The Gables

The Gables is a residential care home providing personal care for up to 24 older people, some of whom may live with Dementia. The service was supporting 23 people at the time of the inspection.

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

People were safe from abuse. Care plans and risk assessments were in place for all people. Staff were recruited safely. The infection control practices were good.

There was a long gap between meal services. Staff did not receive regular supervision however did feel supported by the management team. The registered manager was overseeing a programme of redecoration for the home. People’s needs were assessed prior to moving into the home.

Systems were in place to regularly audit people’s care plans. People, their relatives and staff felt listened to by the management team. People were involved in the running of the home and able to share their views. People had appropriate access to healthcare professionals.

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.

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 22 March 2021)

Why we inspected

The inspection was prompted in part due to concerns received about the safety of people using the service. A decision was made for us to inspect and examine those risks. We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe sections of this full report.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The Gables is a residential care home providing personal care for up to 24 older people some of whom may live with Dementia. The service was supporting 24 people at the time of the inspection.

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

The provider had made improvements since our last inspection to ensure oversight of the service was more robust. However, we found further improvement to the effectiveness of the providers care plan audits was required to ensure care plans contained all relevant information.

We found systems and processes for safeguarding and whistleblowing to keep people safe were effective and people received their medicines as prescribed. We found people’s needs and preferences were met by a enough staff who were recruited safely. Infection control measures were in line with current government guidance.

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 10 March 2020) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

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.

The inspection was prompted in part due to concerns received about the safety of people receiving the service. A decision was made for us to inspect and examine those risks. 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 changed from Requires Improvement to Good. This is based on the findings at this inspection. Please see the Safe and Well Led key questions. 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.

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 home providing personal care for up to 24 older people some of whom may live with Dementia. The service was supporting 22 people at the time of the inspection.

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

Improvements were required to the way medicines were managed. Medicines were not administered as prescribed and placed a person at risk of harm. People were not supported to stay safe as risks were not consistently managed well. Where people had fallen or displayed distressed behaviours timely action had not been taken to ensure care records were updated to guide staff on how to reduce those risks and support people.

Systems to monitor the quality and safety of the service were not effective and had not identified the areas for improvement found at this inspection.

Rating at last inspection

The last rating for this service was Good (published November 2019)

Why we inspected

The inspection was prompted in part by a notification of a specific incident. Following which a person using the service experienced harm. This incident is subject to a police investigation. As a result, this inspection did not examine the circumstances of the incident for that specific person, but we looked at how the concerns may have affected other people at the home.

CQC also received information of concern relating to the care of people living with dementia. As a result, we undertook a focused inspection to review the Key Questions of Safe and Well led only.

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 changed from Good to Requires Improvement. This is based on the findings at this inspection.

We have found evidence the provider needs to make improvements. Please see the Safe and Well Led key questions.

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 have identified breaches of regulation in relation to risk management, medicines practices and quality assurance monitoring of the service.

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 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 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 home providing personal care to 24 people aged 65 and over in one adapted building.

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

People were safe and staff knew how to keep them safe from harm. The provider had a recruitment process to ensure they had enough staff to support people safely. People received their medicines as prescribed. Staff followed infection control guidance and had access to personal protective equipment. Accidents and incidents were recorded and action taken to minimise risk for the future.

Staff had the skills and knowledge to meet people's needs. People's nutritional needs were met. People accessed health care support when needed. The environment where people lived was clean but tired and in need of updating.

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 were supported by staff who were kind and caring and knew them well. Staff had built good relationships with people. People's privacy, dignity and independence were respected by staff. People’s equality and diversity needs were respected.

People's support needs were assessed regularly and planned to ensure they received the support they needed. People's support was individualised. People were supported to take part in social activities. The provider had a complaints process which people were aware of to share any concerns.

The provider had employed an independent consultant to support with auditing of the service, however, further improvements were still required. The registered manager was known to people and made themselves available. The registered manager understood their duty of candour and was open and honest about the improvements they had needed to make since their last inspection

Rating at last inspection

The last rating for this service was good (published 18 January 2017).

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.

The Gables is a care home which provides accommodation with personal care for up to 24 older people. At the time of our inspection 24 people were living at the home.

The provider is also the registered manager. 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 and associated Regulations about how the service is run.

There were audit systems in place to monitor the quality of the care people received, however they were not always effective at identifying some of the issues we had raised with the registered manager and required some improvement.

People and relatives told us they felt the home was a safe environment for people to live in. Staff spoken with could confidently identify the different types of abuse and explained how they would report abuse. People were protected from the risk of harm and abuse because staff knew what to do and were effectively supported by the provider’s policies and processes. Risks to people were being monitored and staff identified risks to people and explained how those risks should be managed. Staff had a good understanding of the risks and the action that was required. The plans and risk assessments were reviewed and updated on a monthly basis and/or when people's needs changed.

Most of those spoken with felt there was a requirement to increase care staff levels. We saw all staff were busy but were available to provide support to people when needed. This included support for people to eat, drink and move around the home safely. Requests for assistance from people were responded to promptly. The provider’s recruitment processes ensured suitable staff were recruited.

