Archived: The Gables

We undertook a comprehensive inspection of this home in December 2016 when we identified that improvements were needed throughout the service. We judged the home to require improvements in all five of the key questions we inspect. [Is the service safe, effective, caring, responsive and well led?] The registered provider had breached two of the legal regulations. This was because the systems in place to monitor the safety and quality of the service had not been effective, and medicines were not being safely managed or given as prescribed. We issued warning notices in regard to these two legal breaches. Warning notices are one of our enforcement powers.

We undertook this focused inspection to check and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. 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.

This inspection was planned and undertaken to look at the key questions of safe and well-led, to check that the action required in the warning notices had been taken, and to provide assurance that people using this service were now safe and receiving a good quality service. This most recent inspection identified that the requirements of the warning notices had been met in full, and although some further improvements were required or continued to need time to be fully operational within the home, people could be more confident that their needs would be met and their safety maintained. We received positive feedback about the difference this had made to people's quality of life and safety.

The home had a registered manager who was unable to be present at our 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. The registered provider had arranged for another member of their staff to be in day to day control of the home.

Improvements had been made to the management of medicines. Improvements continued to be required however people could have greater confidence that they would be given their medicines safely, as prescribed and have assurance that the systems in place to monitor medicines were more robust.

People told us that they felt safe. People told us that they had greater confidence in the staff who were supporting them. Staff we spoke with had knowledge of possible signs of abuse and could describe action they would take in reporting any concerns.

Action had been taken to improve the number of staff available. Most people told us there were adequate numbers of people to support them and that they did not have to wait unreasonable amounts of time for help. Some further work was required to ensure the staff were available when people required support. Newly recruited staff that we met in December 2016 had settled into their role, and got to know people well. Staff told us they had received training and on-going support. We observed staff working safely.

We looked at risks people were exposed to that were related to their health care needs and lifestyle choices. These had been assessed using professionally recognised tools, and for most people had been kept up to date. Some people's records had not been fully completed, and our observations and feedback suggested that they had not always had these care needs well met.

Everyone told us that the new management team had made a positive impact on the quality of care, environment and atmosphere of the home. People, their relatives and staff told us they felt able to approach the management team with concerns or feedback, and people told us they were enjoying the more comfortable and homely environment. Previous inspections and the local infection prevention team had raised concerns about the cleanliness of the home. We found that improvements had been made to the cleanliness of the home, although work continued to be necessary to ensure people enjoyed a consistently clean environment and that the registered provider fully complied with infection control requirements. People had been supported to provide feedback about of their experience of using the service, this had been used to improve their care and life experiences.

The systems in place to monitor the quality and safety of the service had been some what effective. The management team and systems in place had driven improvement, ensured changes were embedded. They monitored the feedback and progress with people who lived, worked or visited the service. The inspection identified some further issues relating to safe care, people's meal time experience and medicines management that required attention. While these did need to be addressed to ensure people’s needs were well met, the issues identified would not have had such a significant impact on people's safety or comfort as we had found in previous inspections. People could have greater confidence that they would receive a good, safe service that would meet their needs and wishes.

We undertook a comprehensive inspection of this home in April 2016 when we identified that improvements were needed throughout the service. We judged the home to require improvements in all five of our key questions. We found the registered provider had breached one of the legal regulations. This was because the systems in place to monitor the safety and quality of the service had not been effective. This inspection identified that these systems remain ineffective and we are considering what further action to take.

A new home manager and senior management team have started work at the home, and we found that significant efforts had been made to improve the environment of the home, to recruit new staff and to make improvements to the experience of people living at The Gables. People had noticed these changes and told us about them with pleasure. However the systems to check the safety of the home had not been entirely effective. People were not receiving their medicines safely or as prescribed. The registered providers own systems had not picked up these issues. The registered provider was not meeting all the legal requirements and people could not be certain their needs would consistently or safely met.

The home has a recently appointed registered manager who was unable to be present at our 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. The registered provider had arranged for another member of their staff to be in day to day control of the home.

People did not all receive their medicines safely and there were ineffective systems in place to monitor medicines administration.

People told us that they were confident no individual member of staff would hurt them, and that generally they felt safe living at the home, however some people shared examples of things that had occurred indicating that they were not always safe. Staff had knowledge of possible signs of abuse and could describe action they would take in reporting any concerns.

Action had been taken to improve the number of staff available. Staff told us they had received induction, sufficient training and on-going support. The handovers between shifts had improved and staff were able to share with us the current needs of the people they were supporting.

Staff had some knowledge of the Mental Capacity Act (MCA) (2005) and described how they supported people with making choices. We identified that restrictions to the liberty of people who had mental capacity had not always been identified. It was possible that people we being restricted unlawfully. Where deprivations to people's liberty had been identified the relevant applications had been made and kept under review.

People had access to regular healthcare and specialist healthcare advice.

People’s feedback about the food provided was mixed. Some people enjoyed the food and other people we spoke with told us they did not always enjoy the food offered to them. People living on the first floor of the home had not been appropriately supported to eat and drink enough to meet their nutritional needs.

Relatives were happy with the care provided by individual staff and told us that staff were kind and caring. Relatives told us with pleasure about the relationship they and their loved ones were building with the new staff. Staff enjoyed working at the home and many demonstrated that they knew the people they supported well. During our observations we saw some good staff practice that ensured people were treated with dignity and respect.

People told us that they had limited involvement in planning their care to meet their individual needs. Reviews of care did not show the involvement of people or their relatives to ensure people were still happy with the care they were receiving.

People told us they were more frequently able to sit in the lounges to join in with activities. These people were provided with increased opportunities to receive stimulation, participation and company. People cared for in bed had fewer opportunities to undertake activities that would protect against social isolation and give them the chance of stimulation and company. The activities worker described plans they had to improve upon this situation. However we found people cared for in bed were at a greater risk of social isolation

The majority of people and their relatives all told us the new management team had made a positive impact on the environment and atmosphere of the home in the past few months. They told us they felt able to approach them with concerns or feedback, and people told us they were enjoying the more comfortable and homely environment. People had been supported to provide feedback about of their experience of using the service. The systems in place to monitor the quality and safety of the service had not been entirely effective. Whilst numerous developments and improvements had been achieved since our last inspection people could not be certain they would receive a consistently good, safe service that would meet their needs and wishes.

Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded

At our last inspection in April 2014 the provider was meeting all of the regulations that we assessed.

The provider is registered to accommodate and deliver nursing and personal care to a maximum of 51 people. At the time of our inspection 46 people lived at the home. People were elderly and lived with needs associated with various health conditions, physical disability, or general frailty.

The Gables premises had two different floors where people lived and spent their time. Each floor had its own dining room and lounges. All bedrooms were single occupancy.

There was a management team that people and relatives could access if they had the need. The manager and provider had some systems to monitor the service. However, the overall governance and leadership of the home was ineffective and placed people at a risk of not having their needs met.

The manager was not registered with us as is required by law. However, they had started the process to register with us to address this. A registered manager is a person who is 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.

Prior to the inspection we were made aware of concerns that had been identified by the local Clinical Commissioning Group and Local Authority both of whom commission care on behalf of some people who lived at the home. We found that cleanliness of the home was not adequate and attention had not always taken to address this. We also found that the premises had not been maintained to a good standard. We identified that there were not always enough staff available to meet people’s needs, or that at times staff had not been suitably deployed to meet needs in a timely manner.

We found that medicine management systems needed some improvement so that people would consistently receive their medicine safely and as it had been prescribed by their doctor.

We found that staff did not always follow instructions to ensure that people were not placed at potential risk of experiencing sore skin.

Some people who lived at the home described the staff as being nice and kind, however other people told us that this was not always the case.

We observed that some staff did not follow basic principles to ensure that people’s dignity was maintained. Relatives felt that the staff were polite and showed their family member respect.

Activity provision was not always tailored to meet people’s individual needs and aspirations.

Records made by staff did not confirm that the support they provided was personalised to the individual.

People told us that they enjoyed the meals provided. However, staff did not always give the support people needed to eat and drink.

Staff had received training about safeguarding the people in their care to prevent them from being placed at risk of abuse or bad treatment. However, staff had not received other core areas of training that was required and did not all receive supervision sessions regularly.

Processes were in place to induct new staff to ensure that they had some knowledge when they first started work.

Staff had understanding and knowledge regarding the Mental Capacity Act and the Deprivation of Liberty Safeguarding (DoLS). This ensured that people who used the service were not unlawfully restricted.

A complaints procedure was accessible for people and relatives to use if they felt they had the need.

You can see what action we told the provider to take at the back of the full version of this report.

Some of the people who lived at the home had dementia care needs. People with dementia are not always able to tell us about their experiences so we looked at records relating to their care and observed staff caring for them.

People told us and we saw that choices were offered and that people's views were sought and acted upon. One person told us. 'I like sitting in my room looking out on what goes on outside and staff support me to do that.'

All the staff spoken with was able to tell us about people's needs so that they received care in a way that they preferred. All five relatives told us they were consulted about their relative's care and kept informed about their relative's health so they felt involved in their care.

We saw that people were relaxed in their environment and that systems were in place to keep people safe from harm. One relative told us, 'I know my X is safe here, I don't have to worry.'

Staff received a range of training so that they had up to date knowledge and skills in order to support the people who lived in the home.

There were systems in place to monitor how the home was run, to ensure people received a quality service.