Archived: The Gables Nursing Home

The Gables Nursing Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The home provides nursing, residential and dementia care to a maximum of 23 older people.

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

There were various activities organised for people focused on their needs and preferences. Families of people using the service told us they felt their love ones were safe living at The Gables Nursing Home. The provider had effective safeguarding systems in place.

People received their medicines safely and as prescribed. Systems and processes were in place to keep people safe and staff protected people's privacy and dignity. Staff were recruited safely and there was enough available to meet people’s care needs. Staff received appropriate training, which was relevant to their role and people's needs.

Staff were supported by the management team and felt supported and listened to. People were supported to have 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.

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 good (published 13 February 2018).

Why we inspected

This was a planned inspection based on the previous rating.

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.

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 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. The Gables Nursing Home is located in a residential area of Pudsey in Leeds, and is close to local amenities. The home provides nursing, residential and dementia care to a maximum of 23 older people.

The service has two registered managers, both were present at this inspection. 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 2008 and associated Regulations about how the service is run.

Areas of the home required repair and refurbishment and the provider did not have a plan in place to address these issues. We have made a recommendation about this.

Activities provided at the service did not always suit people's care and support needs. We have made a recommendation about this.

People received care and support from staff who were appropriately trained and confident to meet their individual needs. Staff protected people's privacy and dignity. Staff received one-to-one supervision meetings with their line manager. Staff felt supported and listened to.

People's needs were assessed and their care plans provided staff with clear guidance about how they wanted their individual needs met. Care plans were personalised and contained appropriate risk assessments to protect people from harm as much as possible in their daily lives. They were regularly reviewed and amended as necessary to ensure they reflected people's changing support needs.

There were policies and procedures in place to assist staff on how to safeguard people from harm and abuse. There were sufficient numbers of staff on duty to meet people's needs. Staff told us they had completed training in safe working practices. We saw people were supported with patience, consideration and kindness and their privacy and dignity was respected.

Fire prevention processes were in place to keep people safe in the event of a fire on the premises. All servicing of utilities, systems and equipment had been carried out by the appropriate professionals. Some areas of the home required better cleaning. Accidents and incidents were investigated to make sure that any causes were identified and action was taken to minimise any risk of reoccurrence.

Thorough recruitment procedures were followed and appropriate pre-employment checks had been made before staff started work, including evidence of identity and satisfactory written references. Appropriate checks were also undertaken to ensure people were suitable to work within the care sector.

Medicines were managed safely in accordance with current regulations and guidance by staff who had received training to help ensure safe practice. There were systems in place to ensure that medicines had been stored, administered, audited and reviewed appropriately.

People were supported to make decisions in their best interests. The registered manager and staff had received training in the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS).

People were provided with suitable amounts of food and drink and were happy with the meals they received. People's nutritional needs were assessed and records were accurately maintained to ensure people were protected from risks associated with eating and drinking. Where risks to people had been identified, these had been appropriately monitored and referrals made to relevant professionals, where necessary. People were able to access health, social and medical care, as required.

The provider had systems in place to assess the quality of care provided and make improvements when needed. People knew how to make complaints, and the provider had a process to ensure action was taken where this was needed. People were encouraged and supported to express their views about their care and staff were responsive to any comments made. Positive feedback was given about the management team and how the service was run.

At our last inspection on 20 and 22 January 2016 we identified six breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches related to safe care and treatment, staffing, responding to complaints, fit and proper people employed, quality assurance and notification of significant events. We rated the service as inadequate and placed it into special measures. At this inspection we found the provider had made the required improvements and concluded the service was no longer in breach of any regulations.

The Gables Nursing Home is located in a residential area of Pudsey in Leeds, and is close to local amenities. The home provides nursing, residential and dementia care to a maximum of 23 older people. On the day of our inspection there were 15 people using the service. There was a registered manager in post when we inspected. 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 2008 and associated Regulations about how the service is run.

People told us they felt safe living at the home, and we found staff understood safeguarding and their responsibilities to report any concerns about people’s safety. Risks associated with care and support were well documented and contained guidance for staff to show how these risks could be minimised.

The provider carried out appropriate background checks before employing staff, and we found they were deployed in sufficient numbers to provide care and support safely. Accidents and incidents were managed safely; however, we found the information relating to actions taken was not always stored with the record of the incident.

Medicines were managed safely. Storage was secure and medicines were kept at appropriate temperatures. Records we looked at showed staff recorded when medicines were taken or refused. There was good guidance in place to ensure people got pain relief when this was needed.

Staff received training at induction and during their employment which ensured they were supported to be effective in their roles. Further support was given through a programme of supervision meetings and an annual appraisal.

People were supported to access a range of health and social care professionals. We saw advice from health professionals was incorporated into people’s care plans.

The provider ensured people who could not make decisions were appropriately supported within the requirements of the Mental Capacity Act (2005). Assessments of people’s mental capacity was assessed for specific decisions and, where needed, best interests decisions were made on their behalf.

People received a choice of meals and were able to have drinks and snacks throughout the day. We saw nutritional risk was assessed for each person on a regular basis.

