We carried out this inspection on 17 July 2018. The inspection was unannounced.

Galtee More Nursing 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. Galtee More Nursing Home does not provide nursing care despite the service’s name suggesting otherwise. Galtee More Nursing Home is known as Galtee More to the people who live and work there is registered to provide accommodation and personal care for up to 28 people over 65 years of age, some of whom are living with dementia. At the time of the inspection there were 20 people living at the home. The home consists of one building with four floors accessed by one passenger lift. The majority of rooms are single without en-suite facilities.

Our last inspection at Galtee More Nursing Home took place on 3 and 5 July 2017. The service was rated requires improvement overall. We found the service was in breach of three of the regulations of the Health and Social Care Act 2008 (Regulated Activities) 2014. At this inspection we checked the improvements the registered provider had made. We found sufficient improvements had been made to meet the requirements of these regulations and the service is now rated good overall.

There was a manager at the service who was registered with the CQC. 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.

People spoken with were very positive about their experience of living at Galtee More Nursing Home. They told us they were happy, felt safe and were respected.

The service provided a programme of activities to suit people’s preferences. People spoken with gave very positive feedback about the quality of activities provided.

Sufficient numbers of staff were provided to meet people’s needs. We saw staff responded in a timely way when people required assistance. We spent time observing lunch and saw there was a relaxed and calm atmosphere. Improvements were identified with the systems in place to calculate staffing levels at the service.

We found systems were in place to make sure people received their medicines safely so their health needs were met. Medicine protocols were in place to guide staff when to administer medicines prescribed on an ‘as and when’ basis to meet people’s health needs.

Staff recruitment procedures were in place. The registered provider ensured pre-employment checks were carried out prior to new staff commencing employment to make sure they were safe to employ.

Staff were provided with relevant training, which gave them the skills they needed to undertake their role. Staff knew people well and positive, caring relationships had been developed. People were encouraged to express their views and they were involved in decisions about their care. People’s privacy and dignity was respected and promoted. Staff understood how to support people in a sensitive way.

People’s care records contained detailed information and reflected the care and support being given.

There were systems in place to monitor and improve the quality of the service provided. Regular checks and audits were undertaken to make sure full and safe procedures were adhered to.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the registered provider’s policies and systems supported this practice.

Galtee More Nursing Home known as Galtee More to the people who live and work there is registered to provide accommodation and personal care for up to 28 people over 65 years old, some of whom are living with dementia.

Galtee More is a residential care home situated in a residential area on the outskirts of Barnsley town centre. The home consists of one building with four floors accessed by one passenger lift. The majority of rooms are single without en-suite facilities. At the time of this inspection there were 23 people living at the home.

We inspected Galtee More on 3 and 5 July 2017. Both inspection days were unannounced. This meant the home did not know when we were coming.

Galtee More was last inspected in September 2015 and was rated Good.

The home had a registered manager who had registered with the Care Quality Commission (CQC) in February 2014. A registered manager is a person who has registered with 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.

During this inspection, we identified that the service was breaching regulations related to safe care and treatment, recruitment, consent and good governance.

People and relatives told us they felt safe and their care needs were met by staff at the home.

Although risks associated with people's individual care needs were identified, such as pressure sores and falls, we found shortfalls in how these and other areas of risk were managed.

Staffing levels were appropriate and dependency tools were found in people’s files however these were not being used to inform the registered manager’s decision in regards to staffing levels or staff deployment.

People had care plan specific to their care needs however its quality was variable.

Medicines were not always administered safely at the home. The temperature of the medicines room was over the advised limit during several days and no action was taken to rectify it; creams were not being administered or recorded properly and there were no protocols for ‘as and when required’ (PRN) medicines.

Mental Capacity Act 2005 assessments and best interest decisions for people, who lacked capacity, were not in place.

Recruitment process were not robust as staff’s full employment history and appropriate references were not always sought in line with regulations.

People and their relatives provided good feedback about the meals and drinks provided. Care and catering staff were well-informed about people's dietary needs, food preferences and dislikes.

When needed, referrals to other professionals were done and during our visit we had positive feedback from a visiting health professional in relation to the care provided at Galtee More.

People had access to activities.

Staff had completed training however it was not always possible to establish when this had been completed. Staff had regular supervision. The registered manager did not have an oversight of staff’s training records or supervision dates.

People felt able to tell staff if there was something they were not happy with and we saw that concerns and complaints were managed well.

People and relatives thought the care staff and management were kind, caring and polite.

The systems in place to monitor and improve the quality of the service provided were not robust. Some checks and audits were undertaken but these did not identify areas for improvement.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) regulations 2014. You can see the action we have told the provider to take at the end of this report.

Galtee More is registered to provide accommodation and personal care for up to 28 older people, some of who are living with dementia. The home is in a residential area on the outskirts of Barnsley town centre.

There was a manager at the service who was registered with CQC. 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.

Our last inspection at Galtee More took place on 29 October 2013. The home was found to be meeting the requirements of the regulations we inspected at that time.

This inspection took place on 11 August 2015 and was unannounced. This means the people who lived at Galtee More and the staff who worked there did not know we were coming. On the day of our inspection there were 24 people living at Galtee More.