People received appropriate support to take their prescribed medicines and senior care staff maintained accurate records of the medicine they administered to people. Medicines were stored securely and consistently at the recommended temperature given by the manufacturer and were safely disposed of when no longer required.

People were supported by suitably trained staff that told us they received training and support which provided them with the knowledge and skills they needed to do their job effectively. People and relatives felt staff were knowledgeable on how to support people effectively and that staff possessed the necessary skills.

We found mental capacity assessments had been completed for people who lacked the mental capacity to consent to their care and welfare. The provider had taken suitable action when they had identified people who did not have capacity to consent to their care or treatment. Applications had been made to authorise restrictions on people's liberty in their best interests.

People were able to choose what they ate and drank and were supported to maintain a healthy diet with input from dietary specialists. People were supported to receive care and support from a variety of healthcare professionals and received appropriate treatment if they were unwell.

People's care records contained information relating to their specific needs and there was evidence that the care plans were updated when people's needs changed. People and relatives told us they were involved in developing and reviewing their care plans. People were supported by caring and kind staff who demonstrated a positive regard for the people they were supporting. Staff understood how to seek consent from people and how to involve people in their care. We saw staff interacting with people in a friendly and respectful way and that staff respected people's choices and privacy.

People were supported to lead active lives and, where appropriate, to access the local community. In addition, people were supported by staff that provided activities on a daily basis. People told us they had no complaints but were confident it they did, that the management team would deal with it effectively. Complaints that had been raised were investigated and where appropriate action plans had been put in place.

During our visit we spoke with three staff, the cook, one visiting professional, two relatives, the provider and four people who lived there. We asked people who lived there about their experiences of the service to enable us to identify if the service met their needs.

We asked if the service was effective

People spoken with told us that they were happy with their care. Relatives and our observation told us that some improvements were required in how the home was run. Risks assessments in place to minimise identified risks were not being used effectively to reduce the risks to people's health. For example, people were not adequately supervised.

We looked at food stocks within the home and we saw that there were limited stocks of some food, for example sugar. The provider and deputy manager confirmed that there was a delivery due that day. A staff member told us the home often ran low on things and it would be better if they had better stocks which were topped up regularly.

We saw that the provisions for maintaining food at safe temperatures was not sufficient. There was a risk that frozen food was not stored safely. The date foods were frozen and to be used by were not clear so there was not an effective stock rotation system so that food was safe to eat.

We carried out a 'responsive' inspection of The Gables following concerns raised with us. We completed our inspection over three days. We looked at information to help us gather evidence about the quality of the registered provider's service to people that lived there. On the day of our inspection, the acting manager told us that 24 people received care at the home.

We saw that there had been a change of manager since our last inspection. The new acting manager, not currently registered with us, told us, "I was a senior care worker before. When the last manager left the provider's asked me if I'd step up to be the acting manager.'

As part of our inspection we spoke with the acting manager and most of the staff team employed to work at the home. We spoke with a few healthcare professionals that visited people at the home. We also spoke with 20 people that lived there and most people's relatives either at the home or by having a telephone conversation with them. We asked them about their experiences of the service. We observed staff interactions with people in the home. Our conversations with people helped us to answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service

effective? and, Is the service well led?

The detailed evidence supporting our summary can be read in our full report.

Is the service safe?

We found that some risks were assessed but found that the assessments were generic and lacked detail about reducing risks to individuals.

We found that staff lacked training or some training was ineffective which meant that most staff did not have the skills or knowledge needed which resulted in poor care practices.

We found that systems in place for cleaning and infection control and prevention were ineffective. We found that the kitchen and other areas of the home were visibly dirty. This meant that there was a risk of cross infection that could cause illness to people. Due to our concerns we contacted the Local Authority Food Standards and Hygiene department to share our findings.

We saw that the premises were on two levels and people had individual bedrooms with shared toilet and bathroom facilities, and communal dining and lounge facilities. We found that the design and layout of the premises was not suitable for all of the people that lived there. A few people told us that their bedrooms lacked light and were too dark due to poor electrical lighting and a brick built wall outside the window. We saw one bedroom was small and lacked space for a chair. Most people that we spoke with found their bedroom doors awkward to open when using a walking frame. This resulted in most bedroom doors (which were fire doors) being propped open which meant that the bedroom doors were not suitable for people that lived there. We had concerns about the fire safety at the premises and raised an alert to the Local Fire Service to share our concerns.

Is the service effective?

We found that staff were not always familiar with people's needs and care records did not always contain the information that staff needed. Most of the people that we spoke and their relatives with told us that they felt shifts were short-staffed. Staff also told us that they felt staffing levels were not sufficient during the day or night shifts.

During our inspection we observed that staffing levels impacted upon how effective staff were in meeting their care needs of people in a timely way and some people did not receive the care they needed.

All of the staff team spoken with told us that they felt shifts would benefit from extra staffing. One staff member told us, "We struggle to meet people's needs.'

As part of our inspection we looked to see how the registered provider implemented the Mental Capacity Act 2005. We saw that a few people may have required a mental capacity to determine whether they could give consent or not to a research study being conducted by Birmingham University. We found that referrals for mental capacity assessments had not been made. This meant that the requirements under the Mental Capacity Act 2005 were not being followed.