We saw people who used the service had good relationships with the staff, and observed caring practice throughout our inspection. The registered manager and staff were knowledgeable about people they supported, and we saw care plans contained information about people’s likes, dislikes and preferences. Care plans were regularly reviewed, and people told us their involvement in the process was welcomed.

There were procedures in place to ensure concerns or complaints raised with the registered manager were acted on appropriately. We found information relating to the management complaints was not always filed in one place.

People had access to a planned programme of activities, and during our inspection we saw people enjoyed their participation.

We received good feedback about leadership in the home. We were told the registered manager was approachable and prepared to listen to suggestions. There were effective processes in place to ascertain, monitor and improve the quality of the service.

At the last inspection in November 2014 we found the provider had breached several regulations associated with the Health and Social Care Act 2008.We found the registered provider was not was not submitting applications to deprive people of their liberty to the supervisory body (local authority). We could find no record of a formal action plan being received to outline how the provider would be addressing these issues. We also found the registered provider was not providing staff with regular supervision and appraisal and clinical (nurses) staff had not received clinical supervision as required by relevant professional bodies in these cases the Nursing and Midwifery council (NMC).

At this inspection we found improvements had been made around applications to deprive people of their liberty but not with regards to staff supervision and appraisal and clinical supervisions.

The Gables is registered to provide accommodation for up to 23 older people who are living with dementia and people who have a physical disability people, who require personal care and/or nursing.

At the time of the inspection 22 people were living at the service. The service is close to all local amenities.

The service had a registered manager in place. 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 2008 and associated Regulations about how the service is run.

Staff were able to tell us about different types of abuse and were aware of action they should take if abuse was suspected. The service were not consistently reporting concerns to the local authority or informing CQC about statutory notifications as required.

We saw the registered provider did not have risk assessments or appropriate checks in place for all of the common hazards found in a care service setting and also when supporting people who displayed behaviours that may challenge. We saw appropriate risk assessments were in place and personalised for areas such as pressure care, moving and handling and falls. These had been reviewed appropriately.

We saw staff training and competence checks were not up to date in all areas.

Family members and staff told us there had been occasions where not enough staff had been on duty to meet people’s needs. We saw on three occasions this had been the case. The registered manager and registered provider had recently managed a very difficult staffing situation and were beginning to re-build relationships with long term staff, new staff and families. We found safe recruitment and selection procedures were not being followed.

We found although staff were working in a way which supported people to make choices day to day they did not fully understand the requirements of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards (DoLS). We also found the registered provider was not sending statutory notifications when DoLS decisions had been made by the supervisory body (local authority).

We saw the management of medicines was not always safe and issues found meant people were at risk of not receiving their medicine as prescribed.

We saw people were provided with a choice of healthy food and drinks which helped to ensure their nutritional needs were met. People were supported to maintain good health and had access to healthcare professionals and services. We saw the records monitoring people’s health outcomes day to day were not robust.

There were not effective systems in place to monitor and improve the quality of the service provided. We saw where issues had been identified; we were not able to track the issue had been resolved.

The registered provider had a system in place for responding to people’s complaints. People were regularly asked for their views. The registered manager was not recording all concerns they were told about.

There were positive interactions between people and staff. We saw staff treated people with dignity and respect. People told us they were happy and felt very well cared for.

We saw people’s care plans were person centred and were regularly reviewed and updated. We saw evidence to demonstrate people and their family members were involved in all aspects of their care plans. People’s independence was encouraged and their hobbies and leisure interests were individually assessed. We saw there were range of activities on offer.

Breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 were found during this inspection. You can see what action we told the provider to take at the end of this report.

Breaches of the Care Quality Commission (Registration) Regulations 2009. The Care Quality Commission will deal with this outside of the inspection process.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

We found the provider had taken appropriate action to protect people from the risk of inadequate nutrition.

We found the provider had taken appropriate action to protect people from the risks associated with medicines.

People who used the service said they felt safe and well looked after. One said the staff were 'very nice people' and another said 'I get on with all the staff'. They said the home was 'very clean and tidy'. They said they could have visitors whenever they wanted, one said 'It is a good home, I am fine here'. One person said there had been a BBQ a few days before we visited which they had enjoyed. Another person said they sometimes got bored. During the inspection we saw staff engage with people on an individual basis on a few occasions but apart from that there did not seem to be much for people to do.

The relatives we spoke with told us they had no concerns. They said their relative was well looked after and they were kept fully informed. They described the staff as 'brilliant'. They said they had been visiting for many years and had seen the staff always treated people with kindness and respect.

We found care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. However, we found people did not always receive the right support to meet their nutritional needs.

We found people were cared for in a clean and hygienic environment.

We found there were enough suitably qualified and experienced staff to meet people's needs.

We found improvements were needed to the way people's medicines were managed.

We saw the atmosphere within the home was relaxed and friendly and people appeared well looked after. We saw staff gave people time and engaged with them in a respectful, encouraging and patient way. Two people told us that there always appeared enough staff on duty and they never had to wait long if they required assistance.