Gilburn

Updated 21 September 2022

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was undertaken by two inspectors and one inspection manager.

Service and service type

Gilburn is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Gilburn is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

At the time of our inspection there was a registered manager in post.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We reviewed information we had received about the service since it was registered. We sought feedback from the local authority. We used this information to plan our inspection.

During the inspection

We spoke with four people who use the service about their experience of the care provided. We spoke with 14 members of staff including the nominated individual, registered manager, commissioning manager, area manager, a team leader and nine care assistants. The nominated individual is responsible for supervising the management of the service on behalf of the provider. We spoke with three professionals who supported the service.

We reviewed a range of records. This included five people’s care records and four people’s medication records. We looked at three staff files in relation to recruitment and staff supervision and three agency staff profiles. A variety of records relating to the management of the service, including policies and procedures, were reviewed.

Updated 21 September 2022

About the service

Gilburn is a residential care home registered to provide personal care to up to seven people with mental health diagnoses, learning disabilities or autistic spectrum disorder. Gilburn consists of a communal lounge and individual apartments, each with their own bathroom facilities, lounge, kitchen and bedroom. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do receive this support, we also consider any wider social care provided. At the time of our inspection there were six people using the service, five of these people received personal care.

People’s experience of using this service and what we found

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

The service was not always able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

Right Support

People did not always receive support from staff who had received the training they required to support people safely.

Improvements were needed to record keeping in relation to care plans and daily notes.

The service worked with people to plan for when they experienced periods of distress so their freedoms were restricted only if there was no alternative. Staff told us they avoided using restrictions on people’s freedom.

People had a choice about their living environment and were able to personalise their apartments. Staff supported people to take part in activities and pursue their interests in the local area.

Staff communicated with people in ways that met their needs. They supported people with their medicines in a way that promoted their independence and achieved the best possible health outcomes.

Staff supported people to have the maximum possible choice and control over their own lives and to be independent. Staff supported people in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. Staff supported people to make decisions following best practice in decision-making.

Right Care

Improvements were needed to record keeping systems relating to accidents and incidents, restrictive practice interventions and debriefs to record in detail lessons learned.

There were not always enough appropriately skilled staff to meet people’s needs and keep them safe. There was a dependency on the use of agency staff at the time of the inspection. The management team told us they were recruiting to staff vacancies and planned to reduce agency use over time. Records showed, and we saw, agency staff knew people well.

Staff promoted equality and diversity in their support for people. They understood people’s cultural needs and provided culturally appropriate care. People received kind and compassionate care. Staff protected and respected people’s privacy and dignity. They understood and responded to their individual needs.

Staff understood how to protect people from poor care and abuse. The service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it.

People took part in activities and pursued interests that were directed by them. The service gave people opportunities to try new activities. Where appropriate, staff encouraged and enabled people to take positive risks.

Right culture

Staff turnover had been high resulting in a number of staff vacancies. This had led to staffing pressures and reliance on agency staff. The provider introduced an enhanced rate of pay and a bonus related to length of service in order to attract additional staff. We saw this had a positive effect on recruitment.

People were supported by staff who understood best practice in relation to the wide range of strengths, impairments or sensitivities people with a learning disability and/or autistic people may have. This meant people received compassionate and empowering care which was tailored to their needs.

The service enabled people and those important to them to work with staff to develop the service. Staff valued and acted upon people’s views. Staff ensured risks of a closed culture were minimised so people received support based on transparency, respect and inclusivity.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

This service was registered with us on 09 July 2021 and this is the first inspection.

Why we inspected

The inspection was prompted in part due to concerns received about staffing levels, staff training, inappropriate use of restraint and the local authority opening a safeguarding enquiry following a recent incident. A decision was made for us to inspect and examine those risks and to undertake a fully comprehensive inspection.

We looked at infection prevention and control measures under the safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, responsive and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to staffing and governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.