorded within their support plan and we saw the person and relevant people had been involved in making this. This meant people were given the opportunity to be involved in decision making and decisions were made in the person’s best interests. The service had effectively implemented the Deprivation of Liberty Safeguards (DoLS) as required.

People who used the service and their relatives spoke highly of individual staff and told us that staff treated people with the utmost respect and kindness. We saw good practice throughout our visit, including the support of people to move around the home and encouragement of people to eat and drink. Staff approaches were professional and discreet. Staff told us they felt supported by the management team and the organisation. Staff told us they had ample opportunities to reflect on the service they provided through supervision and regular contact with each other. Staff told us they had a shared interest in developing and improving the service for people.

The service recruited staff in a safe way, making sure all necessary background checks had been carried out and that only suitable people were employed. Processes were in place to assess the staffing levels that were needed, based on people’s dependency and the lay out of the building. People who used the service told us staff were always available, during the day and night when they needed them. Our observations during the inspection showed there was appropriate deployment of staff, including staff providing care, catering and housekeeping tasks.

Records showed staff received the training they needed to keep people safe. The manager had taken action to ensure that training was kept up to date and future training was planned.

The service was well maintained, clean, fresh smelling and comfortable.

People told us they felt safe and this was confirmed by a visiting health care professional and relatives. Staff knew the correct procedures to follow if they considered someone was at risk of harm or abuse. They had received appropriate safeguarding training and there were policies and procedures to support them in their role. Risk assessments were in place to identify risks due to people’s medical, physical and mental health c

At the time of the inspection there were 20 people living at the home. Due to their health conditions and complex needs not all people were able to share their views about the service they received, but we did speak with fourteen people. We also observed their experiences to support our inspection. We spoke with the registered manager, the regional manager, five care staff and three relatives.

During the inspection five key questions were answered; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people who used the service, their relatives and the staff told us.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

We saw the service was safe, clean and hygienic. The home had effective systems for the prevention and control of infection. Equipment was well maintained and serviced regularly, so preventing any unnecessary risks. All the staff told us how they worked to prevent infection and how they would manage an outbreak at the home so the risk of infection spreading could be reduced. All the people we spoke with told us they thought the home was kept very clean. One person we spoke with told us, “It is always so clean and tidy here. They are very good.”

Safeguarding procedures were robust and staff understood how to safeguard the people they supported. All the people we spoke with told us they felt safe. One person told us, “I am very well looked after here by staff. I feel very safe here.” Another person told us, “I would soon say something if there was something I was concerned about. I definitely feel safe here.”

We spoke with the registered manager about Deprivation of Liberty Safeguards (DoLS). They told us they had received training in making an application and showed us the policy and procedures they followed. They told us some staff had received relevant training and had access to the policy and procedures. Those staff also told us they had received this training. The registered manager told us there had been no application submitted in the last twelve months.

All the people we spoke with told us the care delivered by the staff was of a good standard. One person told us, “The staff are so lovely. They really do care and have such a good sense of humour.” Another person told us, “It is so comfortable here. The staff are there for you all the time. The care is very good.” A relative we spoke with told us, “They are so helpful here. We really feel our relative is very well cared for.” We saw the staff had been well trained and supported in their work and they told us it helped them deliver good care.

Is the service effective?

All the people we spoke with told us that they were well supported. One person told us, “I was poorly last night. The staff were so good. They came during the night to check I was alright. I have been helped to eat this morning and feel a bit better now.” Another person told us, “Before moving here I was having falls at home. Since coming here I have various health check-ups and I haven’t had any more falls.”

All the relatives we spoke with were positive about the care their relatives had received. One relative told us, “They do help my relative to stay motivated; it can be a struggle for him.”

People explained how their care and welfare needs were met. All the people we spoke with told us they had support with health appointments and felt that the service was flexible. One person told us, “I live as independently as I can. I have my own phone and arrange to meet friends and attend community events myself. I do have some support from staff for some things when I need them.”

Is the service caring?

