Gables Care Home

Gables Care Home provides accommodation, personal and nursing care for up to 64 people, across 4 separate wings. Two of the wings provide nursing care and one of these specialises in providing nursing care to people living with dementia. At the time of the inspection there were 32 people living in the home.

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

People were not always supported to receive their medicines in a safe way. Staff did not feel supported and did not receive regular supervisions in line with the provider’s policy. Risks to people were assessed but risk assessments were not always updated to reflect people’s changing needs. The quality and safety of the service was not fully monitored. Quality systems in place at the service hadn’t indicated shortfalls found during the inspection.

There were malodours evident throughout the home and some areas were not thoroughly cleaned.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

Staff did not always meet people’s social needs. There were limited activities available that were not always reflective of people’s individual hobbies and interests. We have made a recommendation about this.

Staff morale was low in the home. People and relatives were happy with the service. However, there was limited evidence that people and relatives were consulted about the development of the home. We have made a recommendation about this. Staff felt that they were not kept informed of changes in the home and communication with management was poor.

People and relatives felt the service was safe. Staff safeguarded people from abuse. There were enough staff to meet people’s needs. Accidents and incidents weren’t thoroughly recorded although there was limited evidence that the provider learned from accidents and incidents to mitigate future risks.

People’s needs were assessed before they moved into the home and on an ongoing basis. Staff were suitably trained. People were supported with their nutritional needs and to access a range of health care professionals.

Staff treated people with respect and supported them in a dignified manner and in line with their wishes. Relatives told us, “The staff are a credit to the home; I can’t fault them. They are very supportive, and they listen” and, “The quality of the staff is what makes the home a good one.” Staff were passionate about their roles and caring for people. One staff member said, “All I want is for the residents to be happy and comfortable.”

Care plans detailed how people wished to be supported. Staff knew how to effectively communicate with people, although alternative communication methods were not always detailed in care records. People and relatives knew how to raise concerns and any complaints received were investigated and actioned in line with the provider’s policy.

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 28 February 2020).

Why we inspected

The inspection was prompted in part due to concerns received about staffing, culture, medicines management, governance, management and the safety of the service. A decision was made for us to inspect and examine those risks.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

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

Enforcement and Recommendations

We have identified breaches in relation to safe care and treatment, consent to care, good governance and staffing. We have also made recommendations around activities and engaging with key stakeholders to improve services.

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 for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

We found the following examples of good practice.

Systems were in place to prevent people, staff and visitors from catching and spreading infections. The home supported people as far as possible with social distancing.

Staff had undertaken training in putting on and taking off PPE, hand hygiene and other COVID-19 related training. The new manager monitored staff practices to ensure correct procedures were followed.

People were supported to have face to face or telephone contact with friends and relatives through an appointment system. National guidance was being followed to ensure visits took place at a safe social distance. Infection prevention and control measures were in place to avoid potential transmission with others.

The home was following national guidance for anyone moving into the home. Staff worked with people and their relatives to ensure they were aware of isolation procedures should they be needed.

Infection control audits and checks were carried out. The new manager spoke positively about the positive support staff had shown, which had helped to minimise the impact of the pandemic on people’s health and wellbeing. The provider passed on important information about COVID-19 to staff.

Gables Care Home is a residential care home providing personal and nursing care to 47 people aged 65 and over at the time of the inspection. The service can support up to 64 people across four separate wings, each of which has separate adapted facilities. Two of the wings provide nursing care and one of these specialises in providing nursing care to people living with dementia.

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

People were receiving their medicines as prescribed but accurate medicines records were not always kept. Risk assessments were in place but did not always contain the necessary information to help staff minimise risk. Although these issues needed to be addressed, there was no evidence of negative impact on people living in the home. Everyone we spoke with felt safe in the home. There were systems and processes in place to help protect people from the risk of abuse.

People and their relatives all gave very positive feedback on the home. One person told us, “Oh I'm happy alright. I'm well looked after.”

There were enough staff on duty to meet people’s needs. Staff understood the needs of the people they supported well. Safe recruitment procedures were followed.

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.

The dining experience was relaxed and enjoyable and the quality of food was good. People were supported with eating and drinking, and any special dietary needs were met. People were supported to have access to a range of healthcare professionals to ensure they remained healthy.

There was a caring culture supported by a strong staff team who respected people and treated them with dignity. Staff encouraged independence and supported people to maintain their skills. The service had a relaxed, homely atmosphere and relatives were always welcome.

People's care was delivered around their wishes and preferences and care plans reflected this.

People had access to a variety of activities inside and outside of the home.

A range of audits and checks were carried out to monitor the quality and safety of the service. Action was taken if any issues or concerns were identified.

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 22 March 2019).

Why we inspected

This was a planned inspection based on the previous rating.

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.

People’s experience of using this service:

• The premises, infection control processes and governance processes had improved but continued and sustained improvement was needed.

• People received their medicines when needed. Staff safeguarded people from abuse. Risks to people were assessed and action taken to address them. The provider ensured there were enough suitable staff working to support people safely.

• Staff were supported with regular training, supervision and appraisal. People received support with food and nutrition, and staff helped them access a wide range of healthcare professionals. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice.

• People and their relatives spoke positively about the support they received from staff, who they described as caring and kind. People were treated with dignity and respect.

• People received person-centred support based on their assessed needs and preferences, and were involved in designing and reviewing this. Clear complaints procedures were in place to address issues at the service.

• Since our last inspection a new management team was in place, and staff spoke positively about their leadership. Systems were in place to ensure the voices of people, relatives and staff were heard. The service worked with other organisations and agencies to promote people’s health and wellbeing.

Rating at last inspection: Requires improvement (Report published 4 October 2018).

Why we inspected: We received information of concern from local authority commissioners and other professionals visiting the service. This inspection was brought forward due to the information we received.

Follow up: We will work with the provider following this report being published to understand and monitor how they will make changes to ensure the service improves their rating to at least Good.

The service was last inspected in January 2016 and the overall rating for the service was good. The safe domain was rated requires improvement as medicine records were not always completed correctly. We spoke with the registered manager of the service at that time, who said action would be taken to address these issues. When we returned for this latest inspection we found that medicines were not managed safely. We also found issues with the maintenance and cleanliness of the premises, and saw that governance and management processes were not always effective.

This is the first time the service has been rated requires improvement.

Gables Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. Gables Care Home accommodates up to 64 people across four units. Two units provide general nursing and residential care, and two units provide nursing and residential care for people living with a dementia. At the time of our inspection 57 people were using the service.

The service had a manager who was applying to be the registered manager at the time of our inspection. A registered manager is a person who has registered with the 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. The manager was registered as the registered manager shortly after our inspection, and will be referred to as the registered manager in this report.

Risks arising out of people’s health and support needs were assessed and plans put in place to reduce the chances of them occurring. Accidents and incidents were monitored to see if lessons could be learned to keep people safe. Plans were in place to support people in emergency situations. Policies and procedures were in place to safeguard people from abuse. We received mixed feedback on staffing levels from people, relatives and staff but this was monitored by the provider and registered manager. The provider’s recruitment process minimised the risk of unsuitable staff being employed.

People’s support needs and preferences were assessed before they started using the service and care plans drawn up to meet them. Staff were supported with regular training, supervision and appraisal. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice. The service had well established links with external professionals in the local community. People were supported with managing food and nutrition. The premises had been adapted for the comfort and convenience of people living there.

People spoke positively about the support they received from staff, describing it as kind and caring. Relatives also praised staff and described the service as caring. Staff treated people with dignity and respect. People were supported to maintain their independence as much as possible. Throughout the inspection we saw numerous examples of staff delivering kind and caring support. The registered manager and staff were committed to ensuring that everyone felt welcome at the service and could live as full and free a life as possible. People were supported to access advocacy services where needed.

People received person-centred support. People were supported to access activities they enjoyed. Policies and procedures were in place to investigate and respond to complaints. At the time of our inspection nobody was receiving end of life care but policies and procedures were in place to provide this where needed.

The registered manager had informed CQC of significant events in a timely way by submitting the required notifications. This meant we could check that appropriate action had been taken. Staff spoke positively about the registered manager and the culture and values of the service. Feedback was sought from people, relatives and staff using surveys and at regular meetings. The service had a number of community links for the benefit of people living there.

We found two breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014, in relation to medicine management, premises maintenance and cleanliness and good governance. You can see what action we took at the back of the full version of this report.

Gables Care Home is a purpose built 64 bedded service. It provides nursing and personal care for older people, including people living with dementia. There are four units within the service, set out over both floors. At the time of the inspection 56 people were using the service.

There was 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.

Medicines were not always managed in a safe way. Medicine records were not always completed fully, and care plans for people using ‘when required’ medicines contained limited detail. We made a recommendation about medicines management

Risks to people arising from their health and support needs or the premises were assessed, and plans were in place to minimise them. A number of checks were carried out to monitor the safety of the premises.

Staff understood safeguarding issues and felt confident to raise any concerns they had.

Robust recruitment procedures were in place to ensure that only suitable staff were employed.

Needs of people were assessed on a regular basis to ensure that staffing levels were sufficient to support people safely.

Staff received training to ensure that they could appropriately support people, and the service was starting to use the Care Certificate as the framework for its training.

Staff received support through supervisions and appraisals, though we did not see any records of these.

Staff understood and applied the principles of the Mental Capacity Act and the Deprivation of Liberty Safeguards to ensure that people’s rights were protected. Care plans contained evidence of mental capacity assessments and best interest decisions.

People were supported to maintain a healthy diet, and people’s dietary needs and preferences were catered for.

The service worked with external professionals to support and maintain people’s health. Care plans contained evidence of regular involvement in delivering people’s care by external professionals.

Staff treated people with dignity, respect and kindness. People and their relatives spoke highly of the care they received. Staff knew how to adapt their communication to have meaningful engagements with people.

The service provided people with information on advocacy services

Care was planned and delivered in way that responded to people’s assessed needs, including any specialist needs they had. Care plans were regularly reviewed to ensure people’s needs were met and relevant changes were added to care plans where needed.

People had access to a wide range of activities, internally and in the wider community.

The service had a clear complaints policy that was applied when issues arose. There was evidence of investigation of complaints and outcomes were documented.

Staff were able to describe the culture and values of the service, and felt supported by the manager in delivering them.

The manager and provider carried out regular checks to monitor and improve the quality of the service.

The manager understood their responsibilities in making notifications to the Commission.

People who used the service expressed satisfaction with the care and service that they received. One person told us, 'Everyone is lovely, you only have to ask for help and someone helps me straight away.' Another person told us, 'I'm alright and the girls are good.' A relative we spoke with told us, 'I have no worries when I go home, he/she is well looked after.'

We used a number of different methods to help us understand the experiences of people who used the service, because some people had complex needs which meant they were not able to tell us their experiences.

There was a friendly and relaxed atmosphere between people living and working at the home. We observed staff interacting well with people and supporting them which had a positive impact on their wellbeing. People's views were taken into account in the assessment and care planning process.

We saw that the home was clean and there were systems in place for ongoing cleaning and infection control.

The home and grounds were safe and secure and systems were in place to ensure maintenance was carried out when required.

We saw the service had appropriate equipment and regular checks and servicing of equipment was undertaken to ensure that it was safe.

We saw the home had a complaints procedure in place and this was accessible to people and their relatives.

We saw that staff interacted well with people living at the home and they spoke to people in a courteous manner. The atmosphere in the home was relaxed and staff frequently smiled at people to offer reassurance and spoke clearly and at a steady pace with people. People who used the service were observed to be well presented and were dressed appropriately.

We found people's personal care records contained sufficient information about their needs and the care required to meet those needs.

We spoke with one relative and they told us that the younger girls were good with their relative. They also told us they had complained to the manager about an issue and had received a response from the home. They told us the food can be repetitive but there are plenty of drinks.

We saw that staff interacted well with people living at the home and they provided support and encouragement in a sensitive and dignified manner. The atmosphere in the home was relaxed and staff frequently smiled at people to offer reassurance and spoke clearly and at a steady pace with people. People who used the service were observed to be well presented and were dressed appropriately.