People told us they felt safe living in the home and relatives we spoke with told us they thought their family members were safe.

There were sufficient staff, with appropriate experience, training and skills to meet people’s needs.

Staff recruitment procedures were thorough and ensured people’s safety was promoted.

We found the home was clean, with no obvious hazards noticeable, such as the unsafe storage of chemicals or fire safety risks.

Systems for managing medicines were safe.

Staff training was up to date. Systems for supporting staff were in place.

People living at the home said their health was looked after and they were provided with the support they needed.

People received a nutritious diet and found the food enjoyable. Close monitoring of people’s nutritional needs was in place and any weight loss was identified and responded to.

People and relatives thought the care staff were kind, caring, patient and polite.

People’s choices were respected and their views were sought through ‘residents meetings’.

People had access to meaningful activities.

People felt able to tell staff if there was something they were not happy with and we saw that concerns and complaints were managed well.

There were effective systems in place to monitor and improve the quality of the service provided. Regular checks and audits were undertaken to make sure full and safe procedures were adhered to.

We found people’s views and experiences were taken into account in the way the service was provided and delivered in relation to their care. People told us they had the choice to do things they wanted and when they wanted to.

People told us that they were happy living at the home and satisfied with the care and support they received. Their comments included, "I’m happy here, the staff are smashing,” “The lasses [staff] are lovely, they are really nice” and “It is very, very good here, we are really well looked after.”

Relatives we spoke with said that they were happy with the care their loved one received. They said, “Lovely staff” and “We are very happy she is a resident here, we don’t think there is anywhere better.”

During the inspection we were able to observe people's experiences of living in the home. The interactions between people living at the home and staff were positive. We found that care and support was offered appropriately to people.

We found that people's needs were identified in care plans. Records showed that people had been involved in the care planning process.

We found there were processes in place to ensure the safety, availability and suitability of equipment.

Our conversations with people, relatives and staff, evidenced that there were enough staff on duty to meet people's needs.

We found people were protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records had been maintained.

We spoke with 11 people who lived at the home and four visiting relatives. They all spoke very positively about Galtee More. They told us they were happy with care at the home, liked all the staff who looked after them, thought the service was kept clean and enjoyed their food. Some people’s comments captured included, “very nice staff”, “it’s a lovely little home, very nice staff, I’ve got my room just the way I like it”, “all the staff here are really friendly and very nice, I feel very safe here.”

We spoke with relatives who were visiting the home and they confirmed that they were very happy with the care provided. They told us, "the staff are very friendly, they keep us informed what’s going on with Mum, I know she’s happy here.” and ”the staff are very good, very approachable, they’re all nice and the home is kept very clean.”

We found that people's needs were identified in care plans. Records showed that people and their relatives had some involvement in the care planning process.

Medication records checked were up to date and regular audits of medication systems were undertaken.

We found that there were sufficient numbers of staff provided to meet people’s needs.

We found that a complaints policy and procedure was in place. People had been provided with information on how to make a complaint. All of the people and their relatives we spoke with said they had no complaints or concerns about the home.

People that were able told us that they were very happy living at the home and that they were "more than satisfied" with the care they received. People said,

"It's great living here." "We're well fed and very comfortable." "I wouldn't go anywhere else." "We all enjoy each others company and look out for each other."

We spoke with 4 relatives who were visiting the home and they confirmed that they were

"Very satisfied with the care provided." They told us "Everything is so much better, there has been lots of improvements" and "The new manager has made a big difference, the staff take time out now to speak to us and make us feel more welcome."

We spoke with Barnsley Local Authority, Contracting, Commissioning and Safeguarding

and they told us that the new manager was "making a significant difference" at the home.

This is not applicable to the purpose of this visit.

People told us that overall they were happy living at the home and generally satisfied with the level of service provided. Individual comments included:

“We used to play bingo but now there are not enough activities which can make the days seem very long”.

“The staff are nice but we often have to wait after we have pressed the call buzzer”.

“We only get a bath once a week, we have to go on a rota.

“I always have to sit in the same place for meals”.

“They look after us well”.

“My son can visit any time”.

“I have a lovely room all to myself”.

Visitors spoken to said that they found the staff friendly.

When we spoke to people who used the service about their experiences of living at the service they told us:

“it’s very nice here. They look after us. We feed well”

“I wouldn’t want to move anywhere else. I’ve got used to it here”

“it’s good here”

In respect of activities they said:

“there’s nowt much to do. We start things and they give up, like bingo”

“we don’t do much, that’s the trouble”

“hairdresser day’s a change. It’s the highlight of the week. I had a bath and had my hair done”

“just snooze”

“I enjoy reading, but don’t do much else”

They told us they felt safe living at the service. One person said, "I feel safe here".

People told us they got their medicines when they needed them. However, a discussion with a group of people told us that when they were given their night time medication they were often woken by staff. Their comments included, “they’re a … nuisance. They wake you up and then you can’t get back to sleep” and “they wake you up just when you’ve got nice and comfortable”.

When we spoke to people living at the service about their experiences of their interactions with staff they said:

“staff are very good”

“it’s the same staff”

“they’re very pleasant”

“they’re not bad at coming to help in night”