We saw staff communicated well with people and were able to explain things in a way which could be easily understood. We saw they did not rush people in the home and that the interactions were caring. All the relatives we spoke with said they felt the care was very good. One relative told us, “I am happy with the care my relative gets here.”

We saw people were treated with respect and dignity by the staff. We saw people were given choice in their care and all the relatives we spoke with told us they were very happy with the care. All the people we spoke with also told us that they were happy with the care and support they received.

Is the service responsive?

All the people told us they were very happy with the service. One person told us, “I couldn’t manage by myself at home. It’s taken time for me to adjust, but the staff have been so helpful.” All the people we spoke with told us the staff were very responsive. One person told us, “I am usually in bed most days now. I have a buzzer to call staff. They are always coming into my room to see if I need anything.”

We saw staff responded to people's requests for help in a timely way.

We saw there was a complaints policy at the home. People told us they found the registered manager very approachable and would not hesitate to raise any issues or complain.

People’s care needs had been reviewed at least every six months. We saw when people's requirements had changed the provider had responded and reviewed their care needs so they could meet their changed support requirements.

People’s preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people’s wishes.

Is the service well-led?

We spoke with the registered manager and the provider’s regional manager. They showed us there was an effective system to regularly assess the quality of service people received. We found the views and opinions of people using the service and their carers, family and relatives were also regularly recorded. The manager showed us activities and suggestions for refurbishment had been arranged in response to the views and opinions they had received.

We saw the home had systems in place to make sure managers and staff learnt from any accidents, complaints, whistleblowing or investigations. This reduces the risks to people and helped the service to continually improve.

Staff also told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the service and quality assurance processes were in place. This helped to ensure people received a good quality care service at all times.

The provider had systems in place to help people make decisions about their care and support. This included involvement in the writing of care plans and seeking their views on the service provided. Where people did not have the capacity to consent, the provider acted in accordance with legal requirements.

People who used the service told us they were happy with the care and support they received. People told us that care was “first rate”, “really good” and “it’s like being at home here.” People’s privacy, dignity and independence were respected.

There was enough equipment to promote the independence and comfort of people who used the service. People were protected from unsafe or unsuitable equipment.

People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard. People referred to staff in a positive way and told us they felt relaxed with the staff supporting them.

There were systems in place to assess the quality of the service people received.

Thirteen people told us they liked living at Gills Top, that it was ‘nice place’ and people described the staff as 'kind' and 'attentive.’ One person told us there was plenty 'going on.' A visitor told us they were kept well informed about their relatives care and that they often attended the relative's meetings, which they found useful.

People we spoke with told us they liked the staff providing their care. Staff were referred to as ‘kind, thoughtful, professional and attentive.’ One person told us, “The staff know their job and they do it really well.” Another person said they could talk to staff about anything and that staff could be ‘trusted’.

People told us that there were always enough staff to 'help them' and 'look after them'. They said that if they needed anything then they did not have to 'wait long'. We asked people about their care records, if they knew about them, if they thought they were accurate and up to date. None of the people we spoke to gave us their view, apart from one person who said, "I leave it to the staff, they know what they are doing."

People using the service told us that they were involved in decisions about their care and day to day living. People told us that they were satisfied with the care and support provided. Staff were described as, 'kind and lovely.'

People said they were helped to maintain their independence and that they were encouraged to do as much as possible for themselves. One person said, "They look after me very well, they let me do what I can, they don't rush me and are always there to help". Other comments included "The staff are attentive and caring" and "The care is good, the staff know how I like things, I have no complaints."

People told us they felt 'safe' at Gills Top and that they knew who to talk to if they were worried about anything or concerned.

People we spoke with told us they were happy with the way their medication was given to them and how it was managed.

People said that although staff managed their care well, there were times when they thought there were insufficient staff on duty. One person said they were 'fearful' that they might find themselves in a situation and be 'left' because staff 'did not have time to answer the buzzer.' Another person told us, "There are times when they are too busy and we need things, we just have to sit and wait."

People said they were asked about their care and how they wanted to be looked after when they first moved into Gills Top.