Archived: The Gable

Updated 29 November 2018

'We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.’

The inspection took place on 1 and 2 October 2018 and was unannounced. The inspection was carried out by one adult social care inspector.

Before the inspection we reviewed the information we held about the service, including notifications and previous reports. The notification is information about important events which the service is required to send us by law. We contacted Healthwatch and various professionals including the local authority contract monitoring and safeguarding teams.

We used the information to decide which areas to focus on during the inspection. We did not use information from the Provider Information Return, as we visited a week before the information was due to be submitted. This is information we require providers to send us at least once annually to give some key information about the service, what the service does well and improvements they plan to make. The provider submitted this following on from the inspection.

We used a range of methods to help us understand the experiences of people who use the service. We spent time having lunch with people at the service informally as well as observing interactions in the communal areas of the home. We spoke with one relative and four people living at the home about their experiences. We also talked to two support workers and the registered manager.

We looked at a sample of records including two people's care plans and other associated documentation such as induction records, staff rotas, training and supervision records. We also viewed minutes from meetings, complaints and compliments records, medication records and maintenance certificates. Development plans, policies and procedures and quality assurance audits were also checked.

Updated 29 November 2018

We carried out an inspection of The Gable on 1 and 2 October 2018. The first day was unannounced. The Gable 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. The Gable provides accommodation and care and support for up to six people with a learning disability. The service does not provide nursing care. There were six people living in the home at the time of the inspection.

At the time of our inspection, we were informed the ownership of the home had change. Appropriate applications had been forwarded to CQC for consideration.This meant new systems and records were being introduced at the time of our inspection.

The Gable is a large end terrace in a residential area close to Burnley town centre. The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

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.

At the last inspection on 16 and17 November, the overall rating of the service was 'requires improvement' and our findings demonstrated there were three breaches of the regulations in respect of unsafe management of medication, failing to ensure risks to people's wellbeing and safety were assessed and managed and a lack of compliance with the Mental Capacity Act 2005. The service was rated "Requires Improvement." Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the service.

At this inspection we found the provider was in breach of five regulations of the Health and Social Care Act (Regulated Activities) Regulations 2014. They related to the provider having insufficient risk assessments, unsafe processes for the management of medication, a lack of appropriate training for new staff, lack of oversight of the service and a lack of compliance with the Mental Capacity Act 2005. You can see what action we told the provider to take at the back of the full version of the report.

At the last inspection, the service was rated as overall 'requires improvement,' at this inspection the rating had remained as 'requires improvement.'

We were aware the proposed new provider was committed to an extensive programme of development which would improve people's lives. This included changes to the environment, policies and procedures and to the records and systems. During this inspection, we found changes were in progress.

We found there were management and leadership arrangements in place to support the day to day running of the home. However, the provider needed to ensure better oversight of the service to ensure they were meeting the regulations and that the service was effectively managed.

There had been improvements to the management of medication since our last inspection and an updated medication policy, including "covert medication" guidance was due to be issued by the new provider.

We found that people's concerns and complaints were not always acted upon and risks around individuals were not fully assessed and managed safely. A safeguarding alert was raised during the inspection, due to concerns raised by a person living at the home.

People were supported to have 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. Staff respected people's diversity and promoted people's right to be free from discrimination. However, we found that there was still some confusion around the processes around the MCA 2005 and the necessary improvements had not taken place. The provider agreed to implement capacity assessments and seek further training and guidance in this area.

We found that the provider was unaware that bank staff were required to have the same training as permanent staff. We found one new staff member was new to care and had not had access to appropriate training.

We found that arrangements on entering the home were not as secure as they could be, however this was addressed immediately during the inspection. We felt that the home required updating and we were advised that a significant refurbishment was due to take place. People at the home were excited at the proposed changes taking place.

People and their relatives told us that they were happy living at The Gable. People told us if they had a complaint, they knew how to raise their concerns. There was an easy read complaints policy in place and we saw evidence that people were able to raise issues. We did note that further work was required in this area, as not all complaints were properly actioned.

People's privacy, individuality and dignity was respected and we observed staff interacting positively with people throughout the inspection.

Each person had a care plan, describing their individual needs and choices, which provided guidance for staff on how to provide people with support. Care and support was kept under review and some people had person centred care plans in place. People's healthcare needs were well met and referrals had been made to other health professionals. However, this was not always consistent and we found important information and updates on medication and medical diagnoses had not been updated and reflected in the plans. The storage of records, also required improvement to ensure they were stored securely.

People were supported with a range of activities that met their needs and preferences and had opportunities to maintain and develop their skills both inside the house and in the local community. People told us that they were consulted about changes in the home and they were involved in menu planning, food shopping, housework and meal preparation.

We saw evidence of the service actively consulting with people and their relatives around changes within the home. People's views were obtained and people generally felt their views and choices were listened to. We saw a range of feedback questionnaire's consulting with people who used the service, their relatives, staff and wider community groups that supported the people in their local community.