The Gables

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.

The Gables is a residential care service. The service provides care and support for up to nine people who have learning disabilities, autistic spectrum disorder or associated physical needs.

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.

The service worked within the principles and values that underpin Registering the Right Support and other best practice guidance. This ensured that people could live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence.

There were two people living at the service at the time of this inspection.

People’s experience of using this service:

Improvements were needed to the way in which governance systems were set out and managed. Additionally, improvements were needed to ensure communications were being maintained consistently with external agencies and professionals.

People were supported to have choice and control of their lives, to be involved in reviewing their care and to make decisions for themselves.

However, peoples care records did not always clearly record how all of the decisions made about care delivery and provision had been agreed.

People continued to receive safe care. Staff understood how to keep people safe from harm and risk assessments were in place to help people and staff manage potential risks within people's day to day lives, whilst also promoting their independence.

There were enough staff who had the right knowledge and skills to meet people’s needs in a personalised way.

People were supported to have access to a varied and nutritious diet.

Information and support provided by external health professionals enabled people to consistently stay healthy.

Staff were caring, and people were treated with respect and kindness.

People, their relatives and staff had a say in how the service was being run.

Rating at last inspection:

The Gables was last inspected on 29 September 2015 and 5 October 2015, (report published on the 13 January 2016) and was rated as good overall.

Why we inspected:

This was a planned inspection based on the rating at the last inspection.

Follow up:

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

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

Information in the home and discussions with staff showed us people were supported to feel socially included and engaged through the provision of activities and outings.

The registered manager showed us full records of meal menus that had been developed and explained that fresh produce was used as much as possible. Menus were all displayed using pictures so that people could express a choice as much as possible.

We found the building had been maintained effectively. The standard of decor was good. We found there was no contract in place for servicing the fire extinguishers. In addition, testing the water supply for Legionella did not take place.

We reviewed the recruitment records for the current members of staff. We saw people had completed an application form and there was a written record of applicant's interviews. People had undergone the appropriate checks before commencing employment.

We observed that the care staff were attentive to people's needs and that their interaction with people was friendly, respectful and professional.