The Gables

Updated 5 August 2021

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 Care Act 2014.

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 carried out by two inspectors and an assistant inspector.

Service and service type

The Gables 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.

The service employed a manager who was also the registered provider and who was registered with the Care Quality Commission. This means that they are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

We gave the service a short period of notice of the inspection. This was because it is a small service and we needed to be sure that the provider would be in the office to support the inspection.

What we did before inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. This information helps support our inspections. We used all of this information to plan our inspection.

During the inspection

We spoke with two people who used the service and one relative about their experience of the care provided. We spoke with two members of care staff.

We reviewed a range of records. This included two people’s care records and medication records. A variety of records relating to the management of the service, including policies and procedures were reviewed.

After the inspection

We continued to seek clarification from the provider to validate evidence found. We looked at training data and quality assurance records. We spoke with two professionals who have visited the service.

Updated 5 August 2021

About the service

The Gables is a residential care home which provides care and support for up to nine people who have learning disabilities, autistic spectrum disorder or associated physical needs. At the time of the inspection two people were receiving care. The service can also provide personal support and care for people in their own homes. The registered provider confirmed that at the time of this inspection there were no people using this part of service.

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

During the inspection we were unable to have meaningful dialogue with the provider. The providers representative was not able to provide the information required. Therefore, we were unable to obtain responses to some concerns we identified.

The provider had a quality assurance policy. However, the organisational governance processes were not always effective in identifying shortfalls.

Staff told us they did not receive regular testing for COVID-19. The provider failed to demonstrate on several occasions a testing programme was in place, in line with government guidelines for staff and people using the service. However, since the inspection the provider has supplied documents demonstrating a regular COVID-19 testing programme.

Risk associated with COVID-19 had not always been identified, assessed and mitigated effectively. Care plans were not in place to enable staff to support people safely. Staff did not always wear the correct personal protective equipment (PPE) which posed a risk of infection. However, since the inspection the provider has taken action to resolve these concerns.

The provider did not always follow or act in accordance with the Mental Capacity Act (MCA). The provider failed to demonstrate best interest decisions in place, this was addressed with the provider, they acted upon this putting in place capacity assessments. Further improvements were required to ensure all capacity assessments were carried out.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People received prescribed medicines. There was a process in place to inform staff of when they may need to seek additional medicines on a as needed basis such as pain relief.”

Staff were positive about their experience of working in the service. Most people and relatives also provided positive feedback on the caring, friendly nature of staff and the provider.

The registered provider had accessed professional development resources and actively encouraged staff to improve their skills.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, 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 providing support to people with a learning disability and/or autistic people.

The service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture. Attitudes and behaviours of leaders led to external agencies being unable to become fully involved in people’s lives. There is a risk of limiting access to opportunities, support and guidance from professional bodies to enhance people’s lives.

Right support:

• Model of care and setting maximises people’s choice, control and Independence

Right care:

• Care is person-centred and promotes people’s dignity, privacy and human Rights

Right culture:

• Ethos, values, attitudes and behaviours of leaders and care staff ensure people using services lead confident, inclusive and empowered lives

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

Rating at last inspection.

The last rating for this service was requires improvement (published 15 May 2019). The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

We received concerns in relation to the management of peoples care, governance systems and staff pre employment checks. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We undertook an initial visit 22 December 2020. Following the inspection, we requested further information from the provider, however the provider failed to send the information and assure the Commission of areas of risk identified by inspectors had been mitigated. A decision was made to make a second site visit 7 January 2021.

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 coronavirus and other infection outbreaks effectively.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has remained requires improvement. This is based on the findings at this inspection. We have found evidence that the provider needs to make improvement. Please see the Safe 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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Gables on our website at www.cqc.org.uk.

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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified a breach in relation to governance.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.