We saw that doors to the home were locked and people could not go out as they wished to. We found that no assessment or referral under the Deprivation of Liberty Safeguards had been made for people that lived there. This meant that the acting manager had not given consideration to, or acted upon, their responsibilities under the Mental Capacity Act and the Deprivation of Liberty Safeguards.

Is the service caring?

Most of the people spoken with told us that they felt that most staff were kind and caring. One person told us, "The staff are kind and try their best. But there are too many of us for them.' Another person told us, 'Staff do not have time to talk with me.' During our inspection we observed that staff were rushed. We observed that when people were spoken with by staff it was to give an instruction about a task such as "Sit here." We did not observe staff to engage in meaningful conversations with people. One staff member told us, "We just don't have the time to sit and talk with people. It's a shame."

Is the service responsive?

Some relatives told us that they had concerns about the quality of the service. A few told us that they had raised concerns or complaints with the acting manager but these had not always been resolved and sometimes reoccurred. This meant that people could not be confident that their concerns would be listened to or acted upon.

Some people that we spoke with appeared anxious when we asked them if they had any concerns or complaints about the service. One person told us, 'I would not want to cause any trouble.'

One relative told us, 'Sometimes the home runs out of basic commodities like biscuits or teabags.' Staff confirmed this to us.

We found that the arrangements, in place for the maintenance of the premises, were not effective. This led to delays in addressing maintenance issues.

Is the service well led?

We found that the acting manager was inexperienced and required support in their role but found no evidence that this support was provided. This meant that the service was not well led.

One relative told us, "There is no effective leadership at the home. I have a lot of concerns."

There were some systems of checks and audits in place but we found that these were not effective or not always completed. This meant that poor practices and actions that were needed to improve the quality of the service were not identified.

We found that the policy on working with volunteers was not being followed. For example, we found that induction and training had not taken place. We saw that volunteer care staff worked with people unsupervised. This meant that volunteer care staff were not supervised or supported as they should have been and that the provider's policy on staff teams was not being followed.

On the day of our inspection 24 people lived at the home. This included one person who was at the home for respite, this meant that they were at the home for a short stay which could be to give their family a break from their caring responsibilities. We spoke with six people who lived at the home. Some people were unable to verbally share with us their views about their care. We used different ways to evidence their experiences such as observing care and looking at care records. We spoke with four relatives. We also spoke with four members of staff, the newly appointed manager and the registered provider of the home.

Care was planned and delivered to ensure people's safety and welfare. One person told us, 'I am very happy here".

Staffing levels were adequate to support people. One person said, "There is enough staff, I don't have to wait long".

People were cared for by staff who were trained to deliver care to an appropriate standard. A relative commented, "I am amazed by how staff have cared for them".

Some people were unable to verbally share with us their views about their care. We used different ways to evidence their experiences such as observing care and speaking with relatives. We spoke with four relatives and a family friend.

Care was planned and delivered to ensure people's safety and welfare. One person told us, 'I get the help that I need from staff, I have seen the doctor and dentist for my health".

Safeguarding procedures were in place so that staff would recognise and report any allegations of abuse so that people were protected from the risk of harm.

People who use the service, staff and visitors were protected against the risks of unsafe or unsuitable premises.

Staffing levels were adequate to support people. One person said, "I have my call button and if I need any help staff come quickly".

People were cared for by staff who were trained to deliver care to an appropriate standard.

Systems were in place to identify, assess and manage risks to the health, safety and welfare of people who use the service and others.

People's care records contained relevant information about people's health and wellbeing to ensure that people were not at risk of inappropriate or unsafe care.

During this inspection we spoke with the provider, the registered manager and three members of staff. We spoke with a relative and five people living at the home, we also sampled two sets of care records.

We saw that improvements had been made in the provider's quality assurance systems which meant that the risks to people had been reduced. Areas of improvements included how people's views were considered in the delivery of service, a more accessible complaints procedure and the implementation of a more robust auditing system.

We saw that further improvements were still required to ensure that findings from quality assurance systems were effectively analysed so that ongoing learning could take place. This would mean that any themes and trends were easily identified and ensure that improvements made were sustainable.

We heard from the provider of their commitment to improve and maintain standards of care.

During this inspection we spoke with five people who lived at the home and observed two people using SOFI. We identified four people to pathway track, this involved following through people's experience of care, we focused on areas of previous concerns. We also spoke with three members of staff, the registered manager and a relative.

On the day of our inspection there were a total of twenty two people living at the home one of whom was in hospital.

We saw that people were not involved in any meaningful activities and people who were unable to verbally communicate had little staff interaction. Care plans and assessments remained inadequate and were not reviewed to show people's current care needs.

Improvements had been made in infection prevention and control procedures.

The safety and suitability of premises did not promote wellbeing.

Staffing levels were inadequate to meet the needs of people in a timely manner and staff did not have appropriate training to meet the needs of all the people that they cared for.

Systems were not in place to monitor the quality of service that people received and identify, monitor and manage risks.

Records did not reflect people's needs and were not stored securely.