The Gables

The Gables is a residential care home providing accommodation for persons who require personal care for up to 24 people. The service provides support to older people. At the time of our inspection there were 21 people using the service. Accommodation is split across 3 floors accessible by a lift, stair lift and stairs.

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

People told us they were happy and had their care needs met by care staff who knew them well. However, we found people had not always been provided with safe care and treatment due to a lack of robust systems and processes. This meant people had been placed at risk of harm.

Staff did not have a clear system to follow to report incidents of actual, or potential, harm. Reportable incidents had not always been referred appropriately to the local authority safeguarding team to ensure external scrutiny of the home. There was not a lessons learned process in place.

People had not always been assessed for risks to their health, safety and welfare. Staff had not always identified when a person was at risk, and this meant they had not always adopted measures to prevent the person from being harmed.

People prescribed high risk medicines such as blood thinning medicines, or sedative medicines, had not been assessed to identify any risks posed to them from taking this type of medicine. Medicines had not always been managed safely and this had put people at risk of not having medicines as prescribed.

The home was clean on the days of our inspection, however, systems to ensure people were protected from the spread of infection were not always robust. Assessments to identify people at increased risk from infections had not always been completed and checks to ensure people were safe from the spread of infection had not always been completed.

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

The home supported people living with dementia however, the adaption and design of the building did not follow best practice guidance to ensure people living with dementia could orientate themselves to their surroundings. We have made a recommendation to the home in regard to the environment for people who are living with dementia.

Governance systems were not robust. The inspection identified five breaches of regulation as systems and processes were either not in place, or not robust enough, to ensure people’s care needs were identified and people received safe care and treatment.

Staff had been recruited safely into the service and there were enough staff to meet the needs of the people living at The Gables. People and relatives were complimentary about the staff. We received comments such as, “the carers are great, they need a raise!”, “I’d recommend this home, they look after me well” and, “staff help me when I need it, I would recommend this home.”

People told us how much they enjoyed the food. People had plenty of choice and people’s dietary needs were catered for.

People, relatives, visitors and healthcare professionals spoke positively about the registered manager of the home. One relative told us, “[Registered Manager] sprinkles her love everywhere she goes.”

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 23 November 2018

Why we inspected

We received concerns in relation to the safe care and treatment of people and the governance of the home. As a result, a decision was made for us to inspect and examine those risks. We undertook a focused inspection to review the key questions of safe and well-led only.

The inspection was prompted in part by a notification of an incident following which a person using the service died. This incident is subject to further investigation by CQC as to whether any regulatory action should be taken. As a result, this inspection did not examine the circumstances of the incident. However, the information shared with CQC about the incident indicated potential concerns about the management of risk of falls and health deterioration. This inspection examined those risks.

In response to our findings, the provider sent CQC an action plan of immediate actions they intended to make to ensure The Gables was safe for the people living at the home, we were unable to assess whether these changes have been effective and sustainable during this inspection.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from good to inadequate based on the findings of this inspection.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We have identified breaches in relation to the need for consent, safe care and treatment, safeguarding people, good governance and training for staff.

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 request an action plan from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.

Since the last inspection, new audit tools were being used, such as for ensuring the safe management of medicines, and records were more detailed, including staff recruitment, assessing people's needs and their capacity to consent to their care. Regular audits of the quality and safety of the service were taking place and recorded.

The Gables 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 accommodates up to 24 people in one adapted building. At the time of our visit 20 people were living in the home. There was an established registered manager in post. 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 and relatives praised the quality of care and all commented about the homely feel of the service.

Staff had a good understanding of how to keep people safe and their responsibilities for reporting accidents, incidents or concerns. Risks relating to people’s health and welfare were assessed and these were recorded along with actions identified to reduce those risks.

People were supported by staff who had received an induction into the home and appropriate training and supervision to enable them to meet people’s individual needs. There were enough staff to respond to and meet people’s needs.

There were suitable systems in place to ensure the safe storage and administration of medicines. Medicines were administered by staff who had received appropriate training and competency assessments.

The service worked well with community health and social care professionals to help ensure people received the care they needed.

Staff followed legislation designed to protect people’s rights and ensure decisions were the least restrictive and made in their best interests.

People were supported to have enough to eat and drink. Mealtimes were a social event and staff supported people in a patient and friendly manner.

Staff developed caring and positive relationships with people, were sensitive to their individual needs and choices and treated them with dignity and respect. The service supported people at the end of life to remain in the home if they wished.

The managers and staff understood the importance of involving people and their relatives in their care and providing support that was personalised to their individual needs. People were supported to maintain relationships and links with the community that were important to them.

The service was responsive to people’s needs and staff listened to what people said. People were confident they could raise concerns or complaints and that these would be dealt with.

People were encouraged to provide feedback about the service they received, both informally and through a survey questionnaire.

People, their visitors and an external professional spoke positively about how the service was managed. Staff understood their roles and responsibilities and felt supported by the management to raise any issues or concerns.

At our last inspection in 2015 the service was rated as Good. At this inspection we rated the service as requiring improvement overall Any shortfalls identified had been quickly acted upon and had not had an adverse impact upon people's care and wellbeing.

As a result of this inspection we have made one requirement. This is where we have identified a statutory breach of regulations. The breach in Regulation requires the service to make more effective use of audits to assess and improve the quality and safety of the service. This is because quality assurance processes did not always identify what improvements were required. We have identified some areas of improvement as part of the inspection process which effective audits should have addressed. We have also identified record keeping needed to be improved to maintain a complete and contemporaneous record in respect to care provided.

We have also made three recommendations where the service could improve. These regarded the management of medicines, staff recruitment and how they managed people’s consent to their care.

The Gables 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 accommodates up to 24 people in one adapted building. At the time of our visit 24 people were in residence and the service was providing some day care for two people. There was an established registered manager in post. They were well liked and led by example. They had a really good understanding of the people they supported and also had the support of their staff team. 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 all praised the quality of the service and said they felt safely cared for. The service had an open culture. This enabled all those involved to have confidence their views about the service would be listened to and acted upon. The registered manager was very quick to take action to review and improve procedures that had been questioned during the course of the inspection.

The Gables provides a homely, caring service staffed by a motivated and trained team who were employed in sufficient numbers to meet people’s needs. The low staff turnover meant most staff were employed for a sufficient amount of time to ensure they had a good understanding of what people needed in terms of their care and support. Staff also had a good understanding of people's interests and their preferred daily routines and they accommodated these as far as possible.

People's health and care needs were well understood and staff worked effectively and cooperatively with health care professionals to ensure needs were met.

Staff ensured people were enabled to make choices and give their consent to care and support whenever possible. Where people did not have capacity to consent, effective systems ensured their rights and well-being were protected in line with legal requirements.

People living at the service and staff knew and got on well with each other. We reviewed care plans for four people at the service and found they were detailed, up-to-date and person-centred.

The service had effective systems in place which meant medicines were ordered, stored, administered and disposed of correctly. People were protected against the risks associated with inappropriate management of medicines.

The building and grounds were well laid out and maintained. People were living in an environment that supported their needs and was conducive to their health and well-being.

The provider's recruitment and selection processes ensured all members of staff were suitable, and sufficiently skilled to provide effective care and support to vulnerable people.

The service was open and responded positively to comments and complaints